Facilitating Motivational Groups

Participants are divided into groups of five "clients" and one or two facilitators. All groups are run at the same time, so the size of the training determines how many groups are needed. Five "clients" per group seems to be a manageable number for the role play.

The trainer(s) meet with the participants selected to play counselors to review the purpose of the group and what is expected in the role play.

'''Option''': You may have other trainees rate leaders’ use of OARS or note other MI strategies or particularly useful reflections. Other trainees may also take notes on similarities and differences they notice compared to conducting individual MI sessions.

Instructions for facilitators may include one of the following:

'''Round 1''':
Ask group participants to report on personal issues in the form of a real-play, perhaps asking some to reflect on changes they should make but haven’t, others on changes they are currently making, and others on changes they previously made but are currently having difficulty maintaining.

Leader assignment: Use OARS to facilitate rapport, assess stages of change, and get a feel for what would be motivating for each person. Attempt to build group cohesion.

Debrief: How are MI groups different from groups used in your agency? How are they different from doing MI in individual format?

'''Round 2''':
Have the entire group generate their own client profiles for the type of group they want to practice (you can use structured role plays on the following page as an alternative).

Trainer performs approximately twenty minute demo using MI directive strategies.

Split trainees into multiple groups and ask leaders to use one of the following strategies.

'''Strategy #1: Use facilitated discussion to explore looking forward.'''
Possible evoking questions:
1) What are some of your hopes for the future?
2) What are you doing now to help you make these hopes come true?
3) What other things could you do (or do more of) to help increase your chances of success?
4) What strengths and supports can you drawn upon?

'''Strategy #2: Use facilitated discussion to explore previous successes.'''
Possible evoking questions:
1) List some positive changes you have made in your life.
2) Choosing one of these changes,
a. What made you decide to make this change?
b. How did you go about achieving the change?
c. What challenges or setbacks did you face?
d. How could you draw upon this experience to consider making a change now?

'''Strategy #1: Use scaling questions to focus on importance of making changes,confidence in making changes, desire to make changes.'''

Have clients respond to scaling questions:
1. Where are you on a scale of 0 -10 regarding how (important it is to make some changes) (confident you feel about succeeding) (much you want to make changes vs. how much you dread it)
2. What makes your score x instead of (lower score, such as 0 or x-2)
3. What would help boost your score to x + 2
4. How could we help you increase your sense of (confidence, desire)
5. End with summary statement for each client, eliciting commitment to take some action if appropriate
6. Tie together similarities in responses.

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Example substance-related client roles:

#1 = Precontemplation (mixed) – You’ve been referred for services after testing positive for cocaine on a random screen at work. However, cocaine is something you can take or leave, and you always kind of thought it was a waste of money anyway. You do smoke pot regularly, but no one mentioned anything about that when they told you you’d tested positive for cocaine, so you assume they don’t test for that and you can’t think of any way to ask about it without making them suspicious. You don’t plan to quit smoking. This is a good job, and they told you that if you test positive again, you’ll be fired.

#2 – Contemplation – You’ve been busted for possession of ecstasy. Although you were selling it, the cops didn’t know and when you were busted you only had a little left and weren’t charged with distribution. You have to submit urine once or twice a week for drug screens, but you’ve heard that none of the drugs you use – ecstasy, acid and mushrooms – are detected in drug screens. You spent 30 days in jail and it was the worst experience you’ve ever had. You never want to go back, but if they don’t even test for the stuff you use, you wonder if you could get by just by not selling anymore and being extremely careful about not carrying anything on you.

#3 – Preparation - Your doctor is encouraging you to get into treatment. Since a car accident, you’ve been taking oxycontin due to extreme pain in your legs, but you never feel satisfied with the doctor’s prescription and almost always want the dosage to be increased. You can’t take the pain, but are also nervous about being addicted. Your doctor has encouraged you to find other ways of relieving pain, and has suggested that whirlpools, swimming and stretching may help.

#4 – Action. You are seeking help on your own. You long-time cocaine and alcohol habits have cost you the business you built from scratch. You’ve been back living with your mother while you are trying to get back on your feet. You’ve not used or drank any alcohol for 6 weeks now, and are looking for some help that doesn’t involve all of the 12-step ideas and rituals, which just annoy you.

#5 – Maintenance – You have been referred by DSS (social services) for treatment after being clean for a year, following being deemed unfit as a parent for using drugs in the presence of your children. You have been actively involved in 12-step groups and are currently living in a halfway house. You have been working steadily for the past six months. Given how well things are going, you are not sure what treatment has to offer you that you haven’t already achieved on your own.