Mindfully Responding to Resistance MI News August 08
MOTIVATION NEWS
Published by Cathy Cole, MSSW, LCSW Motivational Interviewing Network of Trainers
August 2008 http://www.cathycoletraining.com (MI training since 1995) We sit together~ My thoughts you reflect And hope springs forth Cole, 2007
NEWSLETTER FEATURE ARTICLE
MINDFULLY AVOIDING RESISTANCE
IF YOU DO NOT SEE TRAINING THAT WILL FIT YOUR NEEDS, PLEASE EMAIL ME AT cathy@cathycoletraining.com IN ORDER TO DISCUSS HOW I CAN PROVIDE TRAINING TAILORED TO YOUR NEEDS. I FREQUENTLY TRAVEL TO AGENCIES OR CONFERENCES TO PROVIDE MI TRAINING.
ONSITE TRAINING OPPORTUNITIES
2008 ONSITE TRAINING DATES:
ADVANCED MI TRAINING October 13-15, 2008 http://www.cathycoletraining.com/trainingoctoberadvancedmi.php Three day workshops with an emphasis on coached practice Century Center, Carrboro, NC Carrboro is adjacent to Chapel Hill, NC Limited to 15 participants $550, 15 hours CE; ASWB continuing education pending Please email cathy@cathycoletraining.com to reserve a spot Payment accepted via check or credit card at http://www.cathycoletraining.com/paypalpayments.php
November 17-19, 2008 INTRODUCTION TO MOTIVATIONAL INTERVIEWING http://www.cathycoletraining.com/trainingnovemberintroductiontomi.ph p Three day workshops covering the basics with ample opportunity for coached practice Century Center, Carrboro, NC Carrboro is adjacent to Chapel Hill, NC Limited to 15 participants $550, 18 hours CE; ASWB continuing education pending Please email cathy@cathycoletraining.com to reserve a spot Payment accepted via check or credit card at http://www.cathycoletraining.com/paypal_payments.php
2009 Training Dates: INTRODUCTION TO MOTIVATIONAL INTERVIEWING February 17-19, 2009 July 20-22, 2009 November 10-12, 2009 Century Center, Carrboro, NC Carrboro is adjacent to Chapel Hill, NC Limited to 15 participants $595, 18 hours CE; ASWB continuing education pending Please email cathy@cathycoletraining.com to reserve a spot
ADVANCED MI TRAINING May 11-13,2009 September 14-16, 2009 Century Center, Carrboro, NC Carrboro is adjacent to Chapel Hill, NC Limited to 15 participants $595, 18 hours CE; ASWB continuing education pending Please email cathy@cathycoletraining.com to reserve a spot
PROVIDING SUPERVISION March 30-April 1, 2009 I now offer a 3 day workshop focused on coding of interviews using the MITI and providing supervision via the use of an adaptation of the MIA STEP supervisory format. In this workshop, the principles of providing supervision in an MI consistent format are discussed, interviews are scored from the supervisory and supervisee perspective, as well as the MITI, and practice sessions are conducted in providing supervision. Century Center, Carrboro, NC Carrboro is adjacent to Chapel Hill, NC Limited to 15 participants $595, 18 hours CE; ASWB continuing education pending Please email cathy@cathycoletraining.com to reserve a spot
MI COACHING--TAKE ADVANTAGE OF ONGOING SUPERVISION OF YOUR MI PROGRESS VIA COACHING For individuals and agencies with previous MI training either with me or another MI trainer, I offer ongoing coaching/supervision in the application of MI. Generally, this coaching takes place by phone. You can arrange for individual or group coaching. Please email me at cathy@cathycoletraining for more information.
THE PATH FOR BECOMING A TRAINER FOR MOTIVATIONAL INTERVIEWING If you are considering becoming a trainer in MI, you will be expected to demonstrate proficiency in MI. Applications are reviewed for indication of both introductory and advanced MI training as well as supervision of MI fidelity. I am able to assist you in all of these areas.
ADOPTING THE MI PRINCIPLES ON AN AGENCY LEVEL
The fullest implementation of MI is achieved when staff are trained in the use
of
MI and all of the operation of the agency is consistent with MI principles. I
offer
consultation that will assess all levels of function in the agency, from how the
phones are answered, clients greeted, intake achieved and provide guidance
in making changes to incorporate MI into the full process of work. At a
recent
workshop, a staff member, responding to a crisis, remarked that he was able
to
handle the situation more effectively by using MI as an approach. A
receptionist
remarked that she now would use MI in her client interactions.
Please email me at cathy@cathycoletraining for more information and
proposal tailored to your agency.
ABOUT MY WORKSHOPS: I have provided MI training since 1995, following my training with Drs. Miller and Rollnick. My teaching approach is very pragmatic, focusing on the core concepts of MI and allowing the learning to progress from direct practice.
I have elected to limit the size of my workshops in order to maximize the opportunity to provide learning that can both address the concepts and practice of Motivational Interviewing while at the same time assist in the application of MI to each participant's work setting.
Onsite training is limited to 15 participants for Supervising MI, Advanced and Introductory MI.
