Using Motivational Interviewing for Success in Counseling.

Using Motivational Interviewing for Success in Counseling.

1.    Motivational Interviewing is not new to me, having attending several trainings provided by County Learning Partnership.  This was a good review and a good opportunity to go over the ideas that have come through the substance abuse treatment realm but now are part of therapy in the mental health side as well.  The idea behind motivational interviewing is that is a client driven focus, and you are determining the client’s readiness to change so they can direct their own willingness to be in services.  It posts five levels of change in a progressive type fashion, precontemplation, contemplation, ready for action, action and maintenance.  The four skills used are: “OARS,” Open-ended questions, Affirmation, Reflective Listening and Summary Statements.  In this context you use these skills to recognize and then tease out change-talk.  You do this by employing DEARS: Develop Discrepancy, Express Empathy, Amplify Ambivalence, Roll with Resistance and Support Self-Efficacy.

Reflective Leadership: Reflective Supervision

Attended this training while I was doing the supervision curriculum.  It was presented by Maretta Juarez.  Just a few ideas I gleaned from the training.  "We do not learn from experience...we learn from reflecting on experiences" John Dewey.
Reflection is:
Stepping back from the immediate, intense experience to think about what it really means.
Examining our thoughts and feelings about experiences. 
Important skills include self awareness, careful observation and flexible responses.  Elements of reflective practice are relationships and development, parallel thinking, awareness, perspective taking, not knowing and collaborative stance.
Intended impact of reflective practice are: improved outcomes, improved program quality, improved clinical practice, and reflective practice and activities.

Clinical Supervision

Clinical supervision is an important role in social work.  To be able to help someone at the start of their career is important, and the responsibility should not be taken lightly.  I have provided supervision for several different employees of Santa Clara County Behavioral Health, and it is fun to see what some have accomplished.  I wouldn't say because of my supervision, but at least it was a step along the way.
At a recent training given my Melanie Stern, this statement was provided: Clinical supervision is an interactional process between supervisor and supervisee that promotes the development of responsibility, skill, knowledge, attitudes, and ethical standards in the practice of clinical work.
Actions that help accomplish this are:
providing a safe environment, acquiring therapeutic techniques, knowledge about relevant laws and regulations, able to anchor skills to client issues, comfortable and confident, able to assess areas for growth, models how to handle anxiety and able to evaluate.
Some ethical and legal issues to consider, informed consent, due process, confidentiality, Tarasoff (vicarious liability), training, record keeping and dual relationships.
There are also many obligations to do supervision correctly, as required by the BBSE.  This includes contract and reporting requirements.  

Training: Multicultural Supervision

This training was presented by Nicholas Landany from the San Diego area.  There are some topics that are very sensitive; this is one of them.  I can't say I enjoyed this training.  Ladany and his cohorts at the Critical Events Supervision Model had developed a way to score individuals with regards to ideas about race.  fThe levels were adaptation, incongruence, exploration and integration.  In this model adaption seemed to be another word for racist or naive.  He scored Donald Trump and Ben Carson in this area.  That didn't make sense to me, and still doesn't.  Maybe I missed something.  I think any model that gives you the right to pigeon hole others, is a poor model.  People are people, not some score from a psychologist.  I mentioned this at the after-training meeting, but not at the training itself.  

Breathing

I attended a safety training this week.  Two of the presentations including breathing exercises.  Also Employee Wellness was there with handouts, including those about breathing.  I share one of those which seems a very good method.  One of the presenters including gather up the negative with the breath in, and then throwing it away with the breath out; then gathering up the positive with the breath in, and letting it flow over you, or putting it into your heart, with the breath out.

Reflective Practice Guides

I have been to a couple of trainings involving reflective practice.  One was with Kristie Brandt who also provided a work book.  I wanted to share a couple thoughts from the trainings, because I think they can add to anyone’s experience.  These I think are fundamental principles of reflective practice and supervision.

They are both in the book, "Facilitating the Reflective Process.  We don’t learn from experience.  We learn from reflecting on our experiences," T. Berry Brazelton MD

"Treat others the way you would like them to treat others."

**Book Review: Youth Mental Health First Aid USA for Adults Assisting Young People

C 2012 Maryland Department of Health and Mental Hygiene, Missouri Department of Mental Health and National Council for Community Behavioral Healthcare.
This book was given to me as part of a training presentation by the same name.  This training is geared towards nonprofessional people, and provides assistance so they can offer help to their family members, friends, community members or others.  It compares this program to first Aid for a physical problem.  First Aid aims to preserve life, prevent further harm, promote recovery and resiliency and provide comfort.  Mental Health First Aid is geared to promote life when a person may be a danger to themselves or others, prevent the problem from becoming worse, promote recovery, provide comfort and support and help to identify or guide a person to appropriate resources and supports.  It does this through the “Youth Mental Health first Aid Action Plan.”  This plan includes five steps which spell out ALGEE.  1) Assess for risk of suicide or harm; 2) Listen nonjudgmentally; 3) Give reassurance and information; 4) Encourage appropriate professional help; 5) Encourage self-help and other support strategies. 
It includes a section on adolescence and young adulthood, and distinguishing these transitional steps which are part of normal development from mental health issues.  It then has a very large section on different mental health issues, and how to apply this model.  These include: depression, anxiety, eating disorders, psychosis, substance use and attention and disruptive behavior problems. 
It concludes with a how-to handle certain situations.  This includes suicidal thoughts, self injury, panic attacks, trauma, acute psychosis, aggressive behavior and emergencies from alcohol or drug abuse.
This workbook is a tremendous resource.  However, I would advise taking the course so as to have some practice in the techniques before trying them.