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Competency 6: Engagement, Alignment and Application of Motivational Interviewing

Skill 6A: Able to set up an atmosphere that is supportive and conducive for clients to safely explore their experience and ambivalence around change.

  • Recognize and accept that individuals who need to make changes in their lives approach counseling at different stages of readiness to change their behavior.
  • Knowledge that ambivalence, feeling two ways about change is normal.
  • Understand that motivation plays an important role in an individual’s decision to change or remain the same.
  • Understand it’s the client’s task, not the counselors, to articulate or make the case for change.
  • Understand that “Motivational Interviewing is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change” (Miller & Rollnick, 2009).
  • Understand that the Spirit of Motivational Interviewing includes:
    • Collaboration between the treatment provider and the client, rather than confrontation.
    • Acceptance, which includes Absolute worth, Autonomy and Support, Affirmation and Accurate empathy.
    • Compassion
    • Evoking or drawing out the client‘s ideas about change.
  • Knowledge of the 4 Processes of MI:
    • Engaging: process of connecting with clients to establish a working relationship.
    • Focus: maintaining a specific direction, setting a course, identifying what the change behavior is.
    • Evoking: eliciting the client’s own motivation for change.
    • Planning: developing a commitment to change and establishing a plan of action.

Skill 6B: Able to apply core motivational-interviewing techniques and skills to facilitate stage-wise treatment.

  • Knowledge of MI Principles
    • Expressing Empathy: accurate Understanding of an individual’s experience communicated in a warm, non-judgmental manner.
    • Developing Discrepancy: highlighting the gap between where clients are and where they want to be, and or who they are who they want to be.
    • Dancing with Discord: Responding to client sustain talk and discord by reflecting and respecting without reinforcing or opposing it.
    • Support Self-Efficacy: Believe that change is possible. MI builds faith in clients’ choices and actions involved in change, encourages alternatives if initial attempts fall short.
  • Knowledge of:
    • Open-Ended Questions: questions that cannot be answered yes or no or with a restricted range of information, but which invite individuals to express their perspective or encourage self- exploration.
    • Affirmations: accentuating the positive through expressions of appreciation for who the individual is, or what they have done.
    • Reflective Listening: demonstrates to the client that you are listening and trying to understand the situation. These include simple reflections that simply restate or repeat what the client said or complex reflections which infer meaning behind what is said that include:
      • Amplified Reflections
      • Double Sided Reflections
      • Reflections of Feelings
      • Metaphors
    • Summarization: bringing together of several previously expressed thoughts, feelings or concerns often including the clinicians Understanding of how things fit together. Include Collecting, linking, transitional
    • Plus: Giving information and advice with permission
  • Understand that OARS can be utilized in all stages of change but are most useful in pre-contemplation and contemplation stage of change.

Skill 6C: Able to recognize Change Talk and Commitment Language.

  • Knowledge that change talk is associated with the increased likelihood of change. It refers to client’s statements about:
    • Desire (I want to change)
    • Ability (I can change)
    • Reasons (It’s important to change)
    • Need (I should change)
  • Knowledge that commitment talk reflects a more assertive declaration about commitment/actions to change that might include statements about actions or steps taken towards the change.
    • Commitment (I will make changes)
    • Activation (I am ready, prepared, willing to change)
    • Taking Steps (I am taking specific actions to change)

Skill 6D: Able to elicit and encourage Change talk and Commitment talk.

  • Familiar with the following ways to elicit change talk such as:
    • Ask evocative questions
    • Ask for elaboration
    • Ask for examples
    • Looking backward
    • Looking forward
    • Query extremes
    • Change rulers
    • Explore goals and values
    • Come alongside
  • Familiar with ways to encourage commitment to change.
    • Elaborate
    • Affirm
    • Reflect
    • Summaries

Skill 6E: Able to identify sustain talk and signs of discord.

  • Knowledge that sustain talk is the opposite of change talk, which include statements that favor the status quo and express a desire for behaviors to stay as they are, worries about being able to change, reasons not to change and the need to stay as they are.
  • Familiar with the 4 R’s: resignation, rationalization, rebellion, reluctance.
  • Knowledge of the signs of discord such as arguing, interrupting, negating, and ignoring
  • Knowledge of the Motivational-interviewing Traps that increase discord:
    • Question Answer
    • Labeling
    • Premature Focus
    • Taking Sides
    • Blaming
    • Expert Trap

Skill 6F: Able to respond to Sustain Talk and Manage Discord in a supportive and helpful manner.

