Discussing Substance Use with College Students: Incorporating Brief Intervention Approaches into Conversations on Campus and Addressing Marijuana in a Changing Legal Climate 1 of 3
Jason R. Kilmer, Ph.D.
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08/20/2018
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Description
In this workshop, we will discuss the theory behind and reasons for a brief intervention approach, will provide training in and practice with specific motivational interviewing strategies, and will consider ways to incorporate these approaches into conversations already taking place with students across campus.
Additionally, there is recent research on marijuana and the clear implications for college student health that we will review, including impacts on cognitive functioning, mental health, risk for addiction, and other unwanted effects. Along with lessons learned from a legal state, we will discuss these findings in the context of the brief intervention content from earlier in the day.
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- [00:00:04.400]Thank you all for taking time out of your,
- [00:00:06.530]not only your week, but your Friday,
- [00:00:09.090]to be able to attend this and be a part of this.
- [00:00:11.490]I appreciate the nice introduction.
- [00:00:13.650]As you heard I wear two hats
- [00:00:15.390]at the University of Washington.
- [00:00:16.520]I'm a faculty member that's been a part of a team for years,
- [00:00:20.170]has been doing research on causes to alcohol use,
- [00:00:22.770]marijuana use, other drug use,
- [00:00:24.720]but importantly approaches to how we work
- [00:00:26.330]with students with these issues.
- [00:00:27.940]The other half of my job, I work in student life,
- [00:00:30.970]we try and bring with the science as works
- [00:00:32.880]to our students on campus.
- [00:00:34.850]So that involves direct work with Greek life,
- [00:00:36.470]it includes athletics, res life, conduct,
- [00:00:40.220]and even doing trainings in health and counseling,
- [00:00:43.470]and even academic advising with my colleagues
- [00:00:45.440]who are interacting with college students.
- [00:00:47.510]I know from Meghan at the time that we arranged this,
- [00:00:51.160]that a number of you have had trainings
- [00:00:53.410]in motivation interviewing before.
- [00:00:55.240]And so this is not just
- [00:00:56.507]"Look!" "More motivational interviewing."
- [00:00:58.370]But this is really outside of a clinical context
- [00:01:01.160]how you would bring motivation interviewing strategies
- [00:01:03.770]in the conversations you're having with students anyway.
- [00:01:06.360]If you're in this room saying
- [00:01:07.257]"I'm not a therapist, and I don't want to be."
- [00:01:09.585]That's completely understandable
- [00:01:11.710]and you can still implement these strategies ethically
- [00:01:15.730]and appropriately with students in the science back set up.
- [00:01:19.180]In all likelihood, you know, students are already,
- [00:01:21.900]when someone sits down across from you
- [00:01:23.017]and says "Wow!" "Another rough weekend."
- [00:01:25.170]Like that's an opportunity to explore what's going on.
- [00:01:28.410]Where we've been trying to advance our understanding
- [00:01:30.730]of how brief interventions work,
- [00:01:32.210]is going beyond alcohol.
- [00:01:33.710]I was trained by Alan Marlatt who developed Basics,
- [00:01:36.010]Brief Alcohol Screening Intervention for College Students.
- [00:01:39.390]And especially after legalization in Washington in 2012,
- [00:01:43.630]we've been looking a lot more at how can we incorporate
- [00:01:46.330]brief intervention strategies on marijuana use.
- [00:01:49.040]So Meghan and I talked about an idea for today,
- [00:01:50.970]it was how can we do for folks for whom this is new,
- [00:01:54.480]how could we do enough of a training
- [00:01:55.950]on motivation interviewing for you to, if you wanted,
- [00:01:59.020]literally start implementing these strategies
- [00:02:01.210]next time you meet with a student.
- [00:02:03.040]For those of you who have had experience with this
- [00:02:05.100]more practice particularly with the key strategies
- [00:02:08.410]in motivation interviewing, and for everyone,
- [00:02:10.890]a chance to look at how we would bring marijuana
- [00:02:13.680]into those conversations.
- [00:02:15.391]And that would include, not only the science most relevant
- [00:02:18.320]to cause students, but especially if time permits,
- [00:02:21.928]kind of lessons learned so far,
- [00:02:23.930]five years in the legalization in the state of Washington.
- [00:02:26.950]We're a big group,
- [00:02:28.130]my plea to you is to keep this as two-way as possible,
- [00:02:30.690]so if you have questions at any point, comments,
- [00:02:33.190]please don't hesitate to ask.
- [00:02:34.880]There's a lot of bright lights,
- [00:02:35.750]so if I don't see you just holler
- [00:02:37.290]and but just don't holler in a mean way.
- [00:02:40.988]So thank you for that.
- [00:02:44.160]I want to, we've had a tentative agenda
- [00:02:47.037]and the only thing I tweaked a little bit,
- [00:02:49.060]is to bring in some of the marijuana information
- [00:02:50.940]before lunch and extend some of the practice to post lunch.
- [00:02:54.350]But really whatever best meets your needs.
- [00:02:56.710]So if at any point, the content,
- [00:02:58.060]you guys are like "We know this."
- [00:02:59.510]Please let me know and I'll make sure I'll audible
- [00:03:02.070]to make sure this meets your needs
- [00:03:03.091]and interests as best as possible.
- [00:03:05.750]So I wanna talk a bit about alcohol
- [00:03:09.050]before we talk about this.
- [00:03:10.070]When we look at messages, those of you that wear
- [00:03:12.800]a programming or prevention hat,
- [00:03:14.490]those of you that work with students,
- [00:03:16.190]I mean think about the work we do.
- [00:03:18.180]If a fraternity on Monday at eight says
- [00:03:20.157]"Hooray!"
- [00:03:20.990]"The alcohol speaker's coming into our chapter."
- [00:03:23.877]"Hooray."
- [00:03:25.590]There's an expectation of what someone like me,
- [00:03:27.660]someone like you's gonna say.
- [00:03:28.760]What do people expect to hear in a prevention program?
- [00:03:31.840]What kind of message do they expect to hear?
- [00:03:34.610]Don't drink?
- [00:03:35.610]Abstinence only.
- [00:03:38.100]Just say no.
- [00:03:39.020]Does that work with college students?
- [00:03:41.320]No.
- [00:03:42.153]Tell me why.
- [00:03:42.986]Why does "Just say no" not work`with college students?
- [00:03:47.148]Don't tell me not to do something.
- [00:03:48.100]If you tell me not to do something,
- [00:03:49.130]kinda wanna do it more.
- [00:03:50.490]What else?
- [00:03:55.160]So maybe instead of listening to the person
- [00:03:57.810]in front of the room that's a professional,
- [00:03:59.500]they might listen to peers more.
- [00:04:01.140]What else?
- [00:04:03.690]Their personal experiences
- [00:04:04.829]aren't always consistent with
- [00:04:07.220]Right.
- [00:04:08.053]I've said yes and I've kind of liked it,
- [00:04:09.480]and here's this person telling me about these dangers
- [00:04:11.630]that I just don't see.
- [00:04:13.990]What else?
- [00:04:14.950]What else might "Just say no"
- [00:04:16.470]not work with college students?
- [00:04:22.430]You saved researchers a lot of time and grant money
- [00:04:24.830]cause those traditional messages are very,
- [00:04:27.270]you know abstinence only.
- [00:04:29.310]If you look at the research on fact only,
- [00:04:31.240]information only, typically abstinence only approaches
- [00:04:34.060]with college students, they have no impact on behavior.
- [00:04:37.160]It's not fair to say they have no impact period.
- [00:04:39.360]Some of the studies show an increase in knowledge.
- [00:04:41.580]So people can tell you cool facts about the drink
- [00:04:43.730]that's in their hand,
- [00:04:44.740]their just not drinking any fewer of them.
- [00:04:47.669]But when you look at the information on fact only,
- [00:04:49.770]information only, no change in behavior.
- [00:04:53.039]We can tell people to just say no.
- [00:04:55.070]We obviously can't tell people to just say yes.
- [00:04:57.350]But what if they do say yes?
- [00:04:58.960]It was in the late 80's that Alan Marlatt,
- [00:05:01.820]when testing the alcohol skills training program
- [00:05:03.810]said what if we talk about harm reduction?
- [00:05:06.930]If there's a down side to harm reduction,
- [00:05:08.950]or if there's a misunderstanding,
- [00:05:10.460]is that it somehow equals moderation,
- [00:05:12.740]or somehow anti abstinence.
- [00:05:15.030]And nothing could be further from the truth.
- [00:05:16.870]If a student says to you, "I wanna avoid,"
- [00:05:18.527]Oh and I should have said this,
- [00:05:21.120]we have a lot of slides.
- [00:05:22.470]Both to save paper and printing costs,
- [00:05:24.210]and to make sure you get electronic versions of everything.
- [00:05:26.780]I'll let Meghan know the second we're done.
- [00:05:28.320]I'll give her the pdf of these.
- [00:05:29.690]So know that all of these are coming to you.
- [00:05:31.530]Except for the Big Foot picture.
- [00:05:32.836](laughing)
- [00:05:33.870]Unless you really want them.
- [00:05:35.770]But if someone says "I wanna avoid all of alcohols
- [00:05:39.260]and what it affects completely",
- [00:05:40.680]abstinence is the best way to do that.
- [00:05:43.280]But what a Harm Reduction approach acknowledges,
- [00:05:45.240]is that any step towards reduced risk
- [00:05:47.100]are steps in the right direction.
- [00:05:48.810]I come to you drinking 40 drinks a week
- [00:05:50.550]with lots of consequences.
- [00:05:51.627]And you do something with me.
- [00:05:54.270]Now I'm drinking 10 drinks a week and way fewer harms.
- [00:05:57.090]Well done.
- [00:05:58.160]If your treatment outcome goal is abstinence though,
- [00:06:00.670]I'm in treatment failure.
- [00:06:02.260]You can't pretend to call me anything but that.
- [00:06:04.810]In most treatment programs in our country,
- [00:06:06.970]I'm kicked out cause I'm still drinking.
- [00:06:10.490]But especially if someone's not meeting criteria
- [00:06:12.170]for dependence, addiction, a substance use disorder.
- [00:06:15.130]How can we overlook a reduction that significant?
- [00:06:18.180]Particularly if it's associated
- [00:06:19.260]with a reduction in harm for them.
- [00:06:21.380]Sometimes when it comes to alcohol,
- [00:06:22.740]reducing harm makes it look like we've done nothing
- [00:06:25.048]to the quantity.
