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Recommended Books / Web Sites / Session-Specific Resources
"Teaching Patient" Roleplay Guidelines
Session 1 / Session 2 / Session 3 / Session 4 / Session 5
Recommended Books
Main text:
Motivational Interviewing, Second Edition: Preparing People for Change (MI2) by William R. Miller and Stephen Rollnick
• Theoretical underpinnings, empirical evidence
• Some detailed examples of strategies and techniques with an emphasis on general principles
• Specialty settings, populations, topics featured in extensive edited section
Read my detailed review
See more information at Amazon.com
Also see:
Intergrated Treatment for Dual Disorders: A Guide to Effective Practice by Kim T. Mueser, Robert E. Drake, Douglas L. Noordsy and Lindsey Fox - outlines a collaborative approach to working with clients with substance abuse and severe mental illness. Includes numerous reproducible forms and handouts.
See more information at Amazon.com
Resources for group applications of MI:
Motivational Groups for Community Substance Abuse Programs (available from Mid-ATTC for $18.00)
Includes a set of psychoeducational groups focused around MI themes. Detailed therapist notes and client handouts.
Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual by Mary Velasquez, Gaylyn Gaddy Maurer, Cathy Crouch, and Carlo DiClemente - Included MI-based approaches among other tried-and-true psychoeducational group strategies. The authors sort commonly used group inteventions according to client readiness to change.
Read my detailed review
See more information at Amazon.com
My own Motivational Enhancement Group Leader Materials
Web Sites
Steve Rollnick's practice-oriented online discussion board
Session-Specific Resources
Session 1 - Motivation, definition, and principles
Suggested reading -
MI2 Chapters 1-4
MI may be conceptualized as a particular form of the "guiding" style of communication with patients - see Steve Rollnick and colleagues' recent British Journal of Medicine article for more about incorporating MI into daily practice without over-reliance on structured interventions.
Exercise/Discussion topics-
Identify instances of intentional behavior change
within the patient/client's control
where motivation appears to be at least part of the problem. What helps? What is counter-productive?
Also note where motivation is NOT the primary problem. Consider other solutions: Basic behavioral interventions?
Case management needs?
System-level interventions?
Identify opportunities/barriers to interacting with clients in “spirit”
of MI
"Teaching Patient" Roleplay Guidelines -
When in the role of the teaching patient, your job is to help each other learn MI.
The teaching patient is NOT the patient from Hell!
The teaching patient should also NOT be based solely on a single real patient.
Develop a role that is familiar from your work and that you can role-play convincingly.
Consider: demographics (age, gender, race, marital status, household composition); socioeconomic background; the clinician's and client's perspective on what is the presenting problem (these may disagree); the patient's goals and values; the pros and cons of the problem behavior from the patient's perspective; the pros and cons of the desired behavior from the patient's perspective.
Keep roleplays short and focused on one specific skill at a time. Allow the person in the clinician role to set - and change! - the level of readiness or resistance displayed by the teaching patient.
Session 2 - Theory/evidence, client-centered counseling style, and eliciting change talk
Suggested reading -
MI2 Chapters 6-7
A Meta-Analysis of Motivational Interviewing Outcome Trials - November 2004 (online slide presentation; or, download the Powerpoint file)
Toward a Theory of Motivational Interviewing - November 2004 (online slide presentation; or, download the Powerpoint file)
OARS Roleplay instructions - Work in groups of 3
(5-10 minutes per "turn" - do 3 times so everyone plays all 3 roles):
Suggested topics:
- What have you read lately that you would recommend?
- Who in your family are you most like?
- Tell me about a memorable trip you took. What made it memorable?
- What is your dream job?
- What do you like about yourself?
- What is the best advice you ever received?
- Tell me about a challenge you overcame successfully.
INTERVIEWER: Use OARS style to learn about a topic chosen by the TALKER.
TALKER: Respond naturally to the INTERVIEWER's prompts.
