An Introduction to Motivational Interviewing in Social Work

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An Introduction to
Motivational Interviewing
in Social Work
Viv Mumby STARS Training Project
Cheryl Chapman Option 2 Project
Cardiff Alcohol and Drug Team
Who are we?
Viv Mumby – originally trained as a
counsellor 19 years ago. Has been
working in substance misuse for 16
years, and training in behaviour
change for 12 years.
 Cheryl Chapman – 16 years
experience in the substance misuse
field as a social worker. Currently
works in the Option 2 Project
delivering family based interventions.

 The
difficulties of working with
our client group are….

What do we need to do to work
effectively with our client group?

What do our clients need from us in
order to enable them to make
changes?
Engagement v Assessment

What does this mean to you?

Deficit v Strengths focus

What you pay attention to gets bigger
Working motivationally…

Encourages positive engagement

Acknowledges and works with client
resistance

Is collaborative, not collusive

Can help prevent worker burn-out by
enabling you to work ‘smarter not harder’
What is it and where does it come
from?

William Miller & Steve Rollnick

1st Ed. published 1991: Focus on ‘Addictive’
behaviours

2nd Ed. published 2002 : Wider focus on a
variety of applications in a variety of different
settings

3rd Edition on its way….

A blend of different therapeutic approaches,
inc. Person-Centred, Solution- Focused and
cognitive-behavioural ideas/theories with a
process model of change
Cont..

MI was developed in response to
working with client resistance in alcohol
treatment in the late 1980’s

It works in relatively ‘brief’ interventions

It is a more helpful ‘stance’ in working
with high levels of resistance in clients
than a confrontational or coercive style

2-3 times more effective with black or
ethnic minority clients
Why M.I.?




Recent positive research on MI and social
work with parental substance misuse
(Forrester et al 2006)
25-35% of childcare cases for allocation
involve substance misuse (Cleaver et al
1999)
MI particularly effective in engaging and
working with adults with substance misuse
issues
There are to date over 200 controlled trials
of MI and substance misuse
MI is like a tree?
Micro-skills or ‘OARS’
Principles
‘Spirit’
The ‘Spirit’ of MI
 Collaboration
 Evocation
 Autonomy
Principles of MI
 Express
Empathy
 Develop
Discrepancy
 Roll
with Resistance
 Support
Self-Efficacy
The Micro Skills or ‘OARS’
•Ask Open Ended questions
•Affirm
•Listen Reflectively
•Summarise …………….and
•Encourage and elicit Change-Talk
Important Concepts in MI
Helping Clients develop discrepancy;
“the active ingredient underlying
motivational interviewing’s efficacy”
Originally developed from Festingers
Cognitive Dissonance Theory (1957)
ALSO…
 Internal v External motivations to change;
Internal motivation is associated with
greater long term change. Research shows
people with low internal motivation have
worse outcomes and people with higher
levels of both internal and external
motivation are better retained in services
and have better outcomes.

(Deci and Ryan, 1985, 1987, Curry et al 1991)
Transtheoretical Model of Change
(Prochaska & DiClemente 1982)
Pre-Contemplation
Contemplation
Determination/
Preparation
Lapse
Maintenance
Action
Lifestyle/behaviour change
Lapse
To Change Behaviour we
need to…
Recognise the Advantages of Change
“Things would be better if I did……”
 Feel we have the Self-Worth to make the
change
“I deserve better than this….”
 Believe in our own Ability
“I can do this….”
 Have knowledge of Alternative Behaviours
“What I’m going to do differently is…”

‘Raising’ Ambivalence –
Decisional Balance Strategy

How does…….fit into your life?

What do you like.. How does …work for you?

Downsides etc etc….

If you’re still doing this/If nothing has
changed in….weeks/months/years, what will
life look like/what will be happening?

Worst/best case scenario if no change/some
change?

Where does that leave you/what do you think
about that?
Feedback

Challenges?

Opportunities?

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