Integration of Motivational Interviewing Into Behavioral Interventions ...

Integration of Motivational
Interviewing Into Behavioral
Interventions in Probation
Igor Koutsenok, MD, MS,
University of California San Diego, Department of Psychiatry

Motivational
Interviewing
CBT–EPICS II

IBIS – Integrated Behavioral
Intervention Strategies
• Motivational Interviewing (MI),
• Effective Practices in Correctional Settings- EPICS-II
• Incentives and Sanctions

Four Fundamental Processes in
1. Engagement
Motivational Interviewing
2. Focusing
3. Evoking
4. Planning

Cognitive Bridging Skills
• Serve as a “bridge” between relationship
development and behavioral change
• Support the engagement and re-engagement
• MI is the “style”, CBT provides the clientcentered
and directive content

Bridging Skills
Changing
offender
behavior
Role
Clarification
Behavioral
Analysis
Cognitive Model
Relapse
Prevention

Role Clarification as
Engagement Strategy
• Key skill in working with involuntary clients
• Helps the client understand what to expect and
what is expected of them
• Should be covered at the beginning of
supervision

Steps of Role Clarification
1.
2.
Elicit the clients perception and understanding of probation. Ask the client to
identify what he/she hopes to accomplish during the supervision process
Ask permission to teach. Identify the agency’s goals for the supervision process.
Identify what you, as a representative of the agency, hope to accomplish
3.
Define the supervision process
4.
5.
6.
Identify and discuss expectations of confidentiality
Emphasize the dual role (assistance and law enforcement)
Elicit the client’s understanding

“How do I know what to target?”
Focusing Through Behavioral Analysis
•Uncovers specific targets for discussion
•Given as homework
•Used throughout supervision

Behavioral Analysis
When (day of
week and time)
Who were you
with
(before/during)?
Where were you?
What were you
thinking/feeling
(before/during)?
What did you do?
What were you
thinking/feeling
after?

Focusing Through the Behavioral
Analysis
1.
Ask the client if he/she noticed any patterns in behavior
2.
Listen for DARN
3.
Identify specific behavioral and situational targets for change
4.
Ask the client if he/she agrees with the identified targets
5.
Possibility for initial planning for change

The Evoking Process
• Eliciting change talk
• A meaningful engagement and a clear focus
are prerequisites

Evoking Through The Cognitive Model
“Thinking Controls Behavior”
EXTERNAL INTERNAL BEHAVIOR
Selective eliciting
Selective responding
Selective summaries

Cognitive Model Worksheet
EXTERNAL
INTERNAL
THOUGHTS
BEHAVIOR
CONSEQUENCES
REPLACEMENT
THOUGHTS
NEW BEHAVIOR
CONSEQUENCES

The Planning Process
• The Planning is unrealistic without sufficient
engagement (a very important consideration in
probation and CJ system in general)
• It is equally unrealistic without clear shared change
goals
• It is even impossible without sufficient client
motivation for the change as evident by the
increased frequency and strength of the change talk

Planning Through RACE
RECOGNIZE
• High risk influencers that tempt the offender
AVOID
• By taking steps away from situations
COPE
• In situations where the high risk influencer cannot be
avoided
EVALUATE
• Evaluate progress, make changes to the plan

RACE
Recognize
Learn to recognize
high-risk situations
Avoid
How can you avoid?
Cope
If you cannot avoid,
how could you
manage?
Evaluate
How can you better
handle the situation?
What did you do well?

Parallel Between the Four MI Processes and CBT
Engaging –
The Relational
Foundation
Role Clarification
(EPE)
Agenda Setting,
Finding a Focus
Behavioral Analysis
Evoking
Cognitive Model
Planning
Relapse
Prevention

Thank you for your hard work!
Igor Koutsenok, MD, University of California San Diego
ikoutzenok@ucsd.edu
2012