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Handouts For Lansing School District Motivational Interviewing Training

HANDOUTS / LANSING SCHOOL DISTRICT

Mike Stratton, LCSW, ACSW
www.mikestratton.com
www.droppingpot.com
email @ dreamtrane@gmail.com
#517 336-7721

Outline for the day

8 – 9:30 intro / First Exercise
9:30 – Brief Break
9:40 – 11:30 / Motivational Interviewing Exercises and Demonstrations

WHY Motivational Interviewing?
Evidence Based Practice
It’s Effective
It’s Fluid
A really effective tool that should be used first, but not always
(best practice)
M.I. exists in a field of context
NOT a new theory of personality
NOT a new way of assessing problems
Simple not easy
Paradigm shifts
Agent of Change = student, not counselor
Therapeutic alliance is seen as a collaboration
Student is seen as holding the key to change
Confrontation is handled through a technique called ‘developing discrepancy’
Similar to Rogerian, humanistic psychotherapy/but different in that it is more directive
Tends to be short term, though the techniques are appropriate for longer term interventions
It is a profoundly respectful way of working

My own experience with M.I.
Always drawn to models that relied less on medical model
Family Therapy in the 1980s
EMDR
Isolating what helps people change
Attended conference in the 90s that contrasted 4 models
psychoanalytic
brief (O’Hanlon)
cognitive/behavioral
Structural family therapy
Models were radically different on the conceptual level, but what the counselors actually did in the room was more alike than it was different:

1) They were all masters at understanding the client’s predicament and feeding it back to the client in a way that the client felt deeply understood.

2) They all clearly conveyed hope – that change was desirable and possible and within the client’s power.

3) They all relied on a particular intervention (ie – interpretation w/psychoanalytic/homework or having a different experience being prescribed, etc.).

Where’s Waldo…
The more we look for pathology, the more pathology we find
Looking at cars, or buying a new article of clothing, or deciding to paint a room in your home…

We see what we look for… (video of ball players)

When we look at motivation… we find more motivation, strengths, abilities, etc.

Exercise – parent in the room w/young child/ afraid of heights
$$$ vs. heights

Barry Duncan, Mark Hubble & Scott Miller
What Works In Therapy?

Since the mid-1960′s, the number of therapy models has grown from 60 to more than 250. At the same time, virtually all of the research data finds that the various treatment approaches achieve roughly equivalent results. This is true of both the biological and well as the much bally-hoed cognitive and cognitive behavioral revolutions. When all is said and done, virtually all of the data find that the various approaches work about equally well.

Such evidence makes clear that the differences between the various models can not account for the effectiveness of treatment.

the mountain of evidence for equivalent outcomes makes it clear that the similarities rather than differences between models account for the effectiveness of psychotherapy.

The question, of course, is what similarities approaches share that account for success?

The Facts . . .

Research points to the existence of four factors common to all forms of therapy despite theoretical orientation (dynamic, cognitive, etc.), mode (individual, group, couples, family, etc.), dosage (frequency and number of sessions), or specialty (problem type, professional discipline, etc.).

In order of their relative contribution to change, these elements include:

(1) extratherapeutic [40%];

(2) relationship [30%];

(3) placebo, hope, and/or expectancy [15%]; and

(4) structure, model, and/or technique ([15%]

For more – Escape from Babel (Norton, 1997); The Heart & Soul of Change (APA, 1999).

The challenge is which technique(s) or approach(s) to adopt when working with a particular client?

Research conducted by Duncan, Hubble, & Miller (see Psychotherapy With Impossible Cases; Changing the Rules or The Heart & Soul of Change)
shows that the student’s view of the presenting complaint, potential solutions, and ideas about the change process form a theory of change that can be used as the basis for determining, “which approach, by whom, would be the most effective for this person, with that specific problem, under this particular set of circumstances.” This same research shows that the probability for success is greater when the treatment offered fits with or is complementary to the student’s theory.

Translating “The Facts” into clinical practice. . .

Therapists can immediately begin translating the research into their clinical work by mindfully and purposefully working to:

1) Enhance the factors across theories that account for successful outcome

2) Use the student’s theory of change to guide choice of technique and integration of various therapy models

3) Obtain valid and reliable feedback regarding the student’s experience of the process and outcome of treatment.

