Oregon Problem Gambling Services - Teresa McDowell, presenter. 10/25/18

1. Motivational Interviewing With
Families in Problem Gambling
Treatment
Family Treatment Call
Oregon Problem Gambling Services
Teresa McDowell, Ed.D., LMFT

2. Motivational
Interviewing
MI as an approach v model of
treatment (Miller & Rollnick, 2009)
Stages of Change Framework
Tool to increase readiness for
change
Associated with addiction
treatment

3. Stagesof
Change
Pre-contemplative
Contemplative
Preparation
Action
Maintenance

4. Spiritof MI
Partnership
Acceptance
Compassion
Evocation

5. MI
Righting Reflex and
Rolling with Resistance
Developing Discrepancy
Change Talk

6. MIwithFamilies
Acceptance and compassion
for each other
Therapeutic alliance
Shared motivation for change
Shared goals
Common change language

7. Differencesin
Stagesof
Change
Family members may be in
different stages of change
relative to some potential
goals
Family members may want
change but disagree on the
definition of the problem or
vision of change
Avoid taking sides on change

8. UsingMIto
EngageFamily
Members
Considering stages of change/readiness to
have family members attend sessions (Zaida
Gomez, personal communication 9/2018)
Using MI to explore pros and cons of
inviting family members
Considering the impact of family members
on readiness/pressure to change
Continuing to ask clients to consider
including family members (Zaida Gomez,
personal communication 9/2018)

9. Pre-
Contemplative
Raising awareness of gambling
as a problem
Helping families accept there is
a problem
Considering the possibility of
change
Externalizing gambling
Exploring the impact of
gambling on all family members
and their relationships

10. Contemplative
Helping family members weigh pros and
cons of change
Uncovering potential impact of change
(e.g., what is at risk should change
occur)
Creating a shared vision of change
Discovering discrepancy between
values, expectations and effects of
gambling
Getting family members on board for
change

11. Preparation
• Moving from envisioning to planning
• Identifying specific patterns of interaction
and exploring alternatives
• Identifying thoughts and feelings associated
with behaviors and considering alternatives
• Noting exceptions to problems and what is
working
• Identifying obstacles & hurdles for change
• Providing between session tasks to explore,
notice, and experiment

12. Action
Create action plans
In session change
Between session tasks
Follow-up on in session and between
session interventions
Capture exceptions and unplanned
successes – Build confidence for change
Sustain motivation for change
Resolve setbacks

13. Maintenance
 Review action plans & solidify change
 Explore how to maintain and strengthen
change
 Learn from relapse
 Continue to work on interactional change,
family structure
 Identify and move toward congruence with
family values
 Address past traumas and relational injuries
 Continue to build trust and connection
 Continue to encourage non-gambling activities
 Continue to identify and amplify what is
working

14. Additional
Considerations
What can we add to this
framework?
What other tasks can be
included in each stage of
change?
What are additional techniques
for motivational interviewing
with families and couples?