- [00:06:26.690]You've got a student that meets with you and tells you
- [00:06:28.307]"I drink five every Friday, five every Saturday."
- [00:06:31.440]You find out that this pretty small student
- [00:06:33.206]is drinking all five of those as shots
- [00:06:35.520]on an empty stomach in two minutes.
- [00:06:38.300]Pretty high blood alcohol level.
- [00:06:40.460]Gets sick sometimes.
- [00:06:41.930]Black out occasionally.
- [00:06:44.160]And now they go through a Harm Reduction
- [00:06:45.530]focus prevention program.
- [00:06:46.630]They decide I'm done with shots.
- [00:06:49.010]They're gonna drink beer,
- [00:06:50.270]they're gonna alternate every drink with water,
- [00:06:51.970]I'm gonna eat prior to and while drinking,
- [00:06:53.960]and I'm gonna stretch my drinking out over five hours,
- [00:06:56.300]but I'm still gonna have five drinks.
- [00:06:58.240]When they fill out our survey, when they got to us
- [00:07:00.410]they were drinking five and five.
- [00:07:01.830]Now, they're still drinking five and five,
- [00:07:03.850]but they're getting into a way lower blood alcohol level,
- [00:07:06.040]experiencing way fewer harms.
- [00:07:08.130]So when we look at tracking the impact
- [00:07:10.170]of the Harm Reduction approach,
- [00:07:11.580]it's truly measuring those harms and consequences.
- [00:07:14.500]How do we deliver a message like that?
- [00:07:16.210]Legal issues are always acknowledged.
- [00:07:17.670]If you're under 21, it's illegal to drink.
- [00:07:19.800]Driving after any drinking, absolutely not recommended.
- [00:07:22.900]For those that want to abstain,
- [00:07:24.100]we can talk about ways to do that.
- [00:07:26.110]But the language is clear.
- [00:07:27.920]We never say
- [00:07:29.477]"Listen, I know you're gonna drink
- [00:07:30.670]so if you do dot, dot, dot."
- [00:07:32.147]"I know you're gonna drink" first,
- [00:07:33.700]is the normative misperception.
- [00:07:35.520]For all your students in recovery,
- [00:07:37.350]your like following standards,
- [00:07:38.520]for students that haven't really drank in the past year,
- [00:07:41.270]what are they hearing from you?
- [00:07:43.090]I think everyone drinks here.
- [00:07:45.277]"I know you're gonna drink"
- [00:07:46.200]also sounds like permission giving if they're 18, 19, or 20.
- [00:07:50.450]If you make the choice to drink,
- [00:07:52.290]we can talk about ways to do that in a less dangerous
- [00:07:54.460]or less risky way.
- [00:07:55.520]We never say in a safe way
- [00:07:57.420]cause with any positive blood alcohol level
- [00:07:59.010]there could still be harms.
- [00:08:01.480]The key is, if I'm an 18 year old
- [00:08:03.630]and some guy is telling me
- [00:08:04.707]"Here's how you can drink in a less dangerous
- [00:08:06.570]or less risky way"
- [00:08:07.650]Who cares?
- [00:08:08.570]Why would I even want to do that?
- [00:08:10.570]And that's what our job changes.
- [00:08:12.730]A program provider, a student affairs professional,
- [00:08:15.360]an academic advisor, a wellness provider, a peer educator,
- [00:08:19.500]a faculty member, anyone working with someone,
- [00:08:22.431]the key is how do we elicit personally
- [00:08:25.240]relevant reasons for changing.
- [00:08:26.980]What's in it for me as that student sitting across from you
- [00:08:29.380]to go "You know what,
- [00:08:30.560]I'm gonna try something different next time I go out."
- [00:08:33.790]And that's where the stage of change model
- [00:08:35.560]and motivation interviewing comes in.
- [00:08:37.640]This is not new.
- [00:08:39.090]This was developed in the 80's,
- [00:08:40.670]which were awesome, in response to tobacco cessation.
- [00:08:44.854]Prochaska and DiClemente pointed out that rarely do you meet
- [00:08:47.010]the person who smokes cigarettes
- [00:08:48.550]who's unaware of the health consequences.
- [00:08:51.180]Right?
- [00:08:52.013]You don't meet people that are like "Wait, what?"
- [00:08:54.077]"These are bad for me?"
- [00:08:54.957]"No one told me."
- [00:08:56.190]But there are different levels of readiness,
- [00:08:57.890]to have someone say "I really think you should quit."
- [00:09:00.570]Whether that's the healthcare provider or loved one.
- [00:09:03.000]And the parents version of their papers you pick up,
- [00:09:05.940]there's either five, six,
- [00:09:06.820]or seven of these stages of change.
- [00:09:08.980]The other drawn is a ladder,
- [00:09:10.010]a wheel with different entry and exit points,
- [00:09:13.010]this really cool spirally thing
- [00:09:13.923]that I don't know how to make in power point.
- [00:09:16.050]But just for the sake of discussion,
- [00:09:18.930]lets look at these five stages of change.
- [00:09:21.520]If you take three things out of today,
- [00:09:22.940]I hope this is one of the three.
- [00:09:24.520]The first stage of change is a made up word.
- [00:09:27.260]I've always thought that's unbelievably cool.
- [00:09:29.430]I got to present on a panel once with Carlo DiClemente
- [00:09:32.033]and the first thing I said to him is,
- [00:09:32.990]I think it's totally cool you made up a word.
- [00:09:35.930]I think that's fantastic.
- [00:09:36.860]These are people who aren't just contemplating,
- [00:09:38.500]they're pre-contemplating.
- [00:09:40.100]They haven't even begun to think
- [00:09:41.677]"Why would I need to make a change in my behavior."
- [00:09:44.910]A student has 10 drinks,
- [00:09:46.150]breaks stuff and has to go through conduct.
- [00:09:48.330]Lost in the shuffle is they had 10 drinks and broke stuff.
- [00:09:50.800]And instead they make statements like,
- [00:09:52.137]"Don't the cops have anything better to do
- [00:09:54.070]than pick on college students?"
- [00:09:55.990]Or "This isn't my fault, this is my roommates fault,
- [00:09:58.180]cause my roommate answered the door when he already knocked"
- [00:10:01.550]That guy's an idiot.
- [00:10:02.750]Like no recognition
- [00:10:03.930]of why they would need to change themselves.
- [00:10:06.240]Contemplation's what it sounds like.
- [00:10:08.540]Immediate persons noticing stuff.
- [00:10:11.057]"Wow is it the third weekend in a row?"
- [00:10:12.527]"Why don't I remember a part of my weekend?"
- [00:10:15.003]That's not good.
- [00:10:17.537]"I had a hundred bucks in my wallet on Friday,
- [00:10:19.520]the only place we went was the bars,
- [00:10:21.270]it's now Sunday and I have zero dollars."
- [00:10:23.930]Whoo, that's like five grand a year on drinking.
- [00:10:27.550]Maybe they're weighing the pros and cons of change.
- [00:10:29.737]"If I cut down on my drinking,
- [00:10:30.673]I'll feel a lot better in the morning
- [00:10:32.830]and probably do better in school,
- [00:10:34.340]but I wouldn't have as much fun as my friends are having,
- [00:10:36.410]and that would suck."
- [00:10:38.030]The key to this stage of change is ambivalence.
- [00:10:39.970]If you hear the word "but" that's a clue to you
- [00:10:43.060]that a person's in contemplation.
- [00:10:46.377]"I should exercise more,
- [00:10:47.697]but I don't know when I'd fit it into my day,
- [00:10:49.370]and I'm so tired."
- [00:10:50.977]"I really want to eat all those cookies,
- [00:10:52.530]but I know they're not very good for me."
- [00:10:54.410]That's contemplation.
- [00:10:56.330]I carpooled with a woman
- [00:10:57.360]that had the worst job known to humanity,
- [00:10:59.340]but she was in grad school.
- [00:11:01.090]She had to listen to therapy videos 20 hours a week,
- [00:11:03.388]and every time the client spoke she had to code
- [00:11:06.640]what stage of change their sentence
- [00:11:08.240]was most closely in alignment with.
- [00:11:10.200]That's a horribly dull job,
- [00:11:11.990]and if you do that 20 hours a week,
- [00:11:13.780]that has no choice but to trickle into your daily life.
- [00:11:16.920]So we'd pull over to like drive through coffee places,
- [00:11:19.470]on I-5 and they're like
- [00:11:20.303]"Hi can I help you?"
- [00:11:21.460]And Denise is like "Ooh that's contemplative."
- [00:11:24.176](laughing)
- [00:11:25.362]And I'm always like "You really need to stop that."
- [00:11:26.690]And that's not contemplative.
- [00:11:28.680]But there's times we're stuck on I-5,
- [00:11:30.240]which increasingly feels like all the time,
- [00:11:32.290]we will assign different stages of change
- [00:11:34.040]different songs we're listening to,
- [00:11:35.880]which is a little bit nerdy,
- [00:11:37.260]but an oddly fun road trip game
- [00:11:38.800]if you get the chance to play that.
- [00:11:40.240]And she'd point out at least one song,
- [00:11:42.470]that a portion of which sums up contemplation beautifully.
- [00:11:45.420]And it comes from Michael Jackson's 1982 Thriller album.
- [00:11:48.350]And it's a song Wanna Be Starting Something.
- [00:11:50.470]In this song Michael says "You wanna be starting something,
- [00:11:53.990]you gotta be starting something."
- [00:11:55.327]"You wanna be starting something,
- [00:11:56.880]you gotta be starting something."
- [00:11:58.187]"Too high to get over"
- [00:11:59.447]"Yeah, yeah"
- [00:12:00.417]"Too low to get under"
- [00:12:01.697]"Yeah, yeah"
- [00:12:02.530]Thank you.
- [00:12:03.363]"You're stuck in the middle"
- [00:12:04.196]"Yeah, yeah"
- [00:12:05.029]"And the pain is thunder"
- [00:12:08.307]"Yeah, yeah"
- [00:12:09.563](laughing)
- [00:12:10.710]Now this is the same song that later says
- [00:12:12.187]"You're a vegetable, you're a buffet,
- [00:12:13.650]still they eat you, you're a vegetable"
- [00:12:15.470]So you shouldn't read too much into this song
- [00:12:16.840]because that's crazy talk right there.