Extratherapeutic factors – the major portion of improvement that occurs in any treatment(40 percent). Any and all aspects of the student and his or her environment that facilitate recovery, regardless of formal participation in therapy. (Books, beliefs, 12 Steps, churches, relationships, etc.)

Therapists can enhance the use of extratherapeutic factors by

1) Becoming More Change-Focused in Counseling

examples – maid; audit
what did you do since making this appointment?
When are you less depressed?
What helped you quit drinking before?

2) Potentiating any and all change for the future

Helping students see any changes–as well as the maintenance of those changes–as a consequence of their own efforts.
exploring the student’s role in changes that occur during your interaction.

The counselor can ask questions or make direct statements that presuppose student involvement in the resulting change.

The counselor may also summarize the changes that occurred during therapy and invite students to review their own role in the change.

Even if students resolutely attribute change to luck, fate, the acumen of the counselor, or a medication, they can still be asked to consider in detail: (1) how they adopted the change in their lives; (2) what they did to use the changes to their benefit; and (3) what they will do in the future to ensure their gains remain in place.

3) Tapping into the student’s world outside of counseling

Incorporating resources from the student’s world outside counseling. Whether seeking out a trusted friend or family member, purchasing a book or tape, attending church or a mutual-help group (research indicates that in counseling, most students seek out and find support outside the formal therapy relationship).

Being curious about what happens in the student’s life that is helpful as well as actively encouraging students to explore and utilize resources in their community.

Using the student’s theory of change to guide choice of technique and integration of various therapy models.

Simply listening for and amplifying the stories, experiences, and interpretations that students offer about their problems as well as their thoughts, feelings, and ideas about how those problems might be best addressed.

Curiosity about student hunches not only provides access to their theory of change but also, by emphasizing student input, encourages more active participation in treatment–the most important determinant of outcome.

Investigating students’ usual methods of or experiences with change can also provide clues to their theories of change. For example, the counselor and student can consider how change usually happens in the student’s life, paying particular attention to sequence of events, the way the student talks about the role they and others play in the initiation and maintenance of any change, and the success or failure of any attempts to resolve this as well as previous problems.

The Challenge To The Counselor – acceptance of the client’s theory of change. Also how the theory is operationalized (room to develop discrepancy)

Obtain valid and reliable feedback regarding the client’s experience of the process and outcome of your intervention.

Several key findings from the research literature can be combined to create an alternative to psychiatric diagnosis that is not only more empirically sound, but also better suited to the nature and practice of psychotherapy.
-First, research points to the importance and superiority of the client’s rating of therapeutic relationship in successful treatment.
-the client’s experience of meaningful change in the early stages of treatment is one of the best predictors of positive results.
- Clients who are informed, and who inform, feel connected to their counselor and counseling; their participation–one of the most potent contributors to positive outcome–is thereby courted and secured.

Developing an outcome-informed therapeutic practice need not be complicated, time-consuming, or expensive. The counselors can simply choose from among the many paper and pencil rating scales already available and then incorporate them into ongoing clinical practice. Several good sources exist which front-line practitioners can consult for information about existing instruments (see Measures for Clinical Practice: Couples, Families, and Children; Measures for Clinical Practice: Adults; Assessing Outcomes in Clinical Practice). All such measures have the advantage of being standardized, psychometrically sound, and accompanied by an abundance of normative data that can provide reliable and valid feedback about both the fit and progress of treatment.

Measuring fit – researchers estimate that the quality of the therapeutic relationship accounts for as much as 30% of treatment outcome (see Escape from Babel [Norton, 1997]). In particular, clients give the highest ratings to treatment relationships they experience as caring, affirming, accommodating, as well as focused on their goals. The Session Rating Scale–Revised (SRS-R) is just one example of a process measure specifically designed to be sensitive to clients’ perceptions of the therapeutic relationship

Measuring progress – Outcome measures assess the impact or result of the service a therapist offers their client. While results vary depending on the specific treatment objectives and population, research conducted over the last 40 years indicates that changes in an individual’s level of distress, functioning in close interpersonal relationships, and performance at work, school, or settings outside the home are reasonable indicators as well as strong predictors of successful therapeutic work

