Motivational Interviewing introduction
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1) Motivational interviewing (MI) is a collaborative, person-centered counseling approach used to strengthen a person's own motivation for change. 2) MI is based on exploring and resolving ambivalence in a non-confrontational way. The counselor supports autonomy, collaboration, and self-efficacy. 3) A key goal is developing "discrepancy" - a mismatch between where the client currently is and where they want to be - by eliciting "change talk" about committing to and taking steps toward behavior change.
Motivational Interviewing introduction
- 1. Motivational Interviewing motivating social change Tim Curtis
- 3. MI IN PROFILE CONTEXT INDIVIDUAL • Isolated • Ambivalent • Willingness to change ‘PROFESSIONAL’ • Your professionalism • Wanting to help • Knowing ‘what is best’
- 4. INTRINSIC vs EXTRINSIC MOTIVATION • ‘Movere’ Latin for ‘to move’ • Energy and direction. • Goals. • Sources of motivation? • Think of a behaviour of yours that you have thought about changing; – Eg: drinking/smoking/studying/untidiness • Where has the motivation to change originated from? External or internal?
- 5. ASSUMPTIONS ABOUT CHANGE • Easy to assume. • Sometimes people are unaware. • How? • Why? • Pleasure vs pain.
- 6. TRANSTHEORETICAL MODEL • Informed by 7 distinct theories: 1) Conflict and ambivalence (Orford, 1985) 2) *Decisional balance (Janis and Mann, 1977) 3) Health beliefs (Rogers, 1975) 4) Reactance (Brehm and Brehm, 1981) 5) Self-perception (Bem, 1967) 6) Self-regulation theory (Kanfer, 1987) 7) Rokeach’s value theory (Rokeach, 1973)
- 7. CYCLE OF CHANGE (Prochaska and DiClemente, 1984)
- 8. STAGES OF CHANGE • Pre-contemplation Happy to maintain status-quo • Contemplation Question the present situation
- 9. STAGES OF CHANGE (cont) • Decision/determinism Change talk/plan/strategy • Active changes Strategy implemented, steps taken
- 10. STAGES OF CHANGE (cont) • Maintenance Changed behaviour adopted and maintained • Relapse Learning from ‘failure’ One step forward, two steps back….. Most people need more than one attempt.
- 12. MI • Rooted in work of Carl Rogers. • ‘A collaborative, person-centred form of guiding to elicit and strengthen motivation for change’ (Miller and Rollnick, 2009)
- 13. ‘SPIRIT’ OF MI • More than a set of techniques. • Based on 3 key elements: ACE • Autonomy (vs Authority) • Collaboration (vs Confrontation) • Evocation (vs Imposition)
- 14. 4 PRINCIPLES OF MI • Express Empathy (vs sympathy) Empathy because you have ‘been there’ vs sympathy when you have not. • Support Self-Efficacy Supporting the belief that change is possible. Focus on previous successes.
- 15. 4 PRINCIPLES OF MI (cont) • Develop Discrepancy Mismatch between ‘where they are’ and ‘where they want to be’. Conflict between current behaviour and future goal. ‘Throw away’ comments. • Roll with Resistance Comes from conflict between view of ‘problem’ and ‘solution’. Non-confrontation using de-escalation techniques. ‘Yes, but….’ MI focus on client define problem results in more ‘dancing and less wrestling’.
- 16. RESISTANCE/AMBIVALENCE- WHAT IS IT? • Hesitance • Uncertainty • Indecision • Irresolution • Doubt • Fickleness • Being in two minds…
- 17. RESISTANCE vs AMBIVALENCE • Exploration and resolution of ambivalence. • Ambivalence is preferred to resistance in order to explore the dynamic interrelationship (Arkowitz et al, 2008) • Approach-Avoidance-moving betwixt and between e.g. just one more drink, play on the gaming machine, slab of chocolate……..
- 18. HOW NOT TO ‘DO’ MI http://www.youtube.com/watch?v=kN7T-cmb_l0
- 19. YOUR VIEWS…. • What mistakes do you think were made in this clip?