- [00:12:18.294](laughing)
- [00:12:19.127]But, too high to get over, too low to get under,
- [00:12:22.210]you're stuck in the middle, and the pain is thunder.
- [00:12:24.280]This isn't just a wishy-washy
- [00:12:25.570]like "Eh what are you gonna do?"
- [00:12:26.920]It can suck to be in this stage of change.
- [00:12:30.670]Take a lot of college students for a minute.
- [00:12:32.320]Someone goes in to meet with their doctor for a physical,
- [00:12:34.470]get their blood tests back,
- [00:12:35.812]and their like "Wow you need to make some big changes
- [00:12:37.420]in how you eat."
- [00:12:38.253]"Your cholesterol's high, your triglycerides are high,
- [00:12:41.060]you're at risk for this, this, and this."
- [00:12:42.700]What do we do when we get it?
- [00:12:43.810]We stress eat.
- [00:12:45.810]I get it, I want to be okay, and I just need to not,
- [00:12:49.280]I need to feel better right now.
- [00:12:51.950]But the students will tell you,
- [00:12:52.970]I'm the first person in my family to go to college.
- [00:12:54.730]Getting a degree is the most important thing.
- [00:12:57.100]How's school going?
- [00:12:58.290]I party all the time.
- [00:13:00.600]So ambivalence isn't just a "Eh",
- [00:13:02.550]it can really be this "pain is thunder" idea.
- [00:13:05.340]Preparation, a person's thought about it
- [00:13:06.910]and said "I'm gonna make a change."
- [00:13:08.550]The high season in the United States
- [00:13:09.980]for this stage of change is late December.
- [00:13:12.780]Why would you predict?
- [00:13:14.837]New Year's Resolutions, good.
- [00:13:15.980]Yeah, if someone says on January first
- [00:13:17.420]I'm gonna start exercising, they're in preparation.
- [00:13:20.140]Action's what it sounds like,
- [00:13:21.140]a person's actively making a change in behavior.
- [00:13:23.640]Maintenance is also what it sounds like.
- [00:13:25.030]A person made a change six months or more ago,
- [00:13:28.190]and they're trying to maintain those gains.
- [00:13:30.290]I asked you does "Just say no" work with college students,
- [00:13:32.727]and you gave me perfectly great reasons
- [00:13:34.559]why it probably does not.
- [00:13:36.670]With no disrespect to any of those answers,
- [00:13:39.010]at this moment we answer that question
- [00:13:41.880]through the eyes of this model.
- [00:13:44.097]"Just say no" is an action stage request.
- [00:13:48.150]And if we say it to a student or a group of students,
- [00:13:50.497]who are in pre-contemplation or contemplation,
- [00:13:53.180]there's a complete and absolute disconnect
- [00:13:55.570]between what we're asking for,
- [00:13:57.390]as a student affairs professional,
- [00:13:59.490]as a healthcare provider,
- [00:14:01.550]and where that student or group of students may be
- [00:14:03.790]in terms of their level of readiness to change.
- [00:14:06.410]What that means is just say cut down.
- [00:14:09.410]Just say moderate.
- [00:14:11.070]Just say drink in a less dangerous or less risky way.
- [00:14:13.800]Would be as equally dismissible
- [00:14:15.380]and equally laughable goal as "Just say no"
- [00:14:17.980]if it's asking in action in people who aren't there yet.
- [00:14:21.580]And we've the data to back that up.
- [00:14:24.330]Kim Fromey and Will Corbin did a study
- [00:14:26.340]where they said to first year students,
- [00:14:28.040]"Welcome to college everybody."
- [00:14:29.867]"We're done with that high school messaging."
- [00:14:31.517]"Here's how to drink in a less dangerous
- [00:14:33.087]and less risky way."
- [00:14:34.400]They dove right in to Harm Reduction strategies,
- [00:14:37.720]they performed just like a "Just say no" program.
- [00:14:40.150]Knowledge went up, no change in behavior.
- [00:14:43.370]Their explanation was, we dove right in with,
- [00:14:45.750]here's what you should be doing differently.
- [00:14:47.620]And people who aren't even yet thinking about if they
- [00:14:49.510]wanted to do something different
- [00:14:51.080]or people who are ambivalent about what they wanted to do.
- [00:14:54.180]That doesn't mean all hope is lost,
- [00:14:55.310]it means our approach changes.
- [00:14:58.290]If someone says to you "I'm in recovery,
- [00:15:01.080]I'm so excited to be in college and I can't deny
- [00:15:02.880]I'm getting triggered since coming here."
- [00:15:05.437]"Where are some meetings that I can go to?"
- [00:15:07.860]You know we line them up with relapse prevention,
- [00:15:09.440]whether that's support, whether that's counseling,
- [00:15:11.090]whatever it might be.
- [00:15:12.350]Same with actions.
- [00:15:13.230]Someone says "I'm about to make a change, what can I do?"
- [00:15:15.720]You know we provide them with strategies
- [00:15:17.100]around those changes, we meet them where they are.
- [00:15:20.240]Everything I've ever seen about starting exercises
- [00:15:22.100]says consult your doctor before starting.
- [00:15:24.220]So someone's in preparation says
- [00:15:25.457]"I know I want to do something."
- [00:15:27.100]We assess them and line them up
- [00:15:27.933]with the approach that's the best fit.
- [00:15:30.370]But who are we gonna talk about today?
- [00:15:32.700]Motivation enhancement approaches,
- [00:15:34.210]motivation interviewing is the best fit for those people who
- [00:15:37.220]are in pre-contemplation or contemplation.
- [00:15:40.510]They are strategies that could be used
- [00:15:42.420]to prompt thinking about change,
- [00:15:44.850]and those who are in pre-contemplation.
- [00:15:46.530]And for those who are in contemplation or ambivalent,
- [00:15:49.130]or feeling stuck, they can explore that
- [00:15:51.790]and resolve that ambivalence and potentially get unstuck
- [00:15:55.310]if it's in line with what's most important to them.
- [00:15:59.460]So what that means is, even how we define the success
- [00:16:01.810]of a program can change.
- [00:16:04.090]You walk in a group of 50 students to present to them,
- [00:16:06.580]all 50 are in pre-contemplation.
- [00:16:08.400]After one hour, you got five of them ready to do something,
- [00:16:12.250]40 are in contemplation,
- [00:16:13.890]five of them are still in pre-contemplation.
- [00:16:16.640]Those folks that are in contemplation,
- [00:16:18.400]they're important to keep an eye on.
- [00:16:20.100]Helene White has done research on a "sleeper effect"
- [00:16:22.650]a brief intervention that uses motivation interviewing.
- [00:16:24.740]And it's shown that as much as a year later,
- [00:16:26.740]you can see that compared to control groups,
- [00:16:28.620]that have been randomized, these folks that get these
- [00:16:30.810]motivation enhancement approaches,
- [00:16:32.160]it makes a big difference.
- [00:16:33.910]If there's a down side to motivation interviewing,
- [00:16:36.015]it's that we don't use these labels
- [00:16:38.210]in our day to day language.
- [00:16:40.030]You can't walk into a group and go
- [00:16:41.217]"Show of hands where are my contemplators?"
- [00:16:43.710]Right?
- [00:16:44.543]Because we don't identify ourselves this way.
- [00:16:45.770]So you kind of need to know it when you hear it.
- [00:16:47.830]So even though this is a game show
- [00:16:49.080]that has no chance to ever make it on television,
- [00:16:51.450]cause frankly, it just wouldn't be very good.
- [00:16:54.820]We're going to play a game show called Name That Stage.
- [00:16:58.610]Hooray.
- [00:16:59.890]I'm gonna show you statements
- [00:17:00.723]that's conceivable a student could make,
- [00:17:02.670]and as a group I'd like to hear what
- [00:17:03.931]stage of change you feel like it's most closely
- [00:17:06.470]in alignment with.
- [00:17:08.040]A student says my drinking is a problem sometimes.
- [00:17:10.490]What stage of change is that most close in line with?
- [00:17:13.520]Contemplation.
- [00:17:14.353]Good.
- [00:17:15.727]"I don't think I drink too much."
- [00:17:17.940]Pre-contemplation.
- [00:17:18.773]Good.
- [00:17:19.606]"I quit drinking right after my sanction last week."
- [00:17:22.770]Action.
- [00:17:23.670]They just did it.
- [00:17:24.861]It's only been a week long.
- [00:17:26.357]"I quit drinking right after my sanction last year."
- [00:17:28.880]Maintenance.
- [00:17:29.713]Good.
- [00:17:30.546]"I'm planning to limit myself to two drinks
- [00:17:31.940]at the next party."
- [00:17:33.308]Preparation.
- [00:17:34.141]Good, if they haven't done it yet,
- [00:17:34.974]but that's their goal.
- [00:17:36.177]"I enjoy my drinking but sometimes I drink too much."
- [00:17:39.360]Contemplation.
- [00:17:40.193]Good.
- [00:17:41.026]"Drinking less alcohol would be pointless for me."
- [00:17:43.660]Pre-contemplation.
- [00:17:44.493]Outstanding.
- [00:17:45.640]Someone mentioned to me if you take,
- [00:17:47.220]think about how many action stage requests students hear.
- [00:17:51.490]A student says "I'm having a tough time with my roommate"
- [00:17:53.897]"Oh you should talk to the R.A. or talk to the R.D."
- [00:17:56.790]We give advice before we even know what they want.
- [00:18:00.723]"Man college is so stressful, I have a lot of stress."
- [00:18:02.587]"Counseling center, go to the counseling center."
- [00:18:04.990]And it's with no bad intent, but if we're moving faster
- [00:18:08.070]than the student we're working with,
- [00:18:09.780]that's where there can be that disconnect.
- [00:18:11.420]So what that means is again, our job changes.
- [00:18:14.180]The good news is, motivation interviewing strategies
- [00:18:16.880]are in place to prompt that contemplation,
- [00:18:18.880]or move toward committing an action.
- [00:18:21.100]I'll talk about that next,
- [00:18:22.210]but first I'd love to know people's thoughts about this,
- [00:18:24.240]reactions, what comments you have, or what I can clarify.
- [00:18:29.350]Alright so, motivation interviewing, also not new.
- [00:18:34.100]The first edition came out in 1982,
- [00:18:38.050]and every 10 years they've had a new edition come out.
- [00:18:40.280]So I always joke we're looking forward
- [00:18:41.660]to the fourth edition in 2022.