Putting results to work in counseling
(1) anticipating when clients will stop coming for counseling is difficult if not impossible
(2) clients rarely spontaneously report their dissatisfaction with therapy until after they have decided to terminate
(3) therapies in which little or no change (or even a worsening of symptoms) occurs early in the treatment process are at significant risk for a null or even negative outcome
(4)Methods even exist for establishing the rate of change typical for a given practice or therapist that can be used to make empirically based decisions about when to continue, modify, or end a therapeutic relationship.
stages of change model

James Prochaska & Carlo DiClemente

Precontemplation
No desire to change
Usually doesn’t see the need
Often wishes other will change

Tasks: empathy, roll with resistance, education, develop discrepancy

Contemplation
Aware that there is a problem
Beginning to seriously consider addressing it
Highly ambivalent

Task: as above, values clarification

Action
Taking concrete steps to change their behavior
Ambivalence is often still present

Task: support, encourage,

Maintenance
Consolidating gains
Integrating new aspects of change (identity, relationships, etc.)

Principles for working with stages of change:
Don’t assume that all clients are at the action stage – or even want to be
(research indicates 10-15%)

Assess the client’s stage of change

Go slow (Covey says, with people, fast is slow and slow is fast)

Anticipate backsliding
(don’t take anything personally – the 4 Agreements)

Avoid inappropriate interventions & do the right thing at the right time

Honor every stage of change

(ideas consolidated by Jay Lebow, Northwestern University)

Exercise
on paper & then with each other
Think of a change you want to make…. A habit you’ve wanted to break, a trip you want to take, a home you want to build, a project you want to start, a practice you want to begin, a conversation you want to have…or anything else that you’d like to take on…
What stage are you in?
What would move you to the next stage?
How would you rate your motivation?

If time permits, share with your neighbor

Motivational Interviewing
Key Concepts
Ambivalence
Ambivalence is a normative state whenever there is change. The tension between growth and stasis is one of the defining forces of nature. Acceptance of and exploration of ambivalence gives the student a way to address their anxieties and fears and develop value clarification.

Reflective Listening
Simple reflection shows the student you understand what they’re saying. A reflection of meaning opens up their values, and your understanding of their values. A reflection of feelings gets to the emotions that they’re expressing. Asking for more information and stories invites the student to open up. “I see”, “Got it!” or “Let me see if I really understand…” are all ways to open up the conversation.

Open Ended Questions
Open ended questions invite more elaboration. “Tell me about your early experiences with marijuana” is open. “How old were you when you first got high” is closed. “How have your friends reacted to your coming to counseling” is open. “Do you have any friends that don’t get high” is closed. Close ended questions lead to one word answers. It’s one of the great clues we get that we are asking close ended questions, when we get one word answers.

The Five Strategies of Motivational Interviewing
1 – Express Empathy
Empathy communicates respect, understanding and acceptance. It is essential to create an atmosphere where these principals exist for true change to occur. Empathy doesn’t mean agreement, it means you understand the student’s position and are interested in knowing more about their world and experiences. Some programs confuse compliance with change, but compliance is all you can expect if the student doesn’t believe it’s safe to express ambivalence, problems or doubts.

2 – Develop Discrepancy
This is an invaluable tool when combined with empathy. It helps the student understand the cognitive dissonance between what they say they value and what their behavior is. You say you want to stay out of trouble, but you also want to keep drinking is a way to heighten the student’s sense of their conflict. This also helps them feel understood, and puts their dilemma in language that they may not have full explored before.

3 – Avoid Argumentation
One of the primary reasons MET works so well is that it doesn’t evoke resistance. When the sessions are really going well, it’s the student and not the counselor who argues that change is necessary. If the student becomes hostile, the counselor should consider whether or not their previous reply or question may have elicited this reaction. A quick way to de-escalate an argument is to show that you understand (“Let me see if I understand you…”) and use a double sided reflection (“You really enjoy partying, but you hate to be in front of the court”).

4 – Roll With Resistance
Rather than meeting resistance head on (i.e. ‘denial busting’) the counselor deals with resistance by restating the student’s hesitancy to change and letting the student know that it’s up to them to decide if and when to change.
Example:
Client: I came because of the court. I don’t think smoking pot is a problem.
Counselor: You had to come because of the court. You don’t want someone else telling you what’s a problem for you. Sometimes people find that being in a program like this helps them decide for themselves whether or not smoking pot is a problem for them or not.

