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https://sites.google.com/a/state.co.us/dcj-epic/motivational-interviewing
https://sites.google.com/a/state.co.us/dcj-epic/mi-spirit
https://sites.google.com/a/state.co.us/dcj-epic/mi-principles
https://sites.google.com/a/state.co.us/dcj-epic/mi-skills

https://sites.google.com/a/state.co.us/dcj-epic/mi-strategy

MI STRATEGY


The 4 Processes in Motivational Interviewing help make the basic skills of OARS into MI.  These processes help practitioners use OARS skills in a strategic and purposeful way to have a conversation about change in a way that creates a comfortable environment that allows the client or offender to talk about uncomfortable things, finds specific change behaviors, and elicits and reinforces the client or offender’s own motivation for the change behaviors in a way that helps them resolve their own ambivalence to change.

 

The 4 Processes include Engaging, Focusing, Evoking, and Planning.  These processes are not linear or a step by step guide to MI.  Engaging naturally comes first because you need to have good engagement prior to having a conversation about change.  It is tough to go deep into motivation for change without engagement, and it needs to be present throughout the conversation.  If at any point engagement is lost, the practitioner stops moving forward and goes back to the Engaging process to re-engage the client or offender.  Also, it is important to note that how the practitioner uses OARS is somewhat different in each of the processes.  OARS in Engaging are used to create engagement, develop rapport, and create the environment for the conversation.  OARS in Focusing are used to find and narrow in on a target change behavior.  OARS in Evoking are used to elicit and reinforce motivation for change to help guide the client or offender towards resolving ambivalence for change.  OARS in planning help develop and reinforce a plan for change.

 

 

Engaging

The Engaging Process is commonly known in EPIC as the “Hi” process.  This process helps us as MI practitioners to establish a good working relationship with our client/offender as well as get to know what is going on with them.  We use a lot of reflective listening in the Engaging Process with the focus of understanding what the client/offender is saying and what is going on in their life.  The content of the conversation in this process may still include topics around change, but some of the main tasks in this process are developing rapport, reducing resistance/defensiveness, and resolving some ambivalence about your role. In this process the practitioner works to create an environment that is comfortable for the client/offender to talk about change.

 

What things should you be mindful of when you are working on engaging?

       How comfortable is this person in talking to me?

       How supportive and helpful am I being?

       Do I understand this person’s perspective and concerns?

       How comfortable am I feeling in this conversation?

What are the goals in the Engaging Process?

        Relationship and rapport building

        Comfort

        Safety

        Empathy

                                                         

How do I know when I have engagement?

        How real is the conversation that we’re having

        Is it the same thing that anyone would say in this conversation (more generic conversation)

        Is it something that the person we’re talking to would say (conversation unique to the person)

        Talking a lot does not necessarily equal opening up and good engagement

 

What is Discord?

        Resistance due to interpersonal factors (something that the practitioner is doing or how they are communicating that causes resistance and/or defensiveness)

        Can occur at any time

        Does not equal a difficult client/offender

        Engaging can help address discord

        If engagement is lost, stop moving forward and re-engage

        Meet discord with empathy

 

Some things to consider in the Enagaging Process:

        How comfortable is this person in talking to me?

        How supportive and helpful am I being?

        Do I understand this person’s perspective and concerns?

        How comfortable am I feeling in this conversation?

        Does this feel like a collaborative partnership?

 

 

Focusing

The Focusing Process is commonly known in EPIC as the “What?” process.  The focusing process is about finding a clear direction and goal when it might not be clear from the outset. What is the particular goal for change in this client/offender? For some clients/offenders, it may take many weeks to get to this point: for some, you will be there in the first minute of the first session.

 

What things should you be mindful of when you are focusing?

       What goals for change does this person really have?

       Do I have different aspirations for change for this person?

       Are we working together with a common purpose?

       Does it feel like we are moving together, not in different directions?

       Do I have a clear sense of where we are going? Do they?

       Where is this person at with this change? (stage of change)

What are the goals in the Focusing Process?

        Exploring the target behavior

        Honing in on a target behavior

        Clarifying the target behavior

        Exploring ambivalence

        Exploring barriers

        Developing discrepancy

What is a target behavior and why is having one important? 

A target behavior is something that the client or offender wants to or needs to change but is still ambivalent to change.  This is the “goal-oriented” piece of MI.  Without a target behavior that we are focused on, we may just be having a nice conversation with OARS but not moving in the direction of change.

 

        In MI it helps if it is something that they are in Pre-Contemplation or Contemplation for

        Needs to be clear

        Should be specific enough

        Is not terms and conditions

        Needs to be relevant

        Has to be something that they can control

        Needs to focus on one at a time

What is the premature focus trap?

Sometimes we go into conversations with clients or offenders and have our own agenda that we focus on.  Other times, we hear a target behavior right away and spend the rest of the conversation focused on that even if it may not be the best one to talk about.  The questions we should be asking ourselves are:

 

        Have we focused too soon?

        Am I focused on my own agenda?

        Are there other target behaviors that may be more important to talk about?

Some things to consider in the Focusing Process:

 

        What goals for change does this person really have?

        Do I have different aspirations for change for this person?

        Are we working together with a common purpose?

        Does it feel like we are moving together, not in different directions?

        Do I have a clear sense of where we are going?

       Where is this person at with this change? (stage of change)

 

 

Evoking

The Evoking Process is commonly known in EPIC as the “Why?” process.  As the practitioner you are able to focus down and guide the client/offender towards a particular goal that has been identified in the focusing process. It is better if this is their goal for change not ours.  The purpose is to evoke a person’s own internal motivations for change, and to reinforce it to help build their overall motivation for change around the focused target behavior.