- [00:18:43.756]This just allows you to show
- [00:18:45.400]that I learned how to use the copy image from Amazon
- [00:18:47.760]cause you can see the little arrow that says "Look inside."
- [00:18:50.122](laughing)
- [00:18:51.730]Okay, I will look inside.
- [00:18:53.356]But notice even how the title has changed.
- [00:18:57.840]Motivational Interviewing,
- [00:18:58.673]Preparing People to Change Addictive Behavior.
- [00:19:01.000]When this was first developed,
- [00:19:02.210]it was meant as a one on one strategy
- [00:19:04.470]in a clinical therapy room around addictive behaviors.
- [00:19:07.930]10 years later, the body of literature had changed enough
- [00:19:10.760]that they could say Preparing People for Change.
- [00:19:13.000]It had been shown to be done with efficacy
- [00:19:15.390]around anxiety, depression, diet, medication adherence
- [00:19:19.090]and management, you name it.
- [00:19:21.550]By the third edition, Helping People Change.
- [00:19:24.230]There was research that showed that ethically
- [00:19:26.220]and appropriately outside of a clinical context,
- [00:19:29.470]and even in groups, these strategies could be applied.
- [00:19:33.520]Is the goal today to turn people into
- [00:19:34.870]motivation interviewing providers by the end of the day?
- [00:19:36.800]Of course not.
- [00:19:37.890]The time spent training people in M.I.
- [00:19:40.080]in the published literature, is two to 30 hours,
- [00:19:42.740]with the median being 15 hours.
- [00:19:45.140]We're not doing that today.
- [00:19:46.490]But there are elements of these strategies
- [00:19:48.150]that literally you could incorporate
- [00:19:49.470]into conversations at lunch if were so inclined.
- [00:19:53.670]The key to motivation interviewing
- [00:19:55.433]is the most non-judgemental
- [00:19:57.730]and non-confrontational approach we're aware of.
- [00:20:00.766]That's horribly important.
- [00:20:02.110]Non-judgemental, non-confrontational.
- [00:20:05.170]And it very much emphasizes meeting people where they are
- [00:20:08.310]in terms of level of readiness to change.
- [00:20:10.790]And it's all about eliciting
- [00:20:12.080]personally relevant reasons to change.
- [00:20:13.870]What's in it for me, as that person sitting across from you
- [00:20:16.840]to say this is what I want to change
- [00:20:18.930]and this is why it's important for me.
- [00:20:22.449]How do we find out what's important to them?
- [00:20:23.950]We ask them.
- [00:20:25.170]What are your goals for this year?
- [00:20:26.580]What are your goals for your time in school?
- [00:20:29.680]Getting a sense of their values.
- [00:20:30.850]Getting a sense of their hopes.
- [00:20:32.060]That type of thing.
- [00:20:33.070]It's not a values clarification approach,
- [00:20:35.000]but it's looking at personally relevant reasons to change.
- [00:20:38.060]A lot of times we can find this proverbial "hook",
- [00:20:40.270]there'd be the content area or topic
- [00:20:42.030]that would make someone go "Ooh".
- [00:20:43.490]That's what's in it for me.
- [00:20:46.590]Exploring and resolving ambivalence
- [00:20:48.410]is also one of the goals,
- [00:20:49.550]and when relevant we can discuss behavior change strategies.
- [00:20:52.210]Where does this all fall apart?
- [00:20:54.080]Resistance.
- [00:20:55.180]We have very few absolutes in our field.
- [00:20:57.530]One of them is this.
- [00:20:58.920]If you get people upset, they will not change.
- [00:21:02.040]One of the biggest predictors of not changing,
- [00:21:04.480]is people getting defensive or getting resistant.
- [00:21:07.386]It's verbal.
- [00:21:09.160]I used to struggle with that.
- [00:21:09.993]Cause it's like obviously we know
- [00:21:11.440]about non-verbal communication,
- [00:21:13.340]but you can read a transcript and go "Ooh!"
- [00:21:16.340]There's the resistance right there.
- [00:21:19.080]I can make a student sound resistant in five seconds.
- [00:21:21.350]I wouldn't want to, but I could.
- [00:21:24.417]"Come on, don't you think you have a problem with drug use?"
- [00:21:27.670]They're gonna get defensive.
- [00:21:29.870]You say you like drinking because you like the taste.
- [00:21:31.900]If that's true, why do you need 10?
- [00:21:33.650]Couldn't you have two?
- [00:21:35.150]I'm calling them out.
- [00:21:36.200]They're gonna get defensive.
- [00:21:37.270]They're gonna get resistant.
- [00:21:39.380]It is so a function, it's expected and normal.
- [00:21:41.840]Why?
- [00:21:42.673]Cause it sucks being told you're the bad client,
- [00:21:44.960]you're the bad patient, you're the bad person.
- [00:21:48.260]I checked in my calendar today on September 28th,
- [00:21:52.250]I have a dental appointment.
- [00:21:53.850]If you're anything like me,
- [00:21:54.683]I floss like crazy
- [00:21:55.730]for the three days leading up to that appointment
- [00:21:57.553]to maintain the illusion that I've been doing this everyday
- [00:22:00.070]for the last six months.
- [00:22:01.710]Because I always have that way too enthusiastic hygienist
- [00:22:04.500]that's like "Someone needs to floss more."
- [00:22:06.880]And I'm like "Someone needs a hobby, seriously."
- [00:22:09.271](laughing)
- [00:22:10.104]"Go floss with your dental friends."
- [00:22:13.190]But it sucks.
- [00:22:14.023]It's like, I get it.
- [00:22:15.060]I'm sorry I'm not the model patient.
- [00:22:17.690]Literally the last time I was there,
- [00:22:19.560]there's like a six year old in the chair next to me,
- [00:22:23.010]and they're teaching him how to floss.
- [00:22:24.140]They're like do we need to remind you how to floss?
- [00:22:25.912](laughing)
- [00:22:26.990]I'm like that sucks.
- [00:22:27.910]Like that's, it's almost kind of mocking a little bit.
- [00:22:31.220]And so, and certainly has a confrontational element to it,
- [00:22:34.320]if not a judgemental element to it.
- [00:22:36.870]And so it's such a function of interpersonal communication.
- [00:22:40.860]The studies Denise was coding, at New Mexico,
- [00:22:43.560]you put a bug in the ear of a therapist,
- [00:22:45.310]when they hear one tone,
- [00:22:46.550]they would gently confront behavior.
- [00:22:48.500]When they hear another tone,
- [00:22:50.040]they use motivation interviewing strategies.
- [00:22:51.910]A coder, going to know when that tone's going off,
- [00:22:54.320]does nothing but code the behavior of the client.
- [00:22:57.900]Like clockwork, when confronted,
- [00:22:59.610]what do we as human beings do?
- [00:23:00.830]We defend ourselves.
- [00:23:02.650]We defend the status quo
- [00:23:04.110]and we talk about why we're fine
- [00:23:05.540]and we talk about why change would not be needed.
- [00:23:07.940]When the provider uses motivating interviewing strategies,
- [00:23:10.360]the client talked about what gain they may make
- [00:23:12.470]if they were to make a change,
- [00:23:13.570]and they even talked about what change might look like.
- [00:23:17.670]Starting with Chris Dunn, other analysis have shown
- [00:23:20.510]the continued resistance is predictive,
- [00:23:22.430]not only of not changing,
- [00:23:23.960]but sometimes change in the wrong direction.
- [00:23:25.920]If we really piss someone off,
- [00:23:27.570]there's that element of like "I'll show that person."
- [00:23:29.700]And they go out and use more.
- [00:23:31.820]So it's so responsive to our style
- [00:23:33.290]that when you get resistance
- [00:23:34.230]there's a chance to change strategies.
- [00:23:37.010]We look a the goals of a brief intervention,
- [00:23:38.840]it can be if there are signs of potential risks,
- [00:23:41.020]or existing harms, provide early intervention
- [00:23:43.290]to alter trajectories.
- [00:23:44.750]I've heard so many people say,
- [00:23:45.583]"Well you know they haven't hit rock bottom yet."
- [00:23:47.700]Why would we want an 18 year old to hit rock bottom?
- [00:23:50.680]If we see someone going down a road
- [00:23:52.470]that doesn't look so hot, could we alter a trajectory?
- [00:23:56.440]If ultimately in line with what motivates the person,
- [00:23:58.800]prompt contemplation of change,
- [00:24:00.400]or actually commitment to change,
- [00:24:01.770]or even initial action.
- [00:24:03.330]If the sole thing you do
- [00:24:04.490]is reduce resistance or defensiveness,
- [00:24:06.490]you've done something.
- [00:24:08.350]Rebecca Palmer has done research with conduct officers
- [00:24:12.370]and found that when looking at predictors
- [00:24:14.160]of intervention outcome with mandated students,
- [00:24:16.710]one of the biggest predictors of change
- [00:24:18.820]with mandated students is their level of defensiveness
- [00:24:21.530]leaving the meeting with the conduct officer.
- [00:24:24.770]Students that leave that meeting angry
- [00:24:26.750]fair less well regardless of their changes,
- [00:24:28.590]or stage of change,
- [00:24:29.940]than the students that leave that meeting
- [00:24:31.459]having had a chance for resistance to go down.
- [00:24:35.359]And finally exploring behavior change strategies
- [00:24:37.610]and discuss skills to reduce harms.
- [00:24:39.930]So what does all this mean for us today?
- [00:24:41.520]A conversation can absolutely impact student health,
- [00:24:44.440]and you don't have to be the one to do the intervention.
- [00:24:47.150]Maybe the action they take
- [00:24:48.470]is agreeing to accept a referral to someone else on campus.
- [00:24:52.580]But you might plant a seed
- [00:24:53.860]or get students connected with resources.
- [00:24:55.770]The important thing is having that conversation
- [00:24:58.000]and the way in which you do it.
- [00:24:59.210]The good news is, we have strategies in place to do that.
- [00:25:02.710]Research shows with non-clinicians can ethically
- [00:25:05.800]and appropriately be done
- [00:25:07.120]with significant changes in behavior.
- [00:25:09.840]The conversation can lower defensiveness
- [00:25:11.740]which keeps the student open for change
- [00:25:13.330]and sets the student up for success.
- [00:25:15.340]And the main thing is,
- [00:25:16.210]you don't have to fix it for the person.
- [00:25:18.690]It can be collaborative without you being the one to solve
- [00:25:22.110]the problem for the person you're talking to.
