Motivational Interviewing Advanced Empathy PDF

Preview

Summary

Prof: Jason Solowoniuk...

Description

MOTIVATIONAL INTERVIEWING Historical Background 1. Focuses on building client motivation which is seen as the true problem of addictions counselling 2. An applied theory which draws from client-centered cognitive, systems theory, and social psychology 3. Designed to help clients work with ambivalence and build commitment for change -How do we help them get over the hurdles of whether they want help or not? Conception of Human Nature -Rejects that there is a common personality core or set of robust defenses that is characteristic of the addict → Addictions is seen as a motivation problem → Traditional approaches such as direct confrontation are counter-productive as increase resistance in client -Resistance is normal, fluctuates, and is just a sign of need for change in strategy -Integrates Rogerian focus on creating healing and supporting relationship in which a person can move towards self-actualization -Side note: We need to believe in ourselves as a helper--we need to use approaches that we believe in, we need to believe that the client can change Concept of Change 1. Motivation is seen as key principle 2. What predicts change is adherence to a plan rather than saying “I’m an alcoholic” 3. Ambivalence is seen at the heart of the problem (normal and not to be attacked) ● But it can be challenged -Common for people to feel two ways about the same issue Ambivalence is: -the hallmark of the contemplation stage of change ● Not sure if they really want to change -Simultaneously wanting and not wanting something or wanting both of two incompatible things -Common to hear two kinds of talk mixed together: ● Change talk: the person’s own statements that favour change, self-motivational statements ○ Can we hear and use our client's change talk? ○ Stay there in what they said, help them to continue to feel what they said

●

Sustain talk: the opposite of change talk, the person's own arguments for not changing, for maintaining the status quo ○ Belief is important.. If you believe you can’t do something that you won’t be able to do it

-Three essential elements for change are accurate empathy, unconditional positive regard, and genuineness -Clients move through six stages of change (prochaska and DiClemente) -The path out of ambivalence is to choose a direction, follow it, and keep moving in the chosen direction 1. 2. 3. 4. 5. 6.

Precontemplation: doubts need to be raised Contemplation: decisional balance sheet needs to be tipped Determination: determining best course of action Action: client takes steps to change Maintenance: strategies to prevent relapse Relapse: move back through stages

-We meet the clients where they’re at, and we love the change process for ourselves and know how good it is and we want that for them as well Therapist Function: -Rather than taking a side, therapist’s challenge is to increase motivation for change → -Therapist attempts to move client through stages to change → -Motivational strategies are used by therapist -Principles: 1. Express Empathy: acceptance facilitates change ● Can we somehow, with their language get them to help us understand what they feel 2. Develop Discrepancy: between present behavior and goals for the future 3. Avoid Argumentation: counterproductive, change in strategy needed ● Doesn’t mean avoid client’s issues or avoid challenging them ● Your hunch might be right, but the client may not be ready to hear it yet so just wait 4. Roll with Resistance: momentum and energy can be used to advantage ● It’s detrimental to your own skill set to get too meek and quiet ● You can say things like, “I get the sense”, “I’m wondering” ● I have a perspective to offer, its just the way you deal with it 5. Support Self-efficacy: client is responsible for choosing and carrying out change, therapist has belief in client possibility of change

Key Techniques -Rogerian Client Centered Skills ● Accepting someone completely for who they are -Evocative questions (to invite client-responsibility) ● You almost stop the mind in its tracks -Decisional balance sheet ● Cognitive behavioural theory -Elaboration -Using extremes ● Diving into the extremes in the person’s being ● If you wake up tomorrow and everything is perfect, how do you know, what’s the first thing that you notice? ● If you wake up tomorrow and everything is awful, how do you know? What’s changed to make it awful? -Looking back and forward -Paradox (no problem here and now) ● If we can be okay right here and right now ● Putting them in their rightful place instead of focusing and obsession on it -Follow through contact ● Connecting with your client -Utilizing Resistance -Negotiating a plan Therapist Traps ● ● ● ● ●