The therapist is also free to develop discrepancy. Resistance is a clear aligning with only one side of the ambivalence. Express both sides.

5 – Support Self-Efficacy
Self-Efficacy is the development and support of the student’s ability to change. Most people really want a better life, and want to break out of negative habits. Most people will not move toward change unless they believe it can be successful.
Great areas to explore that increase self-efficacy are:
Previous times when the student made a change, even if it was temporary
Earlier successes
Other problems that the student conquered
Attainment of previous goals

MET Sessions
#1
- Rapport Building
– Explanation of What The Student Can Expect From You
– Assessing and Building the Client’s Motivation
– Reviewing the Personal Feedback Report (PFR)
The PFR outlines:
the substances a client used

the extent of the use (with special emphasis on the past 90 days)

problems associated with the use (a dozen potential problems, ranging from impact on meeting responsibilities to loss of control)

reasons for quitting (first emphasizing the main reason for quitting, then going over a list of twenty six potential reasons for quitting)

pattern of use (when, where, with whom)

situational confidence including a % of certainty
(example – “I’m 100% certain I can stay clean at home, but 50% sure I
can around friends)

PFR Sample – possible reasons for quitting (Personal Feedback Report)

To show myself I can quit if I really wanted to
To like myself better
So that I won’t have to leave social functions or other people’s houses
To feel in control of my life
So that my (boyfriend, girlfriend, parents, wife, husband, partner) will stop nagging me
To get praise from people I am close to
Because using doesn’t fit with my self image
Because someone has given me an ultimatum
Because using has become less ‘cool’ or socially unacceptable
So that I will receive a special gift
Because of potential health problems
Because the people I’m close to will be upset if I don’t
So that I can get more things done during the day
Because it’s hurting my health
Because I will save money by quitting
To prove I’m not addicted
Because I may be drug tested
Because I know others with health problems because of the same thing I’m doing
Because using can shorten my life
Because of legal problems related to my use
Because I don’t want to embarrass my family
So I’ll have more energy
So my hair and clothes won’t smell
So I won’t burn holes in the furniture
I’ll be able to think more clearly
My memory will improve

MET #2
Review of progress, thoughts and reactions
Collaboration on setting a counseling goal
Introducing the concept of functional analysis
Preparation for group therapy sessions (Cognitive Behavioral in nature, or CBT)

The Personal Goal Worksheet should include the student’s goal re: using (or other behavior they want to change); It should include some important reasons why they wish to have this goal; It should include the steps they plan to take to achieve their goal

Functional Analysis begins to look at the function drugs or alcohol or other negative behaviors may have played in their lives. Functional Analysis will always include:

Trigger
(What was happening when the person used? What did they expect or wish to have happen? Was to get feelings or to avoid feelings?)

Thoughts and Feelings
(This explores the internal state at the time of the behavior)

Behavior
(What happened when the last time the trigger was experienced? What did the student do?)

Positive Results
(What did they enjoy about using?)

Negative Results
(These are items that may be reflected on the PFR or may be added)

EXERCISE
PRACTICING THE SKILLS (ROLE PLAY OR YOUR INTEREST IN CHANGING)

Freedom Writers Video

The Village Story – Jean Houston

Teaching Resilience
(suggestions by Dr. Patricia O’Gorman)

Help your students develop a vocabulary of their own unique personal strengths.
Demonstrate that they already rely on their resilience
Find examples when they used their resilience in the past
Assist them in consciously using their resilience to deal with the challenge that they are currently facing

Resiliencies, strengths, assets, all describe positive attributes of our students that often get overlooked while we looking at diagnosis or symptoms or legal charges and labels. It’s hard to appreciate a ‘perp’ as a father or a student, a ‘drunk’ as a musician or a hard worker, a ‘character disorder’ as a daughter or a gardener.

Strengths include an individual’s experiences. Their personal traits and virtues. Their talents and their work. Their roles, and their pride. The community they live in and the family they belong to.

