Using Motivational Interviewing (MI) with Latino Populations

Report
Presenter:
James (Diego) Rogers, PsyD, CPRP
VP of Clinical Services
Community Research Foundation
San Diego, CA
MINT Member 2004
What is
Motivational Interviewing?
 A person-centered directive method
for enhancing internal motivation for
change by exploring and resolving
ambivalence.
(Miller & Rollnick, 1991; 2002)
What is
Motivational Interviewing?
A way of being with a person, not
just a set of techniques for doing
counseling.
(Miller & Rollnick, 1991; 2002)
Broader than
Behavior Change
 Decision- to make a choice
 Forgiveness, leaving or staying
 Attitude- to become a different person
 To be more compassionate, assertive etc.
 Resolution- acceptance
 Complicated grief
 Finding peace regarding a decision
 Tolerance for anxiety, uncertainty etc.
MI Spirit
 Autonomy (Person-centered)
 Collaboration
 Compassion
 Evocation (Guiding/eliciting style)
Normal Human Reactions to the
Righting Reflex (Teach/Direct)
Invalidated
Resist
Withdraw
Not respected
Not understood
Not heard
Angry
Ashamed
Uncomfortable
Unable to change
Arguing
Discounting
Defensive
Oppositional
Denying
Delaying
Justifying
Disengaged
Disliking
Inattentive
Passive
Avoid/leave
Not return
Normal Human Responses to a
Listen/Evoke/Empathic Style
Affirmed
Accept
Understood
Open
Accepted
Undefensive
Respected
Interested
Heard
Cooperative
Comfortable/safe
Listening
Empowered
Hopeful/Able to change
Approach
Talk more
Liking
Engaged
Activated
Come back
“Change Talk”
The goal of MI is for the provider to
guide the client to discuss/argue for
his/her own reasons for change in a
compassionate way that respects the
client’s autonomy.
4 Principles of MI
(2nd Edition)




Express Empathy
Develop Discrepancy
Roll with Resistance
Support Self-efficacy/Elicit
Change Talk
(Miller & Rollnick, 1991; 2002)
Express Empathy
(Use your OARS)
 Open-ended questions
 Affirmations
 Reflections
 Summaries
Develop Discrepancy
 Empathize with the ambivalence
 Explore gains/losses of all options
 Imagine extreme outcomes
 Look forward & backward
 Amplify ambivalence with reflections &
affirmations
 Values sorting
What is Resistance?
 Therapy Interfering Behaviors
 Interpersonal (It takes two to resist)
 A signal of dissonance (empathic
failure)
 Predictive of (non)change
What is Sustain Talk?
 Desire for status quo
 Inability to change
 Reasons for sustaining status quo
 Need for status quo
 Commitment to status quo
Sustain Talk and Resistance
 Sustain Talk is about the target behavior
 I really don’t want to stop smoking
 I have to have my pills to make it through the day
 Resistance is about your relationship
 You can’t make me quit
 You don’t understand how hard it is for me
 Both are highly responsive to counselor style
How to Roll w/ Resistance
(Sustain Talk)
 Simple/Double-sided Reflections
 Shifting Focus
 Agreement with a Twist
 Emphasizing Personal Choice
 Reframing
Opposite sides of the same coin
Preparatory Change Talk
DESIRE to change
(want, like, wish . . )
ABILITY to change
(can, could . . )
REASONS to change
(if . . then)
NEED to change (need, have to, got to . .)
Mobilizing Change Talk
Reflects resolution of ambivalence
 COMMITMENT (intention, decision,
promise)
 ACTIVATION (willing, ready, preparing)
 TAKING STEPS
Responding to Change Talk
(All EARS)
 Elaboration- Asking for elaboration, more
detail, in what ways, an example, etc.
 Affirming- commenting positively on the
person’s statement
 Reflecting- continuing the paragraph, etc.
 Summarizing- collecting bouquets of
change talk
Culturally Competent Adaptations
 Balancing act between maintaining fidelity to an
evidence-based practice…
 While adapting and tailoring the practice to increase
engagement, receptivity, efficacy, and value to the
recipent(s) (Cultural Responsiveness).



Linguistic Translations
Incorporating Social Contexts
Incorporating Cultural Values
Linguistic Translations
 Motivational Interviewing (MI) = La Entrevista
Motivacional (EM)
 MI Spirit = Espíritu de EM
 OARS = PARS
Incorporating Social Contexts
 Immigration/migration experiences/status (including
political/historical contexts)
 Contexts of Migration (Falicov, 1998)
 Receptivity of the host community/dominant culture
 Language barriers
 Experiences of Group Antagonism
 Acculturation process/Level of Acculturation
 Ethnic Identity
 Socio-economic Status
Social Context
 A Cultural Adaptation of MI to Address Heavy
Drinking Among Hispanics (Lee, Lopez, Colby,
Caetano, Borrelli, & Rohsenow, 2011).
 Social Context of Immigration (OARS)
 Changing Family Dynamics (immigration & drinking)
 Social Support (familismo y amistades/compadres_
 Alcohol Health Literacy (E-P-E)
Incorporating Latino Cultural
Variables
Assess for value adherence (using OARS/PARS):
 Familismo (family orientation)
 Personalismo (relationships with people not agencies)
 Respeto (mutual respect and deference)
 Confianza (trust and intimacy in the relationship)
 Controlarse (self-containment or control)
 Agüantarse/Luchar (ability to withstand stress & difficult
times)
 Poner de su parte (doing one’s part)
 Religión
Latino Cultural Variables
 Engaging Latinos Through the Integration of
Cultural Values and MI Principles (Añez, Silva,
Paris Jr., Bedregal, 2008).
 Mental Health treatments were four times more
effective when culturally modified for a specific group
and when attentive to cultural context and values
(Griner and Smith, 2006).
General Research Findings on
MI and Latinos
 Still generally limited in number of studies, sample
sizes, and populations.
 Studies that do exist show that adopting the MI Spirit
and incorporating social contexts and cultural values
yielded favorable results in the therapeutic
relationship:
 Personalismo
 Respeto
 Confianza (buena gente, simpatico)
General Research Findings on
MI and Latinos
 Studies also show that incorporating social contexts
and cultural values with the MI principles/techniques
yielded favorable results (High Engagement & Client
Satisfaction):
 Clients enjoyed talking about their cultural values and
striving for change toward those values (OARS).
 Clients enjoyed talking about the change plan goals
and action plans (Agenda Setting and Change Talk).
 Clients enjoyed have an ability to demonstrate
“poniendo de mi parte” (Change Talk)
 Clients enjoyed having their opinion “respected” even
when given advice (E-P-E)
Motivational Interviewing
Web Site
www.motivationalinterview.org

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