Lesson 8: Motivational Interviewing in Groups

Attention

At some point in our careers we may find ourselves practicing our craft in a group setting rather than the usual 1:1 setting.  

This video depicts a behavioral health provider demonstrating "MI Consistent" smoking cessation group intervention skills. The provider models what providers should strive to do when facilitating MDQuit's Behavioral Health Smoking Cessation Group Intervention.

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Discuss the challenges and opportunities associated with the application of MI in groups.

Teaching

Revisiting the Definition of Motivational Interviewing

"Motivational Interviewing is a collaborative, goal-oriented style of communication with particular attention to the language go change. I tis designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the persons' own reasons for change within an atmosphere of acceptance and compassion." - Miller and Rollnick (2012)

  • The "Spirit" of Motivational Interviewing
    • Partnership
    • Acceptance / Autonomy / Absolute Worth
    • Compassion
    • Evocation
  • Key Principles
    • Express Empathy
      • Listening to the client without being judgmental, critical, or blaming. In the early stages a person may not be yet willing to give up their behaviors.
    • Develop Discrepancy
      • Helping clients see a difference between what they are doing now and what they want to be in the future.
    • Roll with Resistance
      • Resistance will happen. The key approach in MI is to "roll" with the resistance. Reflecting back to the client the emotions that you sense and using the resistance to further explore their commitment to change.
    • Support Self-Efficacy
      • Self-efficacy is the perception we have of our ability to do or accomplish something. We work to build our clients' confidence in their ability to bring about change...this ability can then be used to bring about other changes as well.

Application of MI to Groups

Velasquez, M.M., Stephens, N.S., & Ingersoll, K. (2009). Motivational interviewing in groups. Journal of Groups in Addiction and Recovery. 1(1) 27-50

Any approach to facilitating change can be adapted to working in groups. The advantages of working in groups include:

  • Cost effective and efficient.
  • Groups provide a safe opportunity to remediate interpersonal deficits in communication.
  • Peer feedback and modeling may have more impact on individuals than the counselor generated information.
  • Interactions with peers may hep members generalize their new change efforts to the real world.
  • Realization that other share similar problems.
  • Groups provide a meaningful social support system.

For us to use MI effectively in groups we need to focus on how to facilitate group process to address the four Key Principles of MI. These present both challenges and opportunities.

  • Express Empathy
    • Challenges - Individuals within the group may be at different stages of change and ability to express empathy for someone's struggles.
    • Opportunities -Roll modeling by group members will reinforce the fact that one can be in any stage of change and still understand the perspective of others.
  • Develop Discrepancy
    • Challenge - Identifying discrepancies between where someone is now and where they want to be can have a confrontational quality to it. If this feedback comes across as criticizing or "putting down" the impact will be less effective.
    • Opportunities - Learning how to confront (and receive confrontation) is a key interpersonal skill. The group can facilitate learning these social skills.
  • Roll with Resistance
    • Challenges - Again the relative sophistication of the group and their interpersonal skill level can provide some challenges. Some may feel that the ONE WAY they took to recovery is the ONLY WAY.
    • Opportunities - Through the expression of numerous paths to recovery the group members can develop an appreciation for diversity in treatment and recovery and move away from dogmatic, one way practices.
  • Support Self-Efficacy
    • Challenges - Some groups can foster dependence on the group itself. While groups provide a very useful scaffold for self-efficacy, many can become overly dependent on the group to support their recovery.
    • Opportunities - There is a great opportunity to have the group define dependence and inter-dependence as it relates to the role of the group in each of their lives.

Assessment


Lesson 8 Discussion

Review the details of the Challenges and Opportunities of MI in groups and read the Velasquez, et. al. (2009) article. Reflect on the pros and cons of working in groups, your own personal experience (if any) in groups, and what challenges you may have facilitating such a group.