This letter may be forwarded to anyone you feel could benefit as long as it is forwarded in its entirety. Past newsletters available via web site http://www.cathycoletraining.com
Welcome to Motivation News, a newsletter devoted to clinical information on the use of a Motivational Interviewing (MI) approach to change. The authors of this approach, William Miller, PhD and Stephen Rollnick, PhD define MI as a 'client centered, directive method for enhancing an intrinsic motivation for change by exploring and resolving ambivalence". This collaborative approach to working with clients has wide application in mental health, the justice system, addictions, health care and health education. Information in this newsletter is taken from various source material from the Motivational Interviewing Network of Trainers and specifically from the book Motivational Interviewing, Preparing People for Change; Miller and Rollnick, 2nd edition, 2002, Guilford Press. Additional source material: Motivational Interviewing in the Treatment of Psychological Problems, ed. Arkowitz, Westra, Miller, and Rollnick, Guilford 2007; Motivational Interviewing In Health Care, Rollnick, Miller, and Butler, Guilford, 2007.
AUGUST MAIN FEATURE
MINDFULLY AVOIDING RESISTANCE
Rolling with Resistance is one of the Principles of MI and one for which the practice of MI is well identified. Just as a reminder, resistance is viewed as strong ambivalence or falling low on the scale of importance in addressing a change. Therefore it is a reaction, a behavior and can be changed.
I think of clients being in one of three positions: moving away from change, neutral about change and moving toward change. In rolling with resistance a goal is to help the client move to neutral or toward change. How we respond is always vital and knowing when we might get caught in resistance a key need.
Jon Kabat-Zinn defines MINDFULNESS as 'paying attention in a particular way; on purpose, in the present moment, and non-judgmentally'. That definition fits quite well with the Spirit of MI as we pay attention to the client with the goal of understanding that person's reality in a non-judgmental way.
So what can get in our way? Being human of course! All of us are subject to feeling reactive toward clients for any number of reasons. There is no fault in that; the work comes in not allowing those reactions to get in the way and thereby potentially creating resistance.
The work of MI is attending mindfully to the client and to our own internal
reactions and dialogue. For me this means first that I am aware of my state
of being as I enter into conversation with a client: am I still thinking about the
last person I saw? am I thinking about lunch! am I preoccupied about other
things? How can I put aside the distractions and be present with this person?
Often, just noting and acknowledging can bring me back to center.
Once I am with the client, I have to continue to monitor my reactions and not
allow these to interfere. My reactions are often quite valuable in my
understanding; if I am feeling anxious as the client struggles with whether
he/she can manage all the requirements of being diabetic, likely the client is.
This could be the basis of a complex reflection. If I am not mindfully aware, I
could move to being overly reassuring which could raise resistance.
I'll do a brief case example that will have my reactions noted. (I) is for interviewer and (C) is for client.
C: 'I hate that my doctor keeps harping about my weight; she is so pushy!' The client says with a loud, angry tone
I: What I am noting in my reactions: tension in my shoulders, feeling assaulted by the anger, noting that I really like this doctor, don't want her attacked this way
What I could have said that would raise resistance: 'Your doctor knows what is best for you.'
My response: 'You were not pleased with your doctor visit today' (kind of a middle ground response, not playing into the anger but noting the upset)
C: 'You are right; every time I talk to anyone about any complaints I have, all anyone says is "you are too fat; your knees wouldn't hurt so much, your back"...on and on about my weight; I know I weigh too much!'
I: What I am now noting: feeling calmer, able to hear the client's distress/how difficult this must be for her
What I could have said that would raise resistance: 'Then why aren't you doing something about it?'
My response: 'It's not that you are not aware of this yourself; you just don't like it being brought up all the time.'
C: 'Yes! So why isn't someone trying to help me lose weight! Who would want to be this big?'
I: What I am now noting: not so reactive; she is still angry but now I can more easily hear the discouragement, the desire for help.
What I could have said that would raise resistance: 'You should just find a way to eat better, less and get exercise.'
My response: 'You want to do something about your weight; you are just not certain how to go about it.'
C: 'That's right; can you help?'
And so the conversation would continue. Had I not been mindfully aware of my initial reactions to her anger and to my friend the doctor being attacked, we might not have gotten here.
Keep practicing!
Next month we will return to our college client from July MI News and look at the interplay of a commitment to change but ambivalence about what requirements in shifting behavior this would mean.
For more information on MI training and Cathy Cole visit http://www.cathycoletraining.com
Additional Educational/Coaching Offerings: Use of the MITI (Motivational Interviewing Treatment Integrity Code) for feedback on taped interviews.
Use of a structured supervisory feedback form for targeting competence and places for improvement in MI practice based on the MIA STEP materials.
Onsite workshops: one to three day training in MI for agencies or educational consortiums
Onsite consultation: Preparing your agency for MI. Combining this with specific training for agency staff increases the effectiveness of implementing MI.
Additional Advanced MI training: Telephone conferencing for active case supervision and focus on MI skills or on site training for staff groups already trained in MI; feedback on tapes using the MITI.
MI Coaching: assessment of a taped client session with phone supervisory consultation; feedback on tapes using the MITI.
For information on any of these MI trainings, send email to cathy@cathycoletraining.com
Cathy Cole, MSSW, LCSW is an educator and clinician.
She received her Masters of Science in Social Work from
the University of Tennessee and has maintained a varied clinical and
education practice throughout her career. Since her training in
Motivational Interviewing in 1995, she has provided extensive training.
For more information on Cathy visit http://www.cathycoletraining.com
To contact Cathy, use cathy@cathycoletraining.com
cathycoletraining, inc Cathy Cole, President Mission: to provide excellent education and coaching with a specific focus on the use of Motivational Interviewing for exploring and resolving the natural ambivalence for change. Contact Cathy at cathy@cathycoletraining.com for more information or visit http://www.cathycoletraining.com 919-382-8102
For more information on Motivational Interviewing, visit the web site http://www.motivationalinterview.org
(919) 967-9653 — 
cathy@cathycoletraining.com© 2009 Cathy Cole Training, Inc.