- [00:25:24.330]So with that and with the time we have before the break,
- [00:25:27.640]I'd like to show you the basic principles of,
- [00:25:29.980]for those of you who are familiar with this,
- [00:25:31.570]it'll hopefully be a good refresher.
- [00:25:33.190]For people new to this,
- [00:25:34.470]we'll even have a chance to do some practice
- [00:25:36.100]before we take our first break.
- [00:25:37.950]So before I move on,
- [00:25:38.783]can I again see what questions or comments people have?
- [00:25:44.640]I'd like to take a moment and say hi to Linda Major.
- [00:25:46.130]Hi Linda Major.
- [00:25:47.360]Linda completely stole the show
- [00:25:48.970]at our College Coalition
- [00:25:49.920]for Substance Abuse Prevention Conference.
- [00:25:51.950]And what a gift you have in the state of Nebraska
- [00:25:55.100]that you have someone that's so both nationally respected
- [00:25:57.770]and so nationally loved.
- [00:25:58.730]So it's always good to see you Linda.
- [00:26:01.163]I think we should clap.
- [00:26:02.992](laughing) (clapping)
- [00:26:08.200]Linda you're free to go.
- [00:26:09.495](laughing)
- [00:26:10.860]Enjoy your afternoon.
- [00:26:12.590]So we talk about the spirit of motivational interviewing,
- [00:26:15.730]not in a woo-woo way,
- [00:26:16.980]but in a like the over arching spirit of mind
- [00:26:19.320]is it is non-judgemental, non-confrontational.
- [00:26:22.810]Part of that is understanding don't go faster
- [00:26:25.050]than the person you're talking to.
- [00:26:26.630]Direct persuasion, not a horribly effective strategy
- [00:26:29.410]if someone is truly ambivalent.
- [00:26:30.930]Take it out of substance abuse for a minute.
- [00:26:32.900]A student tells you next week yes I'm a senior,
- [00:26:36.340]I don't know if I should apply to grad school
- [00:26:38.630]and go straight into grad school after graduation,
- [00:26:40.650]or if I should take some time off, travel a bit,
- [00:26:43.450]make some money, get more experience
- [00:26:47.130]and then apply to grad school.
- [00:26:49.030]If you say, you're like the smartest student I ever met,
- [00:26:51.730]I would go straight into grad school.
- [00:26:53.400]If they're truly ambivalent,
- [00:26:54.510]999 times out of 1000 what will they say?
- [00:26:57.720]Yeah but if I took time off I could kind of refuel a bit,
- [00:27:00.680]get more experience and maybe get into a better grad school.
- [00:27:04.290]Alright well do that then.
- [00:27:07.380]Yeah but use it or lose it if I go straight into grad school
- [00:27:09.330]I could keep the momentum going.
- [00:27:10.700]So it isn't the Jedi mind trick.
- [00:27:12.310]It's not that you're like "Don't stop drinking"
- [00:27:14.220]But when you tell someone,
- [00:27:15.580]if you cut down think how good it would feel
- [00:27:18.670]if you did this.
- [00:27:19.740]If they push back with
- [00:27:20.637]"Yeah but if I cut down,
- [00:27:21.920]I wouldn't have as much fun as my friends are having."
- [00:27:24.440]Yeah, but you'd remember the fun.
- [00:27:29.100]Well, half the fun stuff happens late at night.
- [00:27:31.300]Like if it feels to you like you're fighting with the person
- [00:27:33.860]it probably feels that way to them too.
- [00:27:35.740]Jim Schaus at the University of Central Florida,
- [00:27:37.810]one of the best screening brief intervention referral
- [00:27:39.790]to treatment providers on this planet.
- [00:27:41.810]Jim says he always tells his staff,
- [00:27:43.380]if you feel like you're dancing with the student,
- [00:27:44.950]that's okay, but the second you feel like you're wrestling
- [00:27:47.410]with them, not okay.
- [00:27:49.210]And that's when the science says,
- [00:27:50.990]it's just not gonna have a good outcome.
- [00:27:53.760]I've always joked with Jim,
- [00:27:54.720]I don't think you should dance with your students.
- [00:27:56.587](laughing)
- [00:27:57.420]But I understand his point.
- [00:27:58.590]If it feels like a fight,
- [00:28:00.320]it probably plays itself out that way.
- [00:28:01.980]So we're not directed in telling people what to do.
- [00:28:03.467]But where we are directed is in helping people examine
- [00:28:06.710]and to explore ambivalence.
- [00:28:09.180]Every time we invent something in psychology,
- [00:28:10.740]it has to spell a cool acronym.
- [00:28:11.990]It's one of our three laws.
- [00:28:13.500]And if it doesn't spell a cool acronym,
- [00:28:15.470]you have to at least, you know,
- [00:28:17.040]come up with something catchy like Miller and Rollnick did
- [00:28:19.500]with this alliteration.
- [00:28:20.670]They did the E-E, D-D, R-R, S-S.
- [00:28:23.780]The first basic principle of M.I. is to express empathy.
- [00:28:26.920]How would you define that?
- [00:28:27.830]What does that mean?
- [00:28:29.190]Empathy?
- [00:28:37.610]Being able to understand the emotional mood of someone.
- [00:28:39.510]That's a great definition.
- [00:28:40.980]It's different than sympathy.
- [00:28:42.410]Students receive sympathy all the time.
- [00:28:44.963]They tell their classmates "Man I'm so stressed."
- [00:28:47.327]"Oh that sucks."
- [00:28:49.557]"Thank you."
- [00:28:50.390]"Good."
- [00:28:51.223](laughing)
- [00:28:52.056]"Good talk."
- [00:28:53.280](laughing)
- [00:28:54.826]Sometimes it's "Aw that sucks, tell me about it."
- [00:28:56.210]I got this, this, this, and this.
- [00:28:57.960]At best that's sympathy.
- [00:28:58.890]At worst that's not very good listening.
- [00:29:01.767]"You've got a lot on your plate
- [00:29:02.650]and you don't even know where to start."
- [00:29:04.150]That's empathy.
- [00:29:06.000]And why would you imagine empathy is so important
- [00:29:08.360]to a brief intervention?
- [00:29:12.650]We don't get eight sessions to get to know someone.
- [00:29:14.610]This might be our single five minute shot.
- [00:29:17.920]I'm gonna make the leap that you are in this room
- [00:29:19.860]cause you're naturally empathic people anyway.
- [00:29:22.460]When you hearing about something
- [00:29:23.440]that's been really rough for someone
- [00:29:24.347]and you take the time to say
- [00:29:25.730]"This has been hard for you"
- [00:29:27.240]or "You've had a rough quarter or semester"
- [00:29:29.440]or "That was scary",
- [00:29:30.950]that matters because it's helpful for establishing rapport,
- [00:29:35.760]and super helpful for establishing trust.
- [00:29:37.730]And when in doubt what do researchers do?
- [00:29:39.107]You look at the science.
- [00:29:40.420]The science shows, the presence of empathy
- [00:29:42.960]is associated with better clinical outcome.
- [00:29:46.210]That's a cool finding.
- [00:29:47.770]So absolutely a component is expressing empathy.
- [00:29:51.070]A big part of why we think motivation interviewing works,
- [00:29:53.470]developing discrepancies.
- [00:29:54.421]What does that mean?
- [00:29:56.430]It means developing discrepancies between values and goals
- [00:29:59.290]that are of importance to the person
- [00:30:00.710]and ways in which the status quo
- [00:30:02.090]could be in conflict with that.
- [00:30:03.660]What's my value?
- [00:30:04.730]Kick butt academically.
- [00:30:06.200]What's the reality?
- [00:30:07.033]Haven't been to class the last three mornings
- [00:30:09.580]cause I was hung over.
- [00:30:11.550]What's my value?
- [00:30:12.383]I'm trying to watch what I eat.
- [00:30:13.810]Working out a lot.
- [00:30:14.643]I wanna be in good shape.
- [00:30:15.930]What's the reality?
- [00:30:16.763]Drink 40 beers a week.
- [00:30:18.070]That's 6000 calories a week coming from alcohol.
- [00:30:22.760]Especially if you're providing feedback.
- [00:30:25.070]We allow the data to be confrontational, not us.
- [00:30:28.460]What's someone's value?
- [00:30:29.320]They say I want to be a good partner in relationships.
- [00:30:31.440]What's the reality?
- [00:30:32.273]I'm a jerk when I get drunk.
- [00:30:34.320]I say and do things that are not me,
- [00:30:35.927]and I totally regret.
- [00:30:38.350]So you can often find that even information,
- [00:30:41.240]you heard me say earlier, information only approaches,
- [00:30:44.594]not effective in changing behavior.
- [00:30:46.740]Too often people hear that
- [00:30:47.890]and say well we shouldn't give information.
- [00:30:49.500]That's not true.
- [00:30:50.610]It's delivering it in a motivational framework.
- [00:30:54.360]What does someone say?
- [00:30:55.530]I wanna do well in school.
- [00:30:56.530]That's my value.
- [00:30:57.890]And I use a lot of weed.
- [00:31:00.090]What's the status quo?
- [00:31:01.240]There's no drug more associated with causing,
- [00:31:03.550]not just worsening, but causing attention, concentration,
- [00:31:06.500]and memory deficits than marijuana.
- [00:31:10.080]What's their value?
- [00:31:10.913]I wanna do well in school.
- [00:31:12.360]What's the status quo?
- [00:31:13.193]Not doing so hot and using a lot of marijuana.
- [00:31:15.520]What can we show them in a non-judgemental,
- [00:31:17.180]non-confrontational way?
- [00:31:18.377]The more people use marijuana,
- [00:31:19.920]the more there are those cognitive deficits.
- [00:31:21.810]If on their own they realize,
- [00:31:23.550]my status quo is in conflict then with my values,
- [00:31:26.190]change can happen.
- [00:31:28.120]So I'll show you instances in which information
- [00:31:31.350]about marijuana can serve to develop discrepancies
- [00:31:34.260]in line with those hooks.
- [00:31:36.120]We can't be the expert that makes the discrepancy happen.
- [00:31:39.930]It has to be the student
- [00:31:40.950]that ultimately voices the argument for change.
- [00:31:44.190]You wanna roll with resistance.
- [00:31:47.340]One, that means avoiding arguing with people.
- [00:31:49.440]Why?