- 20. MI SKILLS IN PRACTICE (OARS) • Open ended questions: • Affirmations-support self-efficacy. – Must be congruent and genuine. • Reflections. Has 2 purposes; help to express empathy and resolution of ambivalence by focusing on negatives of maintenance and positives of change. • https://youtu.be/1uRwwz-b6Zk • https://youtu.be/oG_UlQrFmAY
- 21. REFLECTIONS (cont) • Repeating • Re-phrasing • Paraphrasing • Reflection of feeling
- 22. OARS (cont) • Summarise – communicate interest and understanding. Shift attention/direction- ‘move on.’ – Highlight both sides (but focus more on positives) of ambivalence therefore promote discrepancy.
- 23. Traps
- 25. CHANGE TALK • Seek to guide client to expressions of change talk. • Correlation between statements of change and change behaviour. • DARN CAT-types of change talk.
- 26. PREPARATORY CHANGE TALK • Desire (I want to change) • Ability (I can change) • Reason (Its important to change) • Need (I should change) Examples……..?
- 27. IMPLEMENTING CHANGE TALK • Commitment (I will change) • Activation (I am ready, prepared and willing to change) • Taking steps (I am taking specific action to change)
- 28. STRATEGIES FOR EVOKING CHANGE TALK • Ask evocative questions • Explore decisional balance (pros/cons-more pros) • Good/not so good about behaviour • Ask for examples • Look back • Look forward • Query extremes • Use change rulers • Explore goals/values
- 29. READINESS TO CHANGE • Decreasing resistance/ambivalence. • Less emphasis on the problem. • Change talk; person gives off increasing resolve. • S/he is posing her own questions about her own change process. • Envisioning-how the future might look, could look.
- 30. MI ‘TRAPS’ • Labelling. • Blaming/judging. • Resisting the ‘righting reflex’. • Forgetting the answers lie within the individual. • Any more?
- 32. 8 THINGS THAT MI IS NOT • MI not based on the TTM. What is the difference? • MI not a way of tricking people into change behaviour. ALWAYS in the persons best interests. You do not ‘MI’ someone. You cannot do MI ‘on’ or ‘to’ someone. • MI is not a technique. Not simple with steps to follow. More complex. • MI is not a decisional balance. Exploring pros AND cons can sometimes avoid influencing direction of choice.
- 33. 8 THINGS THAT MI IS NOT (Cont) • MI is not CBT. MI is a brief intervention-new skills are not learned. NOT ‘I have what you need’ rather ‘you have it already.’ • MI is not just client centred counselling. Goal focused. • MI is not what you were already doing. Communication style rather then problem solving. • MI is not a panacea. Not suitable for all health related problems. Short term sessions required.
- 34. REFERENCES • Bem, D. (1967) Self-Perception. An Alternative Interpretation of Cognitive Dissonance Phenomena. Psychological Review 74 (3), p.183-200. • Brehm, S. S. and Brehm, J. W. (1981) Psychological Reactance: A Theory of Feedom and Control. New York: Academic Press. • Janis, I. L. and Mann, L. (1977) Decision- Making. A Psychological Analysis of Conflict, Choice and Commitment. New York: Free Press. • Kanfer, F. H. (1987) Self Regulation and Behaviour. Jenseits des Rubikon. Heidelberg: Springer-Verlag. • Miller, W. R. and Rollnick, S. (2009) Ten Things that MI is Not. Behavioural and Cognitive Psychotherapy 37, p.129- 140.
- 35. REFERENCES (cont) • Orford, J. (1985) Excessive Appetites. A Psychological View of Addictions. New York: Wiley. • Prochaska, J. O. and DiClemente, C. C. (1984) The Transtheoretical Approach. Crossing Traditional Boundaries of Therapy. Homewood, Illinois: Dow/Jones • Rokeach, M. (1973) The Nature of Human Values. New York: Free Press. • Rogers, R. W. (1975) A Protection Motivation Theory of Fear Appeals and Attitude Change. Journal of Psychology 91 (1), p.93-114.