Motivational Interviewing with Clients with CoOccurring Disorders

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Motivational Interviewing with Clients with
Co-Occurring Disorders

• Charlotte Chapman, LPC
• July 20, 2009
• VSIAS

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Goals for training

• Identify challenges and successes with this
  client population
• Practice using MI spirit and specific skills in
  working with clients with various co-occurring
  issues
• Answer the question what, if any, adaptations to
  MI are needed in working with your client
  population?

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Introductions Challenges and Successes

• Dyads Introduce yourself to each other. Speaker
  will talk about challenges and successes of
  working with clients with co-occurring issues
  Listener will practice MI Spirit and OARS and
  TAKE NOTES. 10 minutes and then switch.
• Debrief in large group Each dyad will then
  introduce themselves to the group and share the
  list they developed.

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Review

• MI Spirit
• MI Principles
• OARS skills are familiar intentions are
  different

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Skills practice with client

• Role play with client with SA and psychotic
  features
• Triads Counselor, client, voices 15 minute
  intake session
• Debrief
• (Adapted from Rory Allott and Paul Earnshaw, MI
  Network of Trainers)

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MI Strategies

• List of strategies that worked well and those
  that didnt
• Replay Triads to use these strategies with same
  client 10 minutes
• Debrief

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Adapting MI for clients with Co-Occurring Issues

• Martino et al (2002)
• Different targets for change ambivalence about
  treatment engagement, medication
• Increase affirmations
• Avoid reflections of hopelessness
• Reduce reflections on disturbing thoughts, life
  experiences

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Martino continued

• Frequent, short reflections most effective
• Frequent summaries
• Simple verbal and visual materials make explicit
  links between psychosis, substance abuse,
  lifestyle, consequences
• Pacing
• Clients must have some psychiatric stability to
  benefit from MIs approach

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Empathy

• Saying more than the clients says but not more
  than the client means
• Counselor as expert says more than the client
  means explaining the client rather than
  understanding the client (This will get resistant
  response)
• Reflections are the best approach in
  demonstrating empathy

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Example

• C  Tell me about whats led you to seek
  treatment in our program.
• P Im not seeking treatment. Treatment is
  seeking me.
• C Its not that you want to come here for
  treatment. Treatment is being forced on you.

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Example

• P         My housing counselor and my therapist
  are after me. Partners in crime, thats what they
  are.
• C        Theyve recommended that you come here
  and it seems like an injustice to you. You dont
  want to be here.
•  (MI and Psychological Problems)

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Change Language

• What are the goals for change with our clients?
• What statements do we want to hear clients with
  co-occurring issues say?

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Change Talk Review

• Desire
• Ability
• Reasons
• Need
• Commitment
• Taking steps language

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Eliciting Change Talk Review

• Importance and Confidence Ruler group practice
• Reflections
• Pros and Cons
• Looking back build on any change already made
• Looking forward

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Skills Practice

• Group develops a client profile
• Work in triads counselor, observer, client
• 15 minutes
• Debrief What worked/what didnt

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Closure

• Key Points in using MI
• Client-centered reflections focus on the person
  and less on the delusions, beliefs, lies, etc.
• Reflect strengths, attempts to change, hope for a
  different life
• Dont challenge distortions just calmly state
  whatever you need to say

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Closure

• Dyads Speaker What changes do I need to make
  and/or are needed in my program to use MI with
  our clients?
• Listener practices OARS and DARN C Take notes so
  you can give the speaker her/his change plan NO
  ADVICE PLEASE
• 15 minutes switch

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Resources

• TIP 42 Substance Abuse Treatment for Persons
  with Co-Occurring Disorders (CSAT)
• Motivational Interviewing in the Treatment of
  Psychological Problems Edited by H. Arkowitz, H.
  A. Westra, W.R. Miller, and S. Rollnick ,
  Guildford Press.
• http//coce.samhsa.gov Website for center of
  excellence in co-occurring disorders
• www.chapmantraining.com