- [00:31:50.273]One, it sucks to argue with people,
- [00:31:51.787]and two, go back to intro to psych,
- [00:31:54.600]learn about something called cognitive dissonance theory.
- [00:31:56.850]It says if I say or do something
- [00:31:58.343]that doesn't match how I think,
- [00:31:59.843]I'll change my thinking
- [00:32:01.070]to match what's coming out of my mouth.
- [00:32:03.180]If you've got a student sitting across from you going,
- [00:32:05.027]"Whoa, I do not have a problem."
- [00:32:07.827]"I do not need to change."
- [00:32:09.970]Everything we know about cognitive dissonance theory
- [00:32:11.740]is that they're gonna solidify their thinking
- [00:32:13.490]exactly around that sentiment.
- [00:32:17.210]Think about what that means.
- [00:32:19.670]Labeling, not only unnecessary, completely contraindicated.
- [00:32:23.310]If you hang out with our lab for a day,
- [00:32:25.050]I think we're fun people.
- [00:32:26.340]And we sound ridiculous.
- [00:32:27.790]No one says the word negative.
- [00:32:29.210]No one says the word bad.
- [00:32:30.630]We talk about the good things and the not so good things.
- [00:32:33.330]What are things you like?
- [00:32:34.320]What are things maybe you like a little less?
- [00:32:39.353]The science at this moment in 2018,
- [00:32:41.370]I could look you all in the eye and say,
- [00:32:42.527]"We're not positive."
- [00:32:43.370]The denial exists as a characteristic of people.
- [00:32:46.700]We think denial is a characteristic and by-product
- [00:32:49.120]of our conversation that didn't go so hot.
- [00:32:53.100]Someone sits me down and says,
- [00:32:54.217]"Jason, I love you man, and I'm here for you,
- [00:32:56.100]but I'm worried about you."
- [00:32:57.417]"I think you're an alcoholic."
- [00:32:59.107]"You've got a problem."
- [00:33:01.207]"You need to go to treatment."
- [00:33:02.840]If I go "Well back off, you've got a problem!"
- [00:33:05.307]"You need to go to treatment!"
- [00:33:08.150]Classically we'd say I'm in denial.
- [00:33:10.760]Motivation interviewing would go "Really?"
- [00:33:12.237]"What was he supposed to say?"
- [00:33:13.350]You diagnosed me "alcoholic".
- [00:33:15.700]You labeled me alcoholic and problem.
- [00:33:18.550]You told me what I need to do.
- [00:33:19.780]You need to go to treatment.
- [00:33:23.000]If you're meeting with a student,
- [00:33:23.990]you're like "Man, someone's in denial."
- [00:33:25.390]That's a clue that we've probably stepped on toes,
- [00:33:27.670]said something that really rubbed them the wrong way.
- [00:33:30.420]Our job is to reduce resistance
- [00:33:32.040]since this is correlated with poor outcomes
- [00:33:33.930]and even shifts strategies.
- [00:33:35.960]If time permits, I'm gonna give you some examples
- [00:33:38.290]of resistance statements and show you ways in which you can
- [00:33:40.970]use motivation interviewing strategies in response to that.
- [00:33:43.890]Sometimes you literally roll with it.
- [00:33:45.410]They object or minimize and it doesn't demand a response.
- [00:33:48.960]And in finally supporting self-efficacy.
- [00:33:50.890]What does that mean?
- [00:33:52.180]The students need to pick what they wanna do as their goal.
- [00:33:55.050]So when a student tells you,
- [00:33:55.987]"Right now I'm upstanding
- [00:33:56.900]but down the road I wanna moderate"
- [00:33:59.650]That's their call.
- [00:34:00.690]We don't get to choose that for them.
- [00:34:02.850]We meet them where they are.
- [00:34:04.080]Their follow through will be greater
- [00:34:06.380]when they choose their goal
- [00:34:07.956]rather than we choose their goal.
- [00:34:10.160]We've known for decades
- [00:34:11.330]that confidence and optimism are good predictors of outcome
- [00:34:14.100]among people trying to make the change.
- [00:34:15.980]It's also a good predictor of outcome
- [00:34:17.350]in the people working with that person.
- [00:34:20.090]When we look at the concept
- [00:34:21.220]of the process of motivation interviewing,
- [00:34:24.040]there are four: Engaging, Focusing, Evoking, and Planning.
- [00:34:27.539]If you're doing this in a counseling context,
- [00:34:29.710]maybe you have a structured 50 minute hour.
- [00:34:31.610]If it's in a five minute before we get going conversation,
- [00:34:35.240]there can still be that structure.
- [00:34:37.370]You get that connection with the student,
- [00:34:39.780]have that working alliance,
- [00:34:42.090]develop agenda in the sense of I know I only have 10 minutes
- [00:34:44.910]so I don't wanna open something I can't close.
- [00:34:47.400]And there's that sense of maintaining direction.
- [00:34:50.040]Arguably most important
- [00:34:51.270]would be that concept of eliciting student motivation.
- [00:34:54.410]What would be personally relevant reason for them to change?
- [00:34:57.330]And as you're wrapping up, what might next steps be?
- [00:34:59.970]That they could either commit to or even agree to.
- [00:35:02.610]Maybe what they agree to is
- [00:35:03.607]"Let's talk about this more next time we meet."
- [00:35:06.800]It's not a trick.
- [00:35:07.990]It's not a way of making people do what you want them to do.
- [00:35:10.760]And we can't, you know, you don't "M.I." someone.
- [00:35:14.610]You don't do it on or to them.
- [00:35:16.520]You do it for, or with them.
- [00:35:18.160]And we can't breed motivation that's not already there.
- [00:35:21.830]In a nutshell it's very much interpersonal style,
- [00:35:24.290]not restricted to formal counseling,
- [00:35:26.170]guided by what we know and what makes change happen.
- [00:35:28.260]What makes change happen?
- [00:35:29.630]Natural stuff.
- [00:35:31.040]And the likelihood that change will occur
- [00:35:32.680]is much more influenced by interpersonal interactions
- [00:35:34.820]that are empathic and positive
- [00:35:37.040]than those that are negative, confrontational,
- [00:35:39.770]judgemental, and frustrating.
- [00:35:42.160]People that say "I think I'm gonna change"
- [00:35:43.900]tend to do so.
- [00:35:45.270]What people say about change is important.
- [00:35:47.610]I know that capital letters is shouting.
- [00:35:49.970]That's me shouting MOTIVATION IS FUNDAMENTAL TO CHANGE.
- [00:35:53.000]So why are we doing all this?
- [00:35:54.010]What are you listening for?
- [00:35:55.547]Self motivational statements or "change talk"
- [00:35:59.160]In their books they refer to these two concepts
- [00:36:01.230]with the same terminology.
- [00:36:03.170]These are statements that a person makes
- [00:36:05.100]that suggests they're no longer in pre-contemplation.
- [00:36:07.830]It suggests there's concern
- [00:36:10.460]or recognition of a need for change.
- [00:36:13.570]Problem recognition.
- [00:36:15.630]A student says to you,
- [00:36:16.687]"So I blackout like every time I drink."
- [00:36:19.427]"Is that bad?"
- [00:36:22.180]That's not a pre-contemplator.
- [00:36:23.430]They're saying "Uh-oh, I worry that that's bad."
- [00:36:27.610]And if we just answer the question we miss the change talk.
- [00:36:31.080]Concern.
- [00:36:32.257]"Are there long term effects of blacking out?"
- [00:36:35.727]"Like when, hypothetically, you're 18
- [00:36:37.461]and you do it every other weekend?"
- [00:36:39.150]They're saying "Uh-oh I'm worried there are long term
- [00:36:41.300]effects of blacking out doing this every other weekend."
- [00:36:44.490]That's "change talk".
- [00:36:45.350]Intent to change.
- [00:36:46.300]A student tells you,
- [00:36:47.467]"I went to church every Sunday for my whole life,
- [00:36:50.550]and since coming to college I don't even get in the house
- [00:36:53.230]until four at night Saturday, four in the morning Sunday."
- [00:36:56.227]"If I cut down on my drinking I could get up Sunday morning
- [00:36:58.820]and reunite myself with spirituality
- [00:37:00.370]that would be really important to me."
- [00:37:02.120]I like the sound of that.
- [00:37:03.580]Not saying they're gonna change,
- [00:37:04.580]they're saying I like what would happen if I did change.
- [00:37:08.350]And optimism.
- [00:37:11.900]Someone tells you, actually you can use that same example.
- [00:37:15.540]Intent to change, if someone,
- [00:37:17.230]let me give a different example for intent to change.
- [00:37:18.900]If someone says to you,
- [00:37:20.327]"Don't worry about me
- [00:37:21.160]when I graduate all this is gonna change."
- [00:37:23.350]Why does that count as change shock?
- [00:37:24.670]Cause they're saying I can't keep this stuff up.
- [00:37:26.800]I'm gonna have to make a change.
- [00:37:29.490]So that intent to change
- [00:37:30.750]or the optimism about what they could gain
- [00:37:32.410]if they were to make a change.
- [00:37:33.570]The key is you wanna arrange the conversation so
- [00:37:35.835]that students make that argument for change.
- [00:37:38.737]And I'm gonna, with the time we have before break,
- [00:37:40.620]we're gonna practice with that as a group.
- [00:37:44.750]I mentioned there are three things to take out of today.
- [00:37:46.790]One is stage of change.
- [00:37:48.750]Not going in an action stage if the person you're talking to
- [00:37:51.500]is pre-contemplative or contemplative,
- [00:37:53.270]doing what we can to meet people where they are.
- [00:37:55.290]The second thing would be, where possible,
- [00:37:57.160]ask open ended questions.
- [00:37:59.650]What is an open ended question?
- [00:38:01.330]One that can't be answered with yes or no.
- [00:38:04.400]And you know when we're pressed for time
- [00:38:06.090]we ask lots of close ended questions.
- [00:38:08.130]Were you drinking?
- [00:38:08.963]Were other people drinking?
- [00:38:09.796]Did you get drunk?
- [00:38:10.629]Were you scared?
- [00:38:11.690]Are you concerned?
- [00:38:13.110]The student we're talking to goes no, no, yes, no.
- [00:38:16.803]And we're doing all the work.
- [00:38:18.100]Open ended questions, you don't know where the answers
- [00:38:20.140]are going to go.
- [00:38:21.760]The problem is so often, close ended questions
- [00:38:23.750]with no malicious intent
- [00:38:25.380]can be very leading in a not so good way.
