Kotkin MI 12-11-14

Introduction to Motivational
Interviewing and Stages of
Change
…What the Non-Specialist Needs to Know
By Elizabeth Kotkin, MA, LMFT
Program Director
YES Adolescent Skills Center-
Manhattan

What If Someone Said NO
 Took away all the ways
you relax.
 Told you that you have to
do something else.
 Told you that you have to
stop doing what you like
to do to relax, but
everyone you know can
continue.

Motivational Interviewing
“Motivation can be understood not as something one
has but rather as something one does. It involves
recognizing a problem, searching for a way to
change and then beginning and sticking with that
change strategy” Miller (1995)
 Motivational Interviewing is a way to minimize
resistance, resolve ambivalence and induce change.
 Readiness levels are accepted starting points for
treatment rather than reasons for elimination from
treatment services.

 Motivation is key to change and it is constantly in flux
 Motivation is influenced by social interaction, namely
the counselor’s style
 At all stages of change, ambivalence is seen as normal
and not pathological
CONCEPTUALIZING MOTIVATIONAL
INTERVIEWING

Client Resistance
Involves feelings-actions-behaviors of an
interpersonal nature where there is a lack of
collaboration

Stages Of Change
 Precontemplation stage
 Contemplation stage
 Preparation stage
 Action stage
 Maintenance
 Relapse

For any behavioral problem at a given
time, there are (in the population at large)
• 40% in Pre-Contemplation
• 40% in Contemplation
• 20% on Preparation or Action
• * Prochaska and DiClemente, 1998

“There is a myth…that more is always better. More education,
more intense treatment, more confrontation will necessarily
produce more change. Nowhere is this less true than with
precontemplators. More intensity will often produce fewer
results with this group. So it is particularly important to use
careful motivational strategies, rather than mount high-intensity
programs…We cannot make precontemplators change, but we
can help motivate them to move to contemplation.” DiClemente,
(1991)

Stage 1: Precontemplation
 The client does not consider change. Seeks treatment due to
outside pressures such as family, job, etc., or due to legal
and/or medical concerns

Tasks: Building Readiness
 A) Raise doubt about client’s belief that the behavior is
harmless
 B) Increase the client’s perception of risks and problems
with current behaviors

Clinical Interventions
 A) Establish rapport and offer factual information
 B) Explore the meaning of events that brought the
person in and the results of previous efforts

“Contemplation is often a very paradoxical stage of
change…Ambivalence is the archenemy of commitment and a
prime reason for chronic contemplation. Helping the client to
work through the ambivalence, to anticipate barriers, to
decrease the desirability of the problem behavior and to gain
some increased sense of self-efficacy to cope with this specific
problem are all stage-appropriate strategies.” DiClemente,
(1991)

Stage 2: Contemplation
 The client is highly ambivalent about change. The client both
considers change and rejects it.
 The client will seesaw between reasons for concern and
justifications for continuing the behavior.

Ambivalence
 A state of mind in which a person has coexisting but conflicting
feelings, thoughts, and actions about something.
 In this stage, the client sees the possibility of change but is ambivalent
and uncertain about beginning the process
 Primary task : resolve the ambivalence and helping the client choose to
make the change

Tasks: Increasing Commitment
 A) Tip the decisional balance and strengthen self-efficacy
 B) Evoke from the client reasons to change and risks of not
changing

Clinical Interventions
 A) Show interest in how the behavior affects all areas of
the client’s life
 B) Talk about the person’s sense of self-efficacy and
expectations of what the change will entail
 C) Summarize self-motivational statements

Stage 3: Preparation-
Determination
 The client is committed to and planning to make a change in the
near future but is still considering what to do
 Goal: Help client to get ready to make a change
 Primary task: Help client identify appropriate change strategies
 Elements of Change:…Ready….Willing….Able

Strategies For Preparation Stage
 Clarify goals & strategies
 Menu of options
 Offer advice
 Negotiate change plan
 Identify and lower barriers to
change
 Get social support
 Treatment expectations
 Publicize change plans

Stage 4: Action
• Client has decided to make a change, but hasn’t stabilized the process
• Client has verbalized or demonstrated a firm commitment to change
• Efforts to modify behavior and/or environment are being taken
• Client demonstrates motivation and effort to achieve real change
• Client is involved in, and committed to, the change process
• Client is willing to follow suggested strategies and activities to change

Strategies for Action Stage of
Change
• Summarize a realistic view of
change through small steps
• Help the person identify high-risk
situations and develop appropriate
coping strategies
• Assist the person in finding new
reinforcers of positive change
• Help access family and social
supports

Maintenance and Relapse
 Definition: A stage in which the client has
achieved the goals and is working to maintain
them
 Primary task: Client needs to develop new skills
for maintaining recovery

Possible Strategies for
Maintenance Stage
 Help client identify and try alternative
behaviors
 Maintain supportive contact
 Encourage person to develop escape plan
 Work to set new short and long term goals

 This is an overview of the Stages of Change model by the
psychologists who first wrote about it.
 Another useful resource is TIP 35, (Enhancing
Motivation for Change in Substance Abuse Treatment)
published by the Center for Substance Abuse Treatment
(CSAT) and available at SAMHSA for a free download.
Changing For Good,
by Proshaska,Norcross
and DiClemente

Kotkin MI 12-11-14

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