SUPPORTING CHANGE IN FAMILY WORK

Understand the family environment – assess resources, hot button issues, and potential crisis points. Track strengths, virtues, talents, resiliency and also the current developmental challenges (there will be several). Identify who wants to change.
Educate the family regarding developmental issues, and normalize reactions to such issues.
Joining and engagement are key. There will be no progress unless the family trusts you have their best interest in mind. Show an interest in them. Admire what they’ve accomplished, their taste, their talents, their progress, etc.
Be flexible. When you make suggestions, use language like “experiment” or “temporary” or “pretend”.
Help the identified patient off the hot seat. Being the sick one should be anyone’s full time job. Seek new alignments and alliances in the family structure.
Don’t forget your sense of humor. Wear the world lightly. Problems are never so terrible that there isn’t room for humor.
Secrets should be ‘outed’. The kinds of family secrets are the ones they hide from the world, the ones they hide from each other, and the ones they hide from themselves. With secrets, there will always be shame. The salve for shame is empathy, empowerment, and breaking isolation.

Support parental authority.
Teach conflict resolution skills, face saving techniques and exit strategies. “How can we get on the same side of the problem?” is a very useful question. “Can we find a ‘win-win’?” is another.
Use Covey’s concept of the ‘emotional bank account’ – for every withdrawal there must be numerous deposits.
Make sure positive change is recognized and celebrated. Take your time in developing a ‘ritual of the moment’, even if it’s passing out some candy or gum.
Create a mellow atmosphere in your office or work space.
Exude calmness. Even when you don’t feel calm, act calm. Anxiety, anger and despair are contagious. Model emotional control. Families need ways to cope with emotional intensity. Model hope.

(adapted from a list of suggestions by Mary Pipher – elucidated and expanded upon by Mike Stratton)

Great questions to elicit resilience and strengths

Survival Questions (“How did you get through that?”) (“What kept it from getting worse?”)

Support Questions (“Who, or what, helped you?” “Where did you draw your strength from?” “Is there some belief that assisted you?”)

Possibility Questions (including the dreaded ‘miracle question’ – but
“I know this isn’t true, and may not even likely to ever be true, but if
were possible…)

Future Questions (a conversation where the student is asked to describe their future after there’s been a change)

The Million Dollar Question (“What would you do if you won the Lotto?” “Why?” People will show their values by answering the ‘why’ question – it may be a better social life, a way to protect their children or take care of their families, or it may be financial security. The answer they come up with is almost always something it doesn’t take a million dollars to begin to work on.)

Scaling Questions (“If you were to rate your hope, or despair, or motivation to change, or anger, on a scale of one to ten…” These kinds of questions help people to see that their reactions are not black and white, that they exist on a continuum, and they can explore what might move them up or down the continuum. Explore each direction.

1 ) CHECK YOUR BELIEFS

What are the core beliefs you have about the students with whom you work? How have you come to believe what you believe and know what you know? What have been the most significant influences on your beliefs? To the best of your knowledge, how have your beliefs and assumptions affected your work with students? With colleagues? With the community?
Do you believe that change is possible even with the most “difficult” and “challenging” students? How do you believe that change occurs? What does change involve? What do you do to promote change?
Would you be in this field if you didn’t believe that the students with whom you work could change?

HOW IS YOUR HOPE?

What inspires or moves you?
How does that increase your sense of hope?
What does an increased sense of hope allow you to do?
How can you promote hope with others?
How do you maintain your sense of hope when you are struggling with clients?
A Strengths-Based Philosophy

A strengths-based perspective is not a theory, but an overarching philosophical point of view. It is one in which people are seen as having capabilities and resources within themselves and their social systems. When cultivated, activated, and integrated with new experiences, understandings, ideas, and skills, these strengths help people to reduce pain and suffering, resolve concerns and conflicts, and cope more effectively with life stressors. This contributes to improved sense of well-being and quality of life, and higher levels of relational and social functioning. Strengths- based practitioners promote change through respectful educational, therapeutic, and operational processes and practices that encourage and empower others.