●

Q and A ○ Don't rapid fire questions Confrontation Expert Orientation ○ Lesson the power imbalance as much as possible Labeling Premature focus ○ The presenting issue is rarely ever the issue ○ Try not to get hung up on how to help the person right away Blaming

Applications and Limitations of Motivational Interviewing -Applied addictions focus -Used for substance abuse, gambling, and now smokers -Allows for social users -Avoids labels -Focuses on key issues of ambivalence and motivation -Limitations:

● ● ● ●

Personality issues ignored as well as underlying psychological issues Can the approach deal with chronic addicted sufferers Does not deal with issue of dry drunks (emotional pain) Questions about whether people move through steps in logical way i.e. what about rapid cyclers? ADVANCED EMPATHY

Advanced Empathy: the message behind the message ● What is the person only half saying? ● What is the person hinting at? ● What is the person saying in a confused way? ● What covert message is behind the explicit message? Counsellors rely on hunches (informed guesses) 1. Share hunches based on empathic understanding 2. Hunches can point to big picture 3. Hunches can help clients see what they are indirectly saying 4. Hunches can help clients draw conclusions 5. Hunches can help clients take full ownership of issues 6. Make them tentative 7. Invite client to respond 8. Be open to clients telling you that you are off, or partly correct 9. Can deepen a session 10. Hunches mean that a counsellor is taking a risk, help intensify session Other tools to deepen session: -Immediacy ● “Direct mutual talk between client and counsellor” ○ Finding out how they’re doing and feeling about the session ○ Or how they feel about a challenge you gave them ● Relationship immediacy- discuss with client where each stands in terms of the overall counselling relationship ● Here now immediacy- discuss with client what is happening between the two of you in the here and now of the counselling session ● Feelings in the here and now- notice their body language, ask them about their felt sense Counsellor Self-Disclosure -Keep selective and focused -Make sure appropriate -Be careful of timing -Have therapeutic purpose

-Don’t rely on too much -Don’t overburden clients -Adapts disclosures to clients and situations -My experience of this has been… I wonder if you’re going through the same thing? Healing Dark Emotions -Because we have been conditioned that our pain is unbearable we have been taught to never look directly into the face of our pain -Get in touch with our energy -By sitting with our pain and being at one with it, we can find a deep essence energy within it -Transformation of our pain into healing essence means we no longer have to be attached to it Emotions we Avoid -Loneliness, emptiness, despair, meaninglessness -Grief -Inadequacy, insufficiency -Fear -Abandonment -Trauma Typical Ways we Manage Emotions -Endure -Deny -Bypass or transcend -Avenge -Escape (addiction) -Reason without emotion (the western culture prefers the mind over emotion) -Control and manage Healing Dark Emotions- Greenspan (2003) 1. Experientially working with dark emotions 2. “It’s through surrender to the unwanted that we embrace our vulnerability” 3. Surrender to what is 4. Embrace our dark emotions Recapturing Emotional Flow 1. Attending 2. Befriending 3. Surrendering -The magical key is letting the emotions flow-become spacious and transformed Quick Way

-Be mindful -Accept emotion, don’t fight it -Be one with it -Say to yourself “no judgement” -Watch emotion transform by itself -Also can heal underlying false core driver Example: Abandonment -Had huge abandonment experience early in life, avoided ever since, on the run -Can we meet abandonment and annihilating aloneness head on? -Sit in it, with no judgment, watch it transform all by itself -What about other’s emotions? (I.e. inadequacy) -You don’t necessarily need to believe what you’re thinking about yourself False Core Drivers -As we process dark emotions, may be exposed to deep thought structures of “I’m bad, not good enough, or unlovable.” -Invites us to allow our false core driver into awareness as our whole false self compensates for it (see handout) -We need to dissolve false cores rather than compensate for them

False Core Example -Exercise: trace back experience to false core driver by asking “what’s the worst of that?” -When get to deepest false core stop -Sit in pre-verbal “I amness” and rest with no judgement

-Notice how false core can dissolve into energy just through being aware of it -Where does the false core exist in the body -When was this false core born? Who was around?...