COACH: Use OARS coding sheet to keep track of whether the INTERVIEWER is using OARS. After 5-10 minutes, stop the interview. The COACH then gives feedback -
- Did the Interviewer use mostly open questions? Were there any closed questions that could have been rephrased as an open question?
- Did the Interviewer remember to affirm the Talker? Can you think of any more affirmations for the Talker?
- Did the Interviewer use reflections to show she was listening? What was your favorite reflection?
- Did the Interviewer have the opportunity to summarize? If not, have the Interviewer summarize what she heard.
Additional Exercises -
In clinical practice or “teaching client” roleplay:
- Experiment with open alternatives to closed questions
- Explore how you can demonstrate understanding of the patient’s point of view
- Try one or more semi-structured techniques for eliciting change talk
Session 3 - Eliciting change talk 2, rolling with resistance
Values card sort may be found at the bottom of this page on the MI website
MI2 Chapter 5, 8
Good/Not-So-Good Roleplay Instructions - Work in groups of 3
(5-10 minutes per "turn"- do 3 times so everyone plays all 3 roles):
INTERVIEWER: Ask the client about the good and not-so-good things about the behavior they have agreed to discuss. Your job is to understand their decisional balance, not necessarily to try to change it. Try to reflect, ask for elaboration, affirm, or summarize when you hear change talk.
CLIENT: "Teaching client" role as developed previously. On the first "turn," the client's overall readiness should be around a 3. On the second "turn," start over again from the beginning. This time, the client's overall readiness should be around a 5-6. On the third "turn," start over again from the beginning, but this time the client's overall readiness should be around a 7-8.
COACH: Help keep the interviewer on track.
AS A GROUP - notice any differences between how the interview unfolds with a client at low, medium, and high level of readiness.
Group discussion topics:
- Identify most likely sources of resistance in your clinical population.
Brainstorm: How can you help patients feel in control and understood? Consider counseling strategies as well as system-level or other strategies related to the overall treatment environment.
- When is it hardest to avoid an unproductive back-and-forth with patients/clients?
Brainstorm: Reflective/strategic solutions
Session 4 - Elicit-provide-elicit and moving toward change 1
Elicit-Provide-Elicit Roleplay Instructions
(5 minutes per "turn"- do 3 times so everyone plays all 3 roles):
INTERVIEWER:
- Ask permission to provide information
- Elicit patient's ideas before providing information
- Provide information in small chunks
- Elicit patient's reactions to information
- Reflect patient's reaction
CLIENT: Respond naturally in "teaching client" role
COACH: Give feedback to interviewer: did she follow the steps?
Video case examples for review:
Low-readiness client: DVD Disc 2, part D, Chapter 4: Case example of elicit-provide-elicit
High-readiness client: DVD Disc 2, part D, Chapter 5: Case example with cardiac patient.
Building Confidence Roleplay Instructions - Work in groups of 3
(one or two times through - there is an interviewer tag team instead of a coach for this one):
Don't start all over again at the beginning! This exercise focuses on what to do once the client has expressed reasonably high importance of change, and you are now ready to move on to confidence. So, decide among yourselves what the target behavior change will be, and how the client feels about it, and jump right in and start in the middle! The client should be at a pretty high level of readiness for this exercise. Don't rush into a change plan, but begin to explore ways of building confidence for change.
INTERVIEWER 1: Begin with a brief summary of the client's decisional balance (taken from a prior roleplay, or made up on the basis of your pre-roleplay discussion). Then ask a key question, such as "where does that leave you?" or "what do you want to do?"
CLIENT: Respond in "teaching client" role. You should have a high level of readiness to change - you are convinced of the importance of change, but aren't sure if you can do it..
INTERVIEWER 1: Engage the patient in exploring past change efforts. Remember to reflect and summarize.
INTERVIEWER 2: Engage the patient in any of the other confidence-building strategies..
Change Plan Worksheet
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