 

At this stage, the strategic and directional parts of MI really come into play: selective eliciting of change talk, and selective responding to it. Respond to and reinforce change talk (‘DARN-CT’) using EARS (Elaborating Question, Affirmation, Reflection, Summary).  This is a great time to also use IQLEDGE skills (Eliciting change talk strategies)

 

What things should you be mindful of when you are Evoking?

 

        What are this person’s own reasons for change?

        Is the reluctance more about confidence or importance of change?

        What change talk am I hearing?

        Am I steering too far or too fast in a particular direction?

        Is the righting reflex pulling me to be the one arguing for change?

What are the goals in the Evoking Process?

       Eliciting and reinforcing change talk

       Increasing the amount and strength of change talk

       Get curious about their motivation

       Develop internal motivation

 

What is Change Talk?

        Distinctive to MI

        General: Any speech that favors movement toward change

        Two Types:

§  Preparatory

·         D-esire to Change (want, like, wish…)

·         A-bility to Change (can, could…)

·         R-easons to Change (if…then…)

·         N-eed to Change (need, have to, got to…)

§  Mobilizing

·         C-commitment (intention, decision)

·         T-aking Steps (within the last 2 weeks)

        Building motivation for change

 

What is Sustain Talk?

        Language that favors movement towards not changing or staying the same

·         D-esire to stay the same/not change

·         I-nability to change

·         R-easons to stay the same/not change

·         N-eed to stay the same/not change

·         C-ommitment to stay the same/not change

 

What is the Righting Reflex?

        The reflex that people have to correct someone or something

        To give unsolicited advice or direction

        Assuming that the other person
does not have their own solutions
and needs to be given guidance

        Needing to fix it

 

Some things to consider in the Evoking Process:

        What are this person’s own reasons for change?

        Is the reluctance more about confidence or importance of change?

        What change talk am I hearing?

        Am I steering too far or too fast in a particular direction?

        Is the righting reflex pulling me to be the one arguing for change?

 

 

Planning

The Planning Process is commonly known in EPIC as the “How?” process.  In Motivational Interviewing the Planning process is optional.  The primary goals in MI are to create a good working relationship with the client/offender, identifying specific target behaviors, helping the client/offender to build motivation towards these target behaviors by using specific skills and strategies, and working towards aiding the client/offender in resolving their ambivalence and choosing change. Planning encompasses both developing a commitment to change and formulating a specific plan of action (goal setting; sorting options; forming plans; building support).

 

When is it time to plan?

        When there is significant engagement

AND

        There is a clear shared change goal

                                                AND

        There is sufficient client motivation to change

What things should you be mindful of when you are planning?

        What are this person’s own reasons for change?

        Is the reluctance more about confidence or importance of change?

        What change talk am I hearing?

        Am I steering too far or too fast in a particular direction?

        Is the righting reflex pulling me to be the one arguing for change?

How we plan may look different depending on the situation

Clear Plan

o The path for moving forward is obvious to the client

Menu of Options

o Negotiating plan from a variety of possible options

Unclear Plan

o Exploring, prioritizing, moving from a general to specific plan

What are the goals in the Planning Process?

        Develop skills

        Action planning

        Removing barriers

        Exploring outside support

Some Helpful information about Planning

        Try using a summary to transition from Evoking to Planning. 

–   “You have a lot of great reasons to quit using, you see that your relationships may improve your employment opportunities may change and you might have the energy to engage in social activities you’re interested in. Where do you go from here?”

–   “You have a lot of great reasons to quit using, you see that your relationships may improve your employment opportunities may change and you might have the energy to engage in social activities you’re interested in. What are some next steps you might be able to take?”

Don’t forget if you find resistance, sustain talk or discord go back and either evoke, or re-engage with the client/offender.

        Come up with a menu of options elicited from the client/offender’s own ideas, resources and supports.

–   The ideas don’t have to be perfect solutions.

–   The ideas can be good or bad, just brainstorm as many ideas as possible.

–   Respond with reflective listening, emphasizing change talk, personal responsibility, freedom, and choice.

        You may want to summarize the client/offender’s plan.  Consider a written plan with bullet points of actions to be taken.

–   Try to secure commitment to the plan, however don’t push if they seem wary or ambivalent.

–   Commitment can be enhanced by making it public or shared by including family, friends, etc.

        We always want to elicit ideas and thoughts from the clients.  However there are times when it is ok to give your advice and share your knowledge.

–   First ask the client/offender’s permission before sharing your information or knowledge

–   Ask the client/offender’s for their thoughts or your ideas.

–   Continue to elicit from them if they have come up with additional ideas or solutions of their own.

Giving Information and Advice

M.I is sometimes thought to be incompatible with advice; it isn’t. But the spirit in which it is given has to be right. Before you give advice check that you have (a) elicited the offender’s views on the subject (b) considered the impact of what you are going to say on their motivation for change.

 

        The best time to give advice is when the offender asks for it. If this doesn’t happen, ask for permission to give it; or offer it in a way that acknowledges the offender’s right not to take the advice.

–   This can be done by saying “This may or may not work for you, but this is something that others in your situation have done…” 

–   “I have an idea here that may or may not be relevant. Do you want to hear it?”

–   “I don’t know whether this will matter to you, or even make sense, but I have a worry about your plan. Can I tell you about it?”

        Always make sure to check in with the client before during and after giving advice or suggestions.

It is often helpful to offer an offender a menu of options. This can help avoid ‘yes but’ conversations. When people have the opportunity to choose from several alternatives they are sometimes more likely to adhere to a plan and succeed.