Traditional View
Search for impairments/deficits
Focus is on discovering pathology
Belief is people are bad, have hidden agendas, and are resistant
Focus is on the practitioner finding and administering cures
The practitioner is the “expert”
Focus is on the past/past events
Practitioners emphasize expression of emotion as necessary for change
Practitioners diagnose stuckness
Emphasis is on finding identity and personality problems

Strengths-Based
Identify competencies/abilities
Focus is on promoting health/well-being
Belief is people have good intentions, are cooperative
Focus is on creating small changes and that lead to bigger ones
Services are collaborative—both the practitioner and student(s) have expertise
Focus is on the present and future Practitioners validate felt experience
Practitioners are change-oriented
Emphasis is on action and process descriptions
RULES OF ENGAGEMENT

Create a Context of Collaboration
EXPRESS EMPATHY
ROLL WITH RESISTANCE
AVOID ARGUMENTATION
DEVELOP DISCREPANCY
SUPPORT SELF EFFICACY

Strengthen Through Presence
Listen and Attend to Students; Acknowledge and Validate; Use Possibility-Laced Language and Remain Aware of the Effects of Language; Separate Experience from Action; Summarize, Validate, and Soften, Avoid Platitudes, Be Aware of Problematic Stories; Be a Life Witness; Listen Closely to What Influences Students See as Attributing to Their Concerns/Problems and What May Contribute to Possibilities for Change (e.g., familial, relational, behavioral, biological, cultural, etc.).

3) Information-Gathering; Real-Time Feedback Processes; Create a focus and be clear on what needs to change:
Determine what needs to change means creating goals that are achievable and solvable
Determine how it will be known when things are better;
Determine how it will be known that progress is being made;
Assess Student Readiness to Change; (know the stages of change: Pre- contemplation; Contemplation; Decision; Action; Maintenance)

Focus on Change Steps: Consider means and methods that match students’ ideas about problems and how change positive might occur
Reassess Students’ Readiness for Change; Collaborate with students on tasks and/or ways of achieving goals and improving outcomes

Evaluate and Monitor Progress, and Respond
Identify, amplify, and extend change;
Check in with students, reassess goals and means and methods for achieving change;
Check in with self and be aware of pathways of impossibility;
Follow-Up. SAMPLE QUESTIONS & TALKING POINTS

In Initial Sessions/Meetings/Appointments/Interactions:
What is most important for us to talk about?
What is most important for me to know about you and/or your situation/concern?
Are there certain things that you want to be sure we talk about?
What do you want to be sure that we discuss during our time together?
What ideas do you have about how services and/or seeing me might be helpful?
In what ways do you see me as being helpful to you in reaching your goals/achieving the change you desire?
What do you feel/think you need from me right now?
How can I be helpful to you right now?
How will you know the services we’re offering are right for you? What will be different?
What do you see as my role in helping you with your concern?
What, in your estimation, do workers who are helpful do with their students?

“Checking In” as Sessions/Meetings/Appointments/Interactions Progress:
Have you felt heard and understood?
Do you feel/think we’re talking about what you want to talk about? • Have we been working on what you want to work on?
How has the session been for you so far?
Are we moving in a direction that seems right for you?
What has the conversation we’ve been having been like for you?
What has been helpful or unhelpful?
Are there other things that you feel/think we should be discussing instead?
Is there anything I should have asked that I have not asked?
How satisfied are you with how things are going so far on a scale from 1 to 10, 10 meaning you are completed satisfied with things?
Are there any changes we should make at this point?
At this point, how has what I’ve been doing been for you?
Is there anything I should be doing differently?
To what degree has what we’ve been doing met your expectations for services so far?

At the End of Sessions/Meetings/Appointments/Interactions:
How was the session/meeting/appointment for you?
What was helpful or unhelpful?
Did we talk about what you wanted to talk about?
Did we work on what you wanted to work on?
How was the pace of our conversation/session/meeting?
Was there anything missing from our session/meeting/appointment?
Is there anything I should have asked that I did not ask?
Is the way we approached your concern/situation fitting with the way you expect change to occur?
Are there any changes you would recommend if we were to meet again?
Did you feel heard and understood?
Is there anything you would need me to do differently if we were to meet again?
How would explain your experience today to others who may be curious?

THREE EXAMPLES OF CBT (Cognitive Behavioral Therapy) EXERCISES

1) Identify what you like best about your behavior? Spend time developing three alternative ways to achieve similar results. (Example: I use to relax becomes learning how to meditate, starting an exercise program, listening to music, taking a walk, etc.)