  • Understand the importance of returning to the spirit of MI when there are signs of sustain talk and discord.
  • Understand that the use of reflections, reframing, agreeing with a twist, coming alongside, and emphasizing authority are helpful when responding to sustain talk.
  • Understand that for signs of discord, the use of apologizing, affirming, and shifting focus are helpful.

Skill 6G: At each stage in the Stages of Change model able to identify and incorporate strategic therapeutic activities to help individuals increase commitment to change.

  • Knowledge of the goals, tasks, and strategies associated with preparing individuals to change for each stage. For example:
    • Precontemplation
      • Build Rapport and Raising Awareness
      • Assess and address importance, confidence and readiness
      • Readiness Rulers
    • Contemplation
      • Resolving ambivalence
      • Build Motivation
      • Explore and Resolve Ambivalence
      • Decisional balance
    • Preparation
      • Negotiate a plan
      • Facilitate decision making
      • Change Plans
    • Action
      • Support Implementation of Plan
      • Support Self Efficacy
    • Maintenance
      • Help Maintain the change
      • Prevent Relapse
    • Relapse
      • Re-engage
  • Review goals and strategies

Skill 6G: Demonstrate a commitment to use and improve MI competency by consistently reviewing skills with supervisor and colleagues through feedback and practice.

  • Familiar with different quality improvement measures such as the Motivational Interviewing Assessment Supervisory Tool for Enhancing Proficiency.
  • Familiar with Motivational Resources and Tools to enhance practice.

Skill 6H: Able to identify how a client’s culture impacts their engagement in the treatment process and how one’s own culture impacts their ability to engage clients and provide culturally effective services.

  • Understand that culture includes race, ethnicity, gender, sexual orientation, religion/spirituality, socioeconomic status, and ability status.
  • Understand the social and historical context behind inequality.
  • Familiarity with the concepts of social determinants of health and health disparities.
  • Understand that cultural factors impact how clients: exhibit symptoms, use coping skills, use social supports, access treatment, are diagnosed and treated.
  • Understand that lack of cultural competence on the part of treatment providers can contribute to barriers to engagement and successful outcomes.
  • As defined by SAMHSA, Understand the core elements of cultural competence to include:
    • Cultural awareness: treatment provider’s awareness of their own attitudes, beliefs, biases, and assumptions about others.
    • Cultural knowledge: treatment provider’s investment in gaining cultural knowledge of the populations that they serve and obtaining specific cultural knowledge as it relates to help-seeking, treatment, and recovery. Treatment providers consider communication patterns (verbal and non -verbal), geographical location values, traditions, gender roles, clinical presentations of distress, immigration, migration and acculturation stress, religion and spirituality,  counseling expectations, behavioral norms, and expectations in and outside of the counseling session (e.g., touching, greetings, gift-giving, level of formality between counselor and client).
    • Culturally appropriate clinical skills: treatment providers utilize clinical skills that ensure delivery of culturally appropriate treatment interventions.
  • Understand that cultural competence requires ongoing self-evaluation.

Skill 6I: A Able to reflect upon one’s own assumptions, beliefs, values, and behaviors, and the impact on the therapeutic alliance.

  • Knowledge of one’s clinical strengths and limitations.
  • Understand that while knowledge and skills are important, self-awareness and self-reflection are a major component of engaging clients and providing effective treatment.
  • Understand how past experiences influence one’s world view and assumptions which in turn guide thoughts, interpretations and experiences with clients
  • Understand motivations for becoming a treatment provider.

Skill 6J: Able to identify limitations, set boundaries, seek supervision, engage in self-care, and refer clients when necessary.

  • Understand stressors, triggers, areas of vulnerability, and conflict.
  • Familiar with the concepts of transference and countertransference.
  • Familiar with Code of Ethics assigned to their profession.
  • Understand roles and responsibilities of their position.
  • Understand boundaries and boundary violations.
  • Familiar with signs and effect of burn-out.
  • Familiar with vicarious trauma and the symptoms associated with it.
  • Understand the importance of self-care and support.