- [00:38:29.870]I have heard, for real,
- [00:38:31.210]providers with a white coat and clipboard ask
- [00:38:33.657]"You never have more than five drinks do you?"
- [00:38:36.720]Who would say yes to that?
- [00:38:40.150]You could ask, "Do you drink?"
- [00:38:41.680]If yes, what's the most you've ever had?
- [00:38:43.856]What's the most you had in the last two weeks?
- [00:38:45.710]Open ended question.
- [00:38:47.040]I do R.A. work with Res Life.
- [00:38:48.560]The R.A. is concerned about a student knocks on the door.
- [00:38:50.685](knocking)
- [00:38:51.518]"Everything okay?"
- [00:38:52.351]Close ended yes or no question.
- [00:38:53.800]Sometimes we're fishing for the yes.
- [00:38:55.694](knocking)
- [00:38:56.527]Everything's okay isn't it?
- [00:38:58.317]"Well apparently you want me to say yes
- [00:38:59.630]so yeah everything's good."
- [00:39:00.830]Good talk.
- [00:39:02.755](knocking)
- [00:39:03.588]"How's stuff going?"
- [00:39:04.421]"I wanna check in."
- [00:39:05.254]That's an open ended question.
- [00:39:08.030]You're in this room cause you wanna help students,
- [00:39:10.040]and bless you all for that.
- [00:39:11.690]If you say to someone with the best of intentions
- [00:39:13.937]"Have you thought of trying this?"
- [00:39:16.860]What's the sub text of "Have you thought of trying this?"
- [00:39:21.007]"You should try this."
- [00:39:23.650]What do you think would help an open ended question?
- [00:39:26.110]What have you thought of trying open ended question?
- [00:39:28.550]If they say,
- [00:39:29.383]"I have no idea."
- [00:39:30.247]"What recommendations do you have for me?"
- [00:39:31.760]We meet them where they are.
- [00:39:33.980]But the key is, it's again how we describe that.
- [00:39:36.220]Well one strategy some people use is blank.
- [00:39:39.410]Not "Do you think you could do that?"
- [00:39:41.090]Which is "I think I'd like you to do that."
- [00:39:43.420]It would be, "How would that fit for you?"
- [00:39:44.877]"How would that work for you?"
- [00:39:46.527]"What are your thoughts about that?"
- [00:39:48.250]The more open ended you can keep it, the better.
- [00:39:53.430]Probably the sentence that Bill Miller asked the most
- [00:39:55.630]in the M.I. training videos is,
- [00:39:57.127]"What do you make of this?"
- [00:39:58.320]It doesn't sound "therapisty" it doesn't sound clinical.
- [00:40:00.650]He's eliciting a reaction to what they're discussing.
- [00:40:03.577]"Where do you wanna go with this now?"
- [00:40:04.927]"What ideas do you have about stuff
- [00:40:06.070]that might work for you?"
- [00:40:06.903]"How are you feeling about everything?"
- [00:40:07.897]"How's the year going for you?"
- [00:40:09.270]These are open ended questions.
- [00:40:10.840]The one open ended question that ends the period,
- [00:40:12.667]"Tell me more about that."
- [00:40:15.300]It performs and behaves a million times more differently
- [00:40:18.620]than the more close ended "Can you?" or "Could you?"
- [00:40:20.837]"Tell me more about that?"
- [00:40:23.343]And the science on that is pretty cool.
- [00:40:24.870]Someone says,
- [00:40:25.703]"You know, I've been having a tough time lately."
- [00:40:26.987]"Tell me more about that."
- [00:40:28.057]"Well I noticed that da, da, da, da, da."
- [00:40:29.817]"I've been having a tough time lately."
- [00:40:31.297]"Could you tell me more about that?"
- [00:40:32.767]"No."
- [00:40:34.420]It shuts it down.
- [00:40:35.350]It's crazy, it shuts it down.
- [00:40:37.480]It's not the end of the world
- [00:40:38.480]if you ask a close ended question,
- [00:40:39.670]but you will get a close ended answer.
- [00:40:41.700]And if someone's ambivalent about change,
- [00:40:43.670]and if your close ended question is very leading,
- [00:40:47.100]that's where that can backfire.
- [00:40:48.890]I wanna show you that it takes no expertise on a substance
- [00:40:52.660]to ask questions about "consequences".
- [00:40:56.670]We often start our conversations with students,
- [00:40:59.090]saying "Let's talk about what are the good things
- [00:41:02.290]about drinking for you?"
- [00:41:04.007]"What are the good things about marijuana use for you?"
- [00:41:06.870]They will be delighted to tell you.
- [00:41:09.630]Paul Grossbury, who I believe your state
- [00:41:11.270]has worked with in the past.
- [00:41:12.370]Paul Grossbury is a good friend of mine
- [00:41:13.620]and he has published work that shows that when you ask what
- [00:41:16.670]are the good things about a substance for you,
- [00:41:18.450]it gets coded as expressing empathy.
- [00:41:21.450]How do you most commonly express empathy?
- [00:41:23.180]Through your reflection.
- [00:41:24.260]How else can you?
- [00:41:25.093]By saying "I wanna know why this matters to you."
- [00:41:28.417]"What are the good things about marijuana use for you?"
- [00:41:30.857]"What are the not so good things
- [00:41:32.440]about marijuana use for you?"
- [00:41:35.360]That was a way different question
- [00:41:36.640]than what problems have you had,
- [00:41:37.980]what negative consequences have you had.
- [00:41:40.330]I run the mandated student groups at my school
- [00:41:44.068]for students that have violated marijuana policy
- [00:41:46.320]in a state that's had legal marijuana
- [00:41:48.110]since December 6, 2012.
- [00:41:50.240]When I ask a group of eight to 10 college students
- [00:41:53.140]what are some of the not so good things
- [00:41:54.640]about marijuana use for you.
- [00:41:56.340]How long a list do I get from them?
- [00:42:01.058]I see some of you going like this.
- [00:42:02.160]I saw one person go none.
- [00:42:03.320]Or are you telling me okay.
- [00:42:04.881]Just to make the point, two back to back groups,
- [00:42:07.990]I eliminated the duplicates.
- [00:42:09.460]Here's the list the students gave.
- [00:42:12.060]It bugs me when people say you can't talk about weed
- [00:42:13.990]with college students
- [00:42:14.823]cause they don't see negative consequences.
- [00:42:16.230]That's not true.
- [00:42:17.260]It's what we call them.
- [00:42:20.150]If we start a presentation.
- [00:42:22.070]So, (clap)
- [00:42:23.207]"Today we're gonna, my names Jason, we're gonna do this."
- [00:42:25.087]"Let's start by talking about some
- [00:42:26.160]of the negative consequences you've had from marijuana."
- [00:42:27.787]"What problems have you had?"
- [00:42:29.513]"I don't have problems, you have a problem."
- [00:42:30.927]"Nice shirt."
- [00:42:31.760]"Thank you."
- [00:42:32.835](laughing)
- [00:42:33.668]"I bought it at an outlet."
- [00:42:34.727](laughing)
- [00:42:36.490]What are the good things?
- [00:42:37.440]What are the not so good things?
- [00:42:38.480]My last group of the academic year,
- [00:42:40.120]I asked them what are the good things.
- [00:42:41.490]They made it through three
- [00:42:42.600]before they spontaneously brought up a not so good.
- [00:42:45.910]I said, "Interesting."
- [00:42:46.947]"Well maybe we can make another column
- [00:42:48.330]and call that like the Not So Good Things."
- [00:42:50.397]"Let's go back, what are some of the good things?"
- [00:42:52.300]They did one,
- [00:42:53.133]and then they offered up another not so good.
- [00:42:55.080]Scott Walters at the University of North Texas said,
- [00:42:57.317]"Heads up, brief intervention researchers,
- [00:42:59.600]we found out with marijuana
- [00:43:01.010]that our providers were the ones killing the list."
- [00:43:04.810]The client would list about four or five things.
- [00:43:06.620]The provider would go "Great."
- [00:43:07.997]"Anything else?"
- [00:43:09.400]Which is a close ended yes or no question.
- [00:43:11.810]That's code for "Let's wrap this up."
- [00:43:14.670]When you ask "What else?"
- [00:43:15.977]"What else if anything?"
- [00:43:17.180]It keeps the list coming.
- [00:43:19.570]When you've got 10 seconds to science you've got your list.
- [00:43:23.730]But you can ask "So what would it be like
- [00:43:26.660]if some of those not so good things happened less often."
- [00:43:28.670]Or if they really got animated about one of these,
- [00:43:30.870]pick it and say,
- [00:43:31.977]"You really mentioned that you don't like blank."
- [00:43:33.637]"What would it be like if blank was no longer an issue?"
- [00:43:36.730]Any positive answer they give is "change talk".
- [00:43:40.370]What would make some of those not so good things
- [00:43:42.457]happen less often?
- [00:43:43.840]Anything the student says is a student identified strategy
- [00:43:46.610]for making a change.
- [00:43:49.210]So with that, just to give you an example
- [00:43:51.970]of what we could do with open ended questions.
- [00:43:54.170]I've got four statements,
- [00:43:55.380]it's conceivable a student could make.
- [00:43:57.910]Keep in mind
- [00:43:58.743]that you're not just asking an open ended question
- [00:44:00.060]for the sake of asking an open ended question.
- [00:44:01.970]But you're asking to get more information,
- [00:44:03.940]clarify values or goals, or if you hear "change talk"
- [00:44:07.160]explore the "change talk" and what that might be.
- [00:44:09.590]A student says to you,
- [00:44:10.423]"So I know everything can't be perfect,
- [00:44:11.870]but I really hate my roommate right now."
- [00:44:14.560]What are some open ended questions
- [00:44:15.950]you could ask the student?
- [00:44:21.867]"Tell me more about what's going on"
- [00:44:23.000]is a fantastic open ended question.
- [00:44:24.860]What else?
- [00:44:29.227]"What do you not like about them?"
- [00:44:30.710]I appreciate the word choice.
- [00:44:31.820]We've backed away from "hate".
- [00:44:34.760]We've avoided that label even though they said it first.
- [00:44:37.070]Then we say "What do you not like about them?"
- [00:44:38.880]Great open ended question.
- [00:44:40.170]What else could we do?
- [00:44:46.277]"How do you find this to be affecting you?"
