Soc Work 453 Edition 1nd Lecture 17 Outline of Last Lecture I Announcements II IClicker Question and Notes III Similarities in the treatment of chronic medical conditions IV Affordable Care Act V Addictive disorders as chronic medical illnesses a Addiction medicine VI Common treatment settings VII Video notes VIII FDA approached medications for alcohol dependence a Disadvantages to medications Outline of Current Lecture II Trying to Communicate Effectively with people help someone III MI is NOT easy to learn IV Speaker Listener Role V Confrontation VI What does it take Four Common Solutions VII Talking about benefits of change and concerns of not changing VIII What is Motivational Interviewing a 4 processes b Does it work c Continuing to Learn Current Lecture Guest Lecture about Motivational Interviewing Talking to people about alcohol and drug problems can fit into primary care Now there are behavioral help people all over primary care How many drinks can you have to keep yourself save For women it is 3 for men it is 4 When you consistently go over that things can go downhill Trying to Communicate Effectively with people help someone Treat like equals this is called collaboration Ask their feelings thoughts Ask open ended questions These allow people to really be able to say what is important to them They are not closed questions so answering the questions will not just give a little bit of information Good body language to look open Good eye contact MI is NOT easy to learn Comprises a complex skill set No correlation between self perceived and actual MI practice One shot trainings insufficient to promote competency The first thing to do is learn about it And then you have to get someone to coach you You have to do it in front of someone Remember Just because MI seems SIMPLE that it doesn t mean it is EASY Just because it seems like COMMON SENSE that doesn t mean it is COMMON PRACTICE MI is like learning to play the piano Speaker Role Things about yourself that you Want to change Need to change Should change Have been thinking about changing Have tried to change and have Not been successful Something someone else says You need to change Listener Role Explain to this person why s he should make this change JUST DO IT This is frustrating It is overwhelming Almost feels like getting put down It felt scripted This happens all the time People get frustrated when people don t change they want to make it right They want them to be okay So then the problem attempts to get resolved by saying do it but this is actually very unhelpful Confrontation Guys who got confrontation being told they were alcoholics this is what is going to happen to fix it These guys were drinking more Guys who got Motivational Interviewing ended up drinking less after I m going to fix you this is a Deficit World View It looks like there is nothing in someone s head a helper then will come in and fill up someone s head with solutions to make you get better This makes it seem like person doesn t see doesn t know in denial and this isn t true What does it take Four Common Solutions INSIGHT if you can just make people see then they will change KNOWLEDGE if people just know enough then they will change SKILLS if you can just teach people how to change than they will do it HELL If you can just make people feel bad or afraid enough they will change BAD WAYS Don t do these Why don t people change Everyone in the room has a behavior they feel like they should change There are good things that come out of that behavior but there are bad sides to the behavior as well So much so that people make earnest attempts to change At this point there was probably some success but most people will end up doing that behavior again Behavior change is hard Smarts enough to make it happen No It doesn t make it easy even if you are smart Not sticking with the change A whole bunch of people changed but no one maintained the change Many times it can be emotional rather than rational Or people just go back to doing the behavior There are more benefits to change than not to change possibly Seems like a lot of concerns about not changing Pattern between quadrants Concerns of change are repetitive like benefits of change and concerns of no change And benefits of no change and concerns of changing Where would you get excited What is favoring change What kind of talk Talking about the benefits of change and concerns of not changing This is called change talk What we know is that when things favoring movement in the direction of change it is highly correlated with outcome The more change talk someone gives the more change is likely The helper gets to decide how much change talk is going to happen Just do it doesn t make change talk But if instead you use a style of communication that is more aligned with motivational interviewing you are going to get more change talk And Change talk Change Other stuff doesn t go away its called sustain talk It is people s talk about why they want to keep doing behaviors Benefits about no change and concerns about changing are stuff you like about the behavior Need to let client give voice about why things would be great for them if they changed Ambivalence is a normal and defining state of human experience People like dysfunctional behaviors for some reason or another I need to but I don t want to I d like to but I don t think I can I will one day but not today Before only treated people when they wanted someone to tell them exactly what to do Motivational Interviewing is not keeping people stuck They want to help people find the change talk What is Motivational Interviewing It is helping people Motivational Interviewing is a collaborative conversation style for strengthening a person s own motivation and commitment to change Collaborative teaching people like equals It is a conversation between two people each of whom have an equal amount to bring to the conversation In order to strength motivation need to believe that people have own strengths and own values People have achieved things the motivation already exists The helper needs to shine a light on it and bring it out Not going to install it or bring the motivation The motivation is already there you just have to draw it out from people Then going to strengthen this commitment to change 4 processes to Motivational Interviewing The relational foundation Engaging Focusing Evoking Planning Engaging Get to know one another from a person centered perspective I