UNDERSTANDING THE FACTORS THAT DETERMINE THE BEHAVIOURS OF YOUNG PEOPLE

A talk by Karim Ghalmi25.06.15

South Oxfordshire Food and Education AcademyDidcot

Setting the Scene

FACTORS THAT DETERMINE BEHAVIOUR

• Culture• Family• Social Group• Lifestyle• Environment• Behavioural Skills• Thoughts• Feelings• Physical factors

Premature Exit

Exit

Start

 Relapse

Contemplative

Pre-Contemplative

Decision

Active Change

Maintenance

Lapse

(After Prochanska & Di Clemente, 1982)

Cycle of Change

(COGNITIVE) GAMES PEOPLE PLAY1. “I can’t help – I’m ill”

(Justification by using the disease model)2. “My wife made me do it”

(Abdication of responsibility)3. “That will show them”

(Relapse as punishment for perceived injuries)4. “I can control it this time”

(Planned relapse on the basis of ill-founded prediction)5. “I’ve earned it”

(Relapse as an unlikely vehicle of positive reinforcement for sustained abstinence!)6.“Life’s hell anyway”

(The devaluation of abstinence as a vehicle for relapse)7. “See? You can’t make me stop”

(Relapse as an assertive gesture or attempt to establish autonomy)8. “Me? I’m not relapsing”

(Denial)9. “I’ll never relapse – I’ve got it cracked”

(Unrealistically optimistic predictions)10. “Everyone relapses – It’s just a matter of time”

(Unrealistically pessimistic predictions)

HIGH RISK SITUATIONInterpersonal Determinants• Interpersonal conflict• Social Pressure

Interpersonal Determinants• Negative Emotional States