- [00:44:47.900]Go ahead.
- [00:44:53.030]And that my friends, all of these have been great,
- [00:44:55.230]gold standard open ended questions.
- [00:44:57.050]That's how we do,
- [00:44:57.883]that's in line with motivation interviewing.
- [00:44:59.387]"What's going on?"
- [00:45:00.827]"Why don't you like them?"
- [00:45:01.860]Status quo.
- [00:45:02.797]"How would you like things to be?"
- [00:45:04.790]Values and goals.
- [00:45:06.040]Perfect.
- [00:45:06.880]That's perfect.
- [00:45:09.750]You could ask "What would perfect look like?"
- [00:45:12.330]But they didn't even say I want perfect.
- [00:45:14.210]You could explicitly ask "How would you like things to be?"
- [00:45:18.120]If you pair that with "What's going on?"
- [00:45:21.030]You're gonna get the sense of the status quo.
- [00:45:22.820]If there's a discrepancy that might make change happen.
- [00:45:26.560]There's change talk in here.
- [00:45:27.710]What can we ask that would help us get at the change talk
- [00:45:31.020]or explore the change talk?
- [00:45:40.630]What do you think would help?
- [00:45:42.330]Will I make things better?
- [00:45:44.560]Those are examples of open ended questions
- [00:45:46.150]that could get at what they might wanna do.
- [00:45:48.940]You could even ask "What would you wanna see happen,
- [00:45:50.710]if anything?"
- [00:45:52.370]That could be an open ended question.
- [00:45:53.880]How's this feeling for folks in terms of what an open,
- [00:45:55.780]I see a lot of heads nodding.
- [00:45:57.160]If there are comments or questions
- [00:45:58.590]or things you'd like clarified,
- [00:45:59.750]please don't hesitate to ask.
- [00:46:01.360]A student says to you,
- [00:46:02.407]"I know I'm not the smartest person in my class,
- [00:46:04.490]and sometimes I wonder
- [00:46:05.450]if I should even be in college right now."
- [00:46:09.430]That's hard to hear.
- [00:46:10.560]What are some open ended questions
- [00:46:11.760]we could ask this student?
- [00:46:13.070]Either to get more information, clarify values or goals,
- [00:46:16.330]or explore change talk.
- [00:46:22.757]"Tell me why you feel that way."
- [00:46:24.690]Good open ended question.
- [00:46:25.610]Very inviting.
- [00:46:28.710]Go ahead.
- [00:46:29.719]What do you like about college right now?
- [00:46:30.667]"What do you like about college right now?"
- [00:46:32.110]Is a fantastic question.
- [00:46:34.840]Get a sense of what's going well.
- [00:46:37.960]Awesome.
- [00:46:38.793]That's gonna be nicer in supporting self efficacy.
- [00:46:40.980]What else could we ask?
- [00:46:45.927]"What's making you feel like you shouldn't be in school?"
- [00:46:48.150]So we're getting at what's going well,
- [00:46:49.790]we're getting at maybe what's going not so well.
- [00:46:52.150]What else could we explore?
- [00:46:55.217]"How long have you felt this way?"
- [00:46:56.450]Nice.
- [00:46:57.400]What else?
- [00:47:03.290]What if you wanted to clarify values and goals?
- [00:47:05.400]What questions could you ask to get at that?
- [00:47:13.150]So good.
- [00:47:14.170]Holy cow that's good.
- [00:47:15.440]Sorry got a little animated.
- [00:47:16.732](laughing)
- [00:47:17.780]Calm down Jason.
- [00:47:18.867]"What brought you here?"
- [00:47:20.580]That is as gold standard as it gets.
- [00:47:23.460]Fantastic.
- [00:47:24.670]You could ask "If you weren't here what would you be doing?"
- [00:47:27.870]Anything like that.
- [00:47:28.703]But you're obviously getting the sense
- [00:47:29.810]of what an open ended question would be.
- [00:47:31.650]What happens a lot of times when we hear this
- [00:47:33.160]we want to fix it.
- [00:47:34.110]Right, no you're really smart.
- [00:47:36.160]But that's not where they're at right now.
- [00:47:37.780]Those are great open ended questions.
- [00:47:39.430]A person says to you,
- [00:47:40.267]"I know my partner doesn't treat me the way I'd like,
- [00:47:42.410]but I don't want to wind up alone by breaking up."
- [00:47:47.370]What are some open ended questions you could ask here?
- [00:47:50.280]Go ahead.
- [00:47:51.653]How do you feel you should be treated?
- [00:47:53.160]"How would you like to be treated?"
- [00:47:54.207]or "How do you feel you should be treated?"
- [00:47:57.500]Fantastic.
- [00:47:58.333]What else?
- [00:48:07.920]Go ahead.
- [00:48:15.100]We think that there's only three open ended questions
- [00:48:16.103]that could be asked here
- [00:48:17.400]and you just got two of the three right there.
- [00:48:19.810]Go for the trifecta man, what are we missing?
- [00:48:23.650]There's really,
- [00:48:24.678](laughing) Yeah you're like,
- [00:48:25.511]just drop the mic and walk away.
- [00:48:26.860](laughing)
- [00:48:28.550]Really there's only three things to explore here.
- [00:48:30.260]And keep in mind how different,
- [00:48:31.400]you say that to a friend, what does the friend say?
- [00:48:33.783]I think you should dump them.
- [00:48:35.220]Thank you.
- [00:48:36.209](laughing) Good talk.
- [00:48:38.580]That's not advice we want to be giving.
- [00:48:39.950]None of us want to be on the receiving end
- [00:48:41.240]of a really angry person pounding on our door who says
- [00:48:43.337]"I heard, I just got dumped and I heard it was your idea."
- [00:48:46.080]Go ahead.
- [00:48:47.192](speaker too far from microphone)
- [00:48:50.520]Mm-hm.
- [00:48:51.353]So my thought process is (too far from mic)
- [00:48:52.860]Yes.
- [00:48:53.760]How does that, you know mix
- [00:48:55.402]with (too far from mic)
- [00:48:58.530]It's completely appropriate and okay to do
- [00:49:00.870]and that's the third thing that was missing.
- [00:49:02.490]You wanna get a sense that what's going on,
- [00:49:04.990]what threats there are to safety.
- [00:49:09.300]You know being in a life threatening situation,
- [00:49:11.610]again, we don't get to decide
- [00:49:12.660]for someone if they break up or not,
- [00:49:14.130]but if we have to do an assessment
- [00:49:15.320]like that what we have so far was,
- [00:49:17.450]what concerns you have about being alone,
- [00:49:19.020]and how would you like to be treated.
- [00:49:20.350]What was missing is, how are you being treated
- [00:49:22.610]and what are those issues.
- [00:49:23.480]So it's completely appropriate
- [00:49:24.660]and fits just fine in a motivation interviewing framework.
- [00:49:28.820]It's completely appropriate.
- [00:49:31.680]With all the sexual assault, relationship violence,
- [00:49:35.140]harassment and stalking folks, not only do we do trainings
- [00:49:38.030]in this, we've even co-presented together
- [00:49:39.760]cause we think that's very important in that assessment.
- [00:49:42.480]That's the trifecta though.
- [00:49:44.207]"How are you being treated?"
- [00:49:46.227]"How would you like to be treated?"
- [00:49:47.740]Because go back to the idea of a discrepancy.
- [00:49:50.070]Values and goals of importance,
- [00:49:51.700]how you like to be treated,
- [00:49:52.850]and the status quo, what's going on.
- [00:49:55.650]Nicely done.
- [00:49:56.620]Last but not least,
- [00:49:57.837]"My friends want to go out tonight,
- [00:49:58.980]but I feel like I should stay home,
- [00:50:00.290]I'm getting behind on stuff."
- [00:50:06.067]"What stuff do you have to do?"
- [00:50:07.130]Good open ended question.
- [00:50:08.400]What else?
- [00:50:21.120]Good open ended question.
- [00:50:21.953]"How does going out impair your ability to get stuff done?"
- [00:50:25.840]Good.
- [00:50:26.673]What else?
- [00:50:28.927]"What's going on tonight?"
- [00:50:30.410]We're exploring where that kind of
- [00:50:32.670]pull might be coming from.
- [00:50:35.100]What else?
- [00:50:40.290]Say again.
- [00:50:41.585]How do you feel
- [00:50:42.418]once you're caught up on stuff?
- [00:50:43.251]"How do you feel once you're caught up on stuff?"
- [00:50:44.730]Notice that they do cast their vote.
- [00:50:46.307]"I feel like I should stay home."
- [00:50:48.210]So this is a directive question
- [00:50:50.120]that's exploring further how that part would feel.
- [00:50:52.760]If you were to stay home and get caught up
- [00:50:54.460]how would that feel?
- [00:50:56.120]If that would feel awesome, that might tip the balance.
- [00:50:59.240]Cause there is ambivalence here.
- [00:51:00.670]But, yet that "but" does cast their vote.
- [00:51:03.930]Here's what my friends want, here's what I want.
- [00:51:06.150]So you're exploring that part.
- [00:51:07.310]There's another person saying something.
- [00:51:09.734](too far from microphone)
- [00:51:13.557]"What would happen if you did go out?"
- [00:51:15.690]So exploring kind of that opposite side.
- [00:51:17.800]These are open ended questions.
- [00:51:19.460]I will say again that it's not the end of the world
- [00:51:21.210]if you ask a close ended question,
- [00:51:22.920]but keep in mind you're not just asking open ended questions
- [00:51:25.230]for the sake of asking open ended questions.
- [00:51:27.190]You're asking open ended questions with the intent
- [00:51:29.160]of getting more information, exploring values and goals,
- [00:51:33.360]and when you hear change talk, considering that change talk.
- [00:51:37.980]I know we break for lunch at 12:15.
- [00:51:39.840]I wanna keep this as humanely paced as possible.
- [00:51:42.600]And we got a little bit of a late start,
- [00:51:43.890]but just to keep the break schedule on pace,
- [00:51:46.170]it is 11:10 now, we will take a five minute break,
- [00:51:49.580]resume at 11:15 and we'll have the hour run prior to lunch.
- [00:51:55.050]You all have been fantastic.
- [00:51:56.530]This bodes very well for us today
- [00:51:58.070]because these were great open ended questions people asked.
- [00:52:01.600]When you come back we will resume
- [00:52:02.990]with the A.R.S. part of the course.
- [00:52:05.110]Thank you.
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