2) Symptomatic behavior always occurs in a larger context.
Examples: I usually smoke after eating.
I only smoke pot when my parents aren’t home.
I eat more when I’m alone.
I binge shop with Jamie but never with Trudy.

IDENTIFY the factors and variables and the stories connected to the larger context.
This is one way to identify internal & external triggers.

3) Social Support Network

Take a piece of paper.

Draw a circle in the middle of the paper, large enough to accommodate several names inside the circle.

Draw a larger circle outside of that circle.

Draw one more larger circle, encompassing most of the rest of the sheet.

Ask these questions:
In the inner circle, write the names of the people who are IN your inner circle.

These are the people who you are most likely to confide in. They have your back.
You’d call them if you were in trouble or had happy news to share.

In the next circle write people who are close to you, but not in your inner circle.

In the last circle write names of other significant people in your life, but who aren’t
in either other circle.

Who supports the change you are trying to make in your life? Who is likely to
sabotage or discourage the change?

Are there people in your inner circle who might discourage your change?
Are there people outside of your inner circle you might want to spend more time with?

BIBLIOGRAPHY

Bibliography for Utilzing Motivational & Cognitive Behavioral Techniques In Your Practice
Addiction and Change: How Addictions Develop and Addicted People Recover (The Guilford Substance Abuse Series) by PhD Carlo C. DiClemente Phd (Paperback – April 27, 2006)

Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward by James O. Prochaska, John Norcross, and Carlo DiClemente (Paperback – Sep 1, 1995)

Motivational Interviewing, Second Edition: Preparing People for Change by PhD William R. Miller Phd, Stephen Rollnick PhD, William R. Miller, and Stephen Rollnick (Hardcover – April 12, 2002)

The CYT series site:

http://www.kap.samhsa.gov/products/manuals/cyt/index.htm

For handouts and educational material: http://store.health.org/catalog/SC_Itemlist.aspx and http://www.nida.nih.gov/

For the TIP 35 manual on Enhancing Motivation for Change in Substance Abuse Treatment:
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302
(excellent resource in techniques and skills)

As Motivational Interviewing(MI) is at the heart of Motivational Enhancement Therapy another website for information and resources on MI: http://www.motivationalinterviewing.org/

Thoughts & Feelings: Taking Control of Your Moods and Your Life: A Workbook of Cognitive Behavioral Techniques by Matthew McKay, Patrick Fanning, and Martha Davis (Paperback – Jan 1998)

The Client’s Guide to Cognitive-Behavioral Therapy: How to Live a Healthy, Happy Life…No Matter What! by Aldo Pucci (Paperback – May 22, 2006)

Strengths-Based Engagement and Practice: Creating Effective Helping Relationships (MyHelpingKit Series) by Bob A. Bertolino (Paperback – Feb 6, 2009)

The Heart & Soul of Change: What Works in Therapy by Mark A. Hubble, Barry L. Duncan, and Scott D. Miller (Hardcover – Mar 1999)

The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client- Directed, Outcome-Informed Therapy by Barry L. Duncan, Scott D. Miller, and Jacqueline A. Sparks (Paperback – Feb 27, 2004)

Essentials of Outcome Assessment (Essentials of Mental Health Practice) by Benjamin M. Ogles, Michael J. Lambert, and Scott A. Fields (Paperback – April 22, 2002)

Change 101: A Practical Guide to Creating Change in Life or Therapy by Bill O’Hanlon and William Hudson O’Hanlon (Hardcover – Sep 17, 2006)

Do One Thing Different: Ten Simple Ways to Change Your Life by Bill O’hanlon (Paperback – Oct 24, 2000)
www.talkingcure.com

Drive: The Surprising Truth About What Motivates Us – Daniel Pink (Riverhead Books, 2011)

A Brief History of Everything by Ken Wilber (Mass Market Paperback – Mar 27, 2007)

Developing Discrepancy example via Wise Woman:

https://www.youtube.com/watch?v=EJ6A7C3pcHE

(This is part of a series of videos done by Mike Stratton for State of Michigan Department of Health to illustrate techniques of Motivational Interviewing)

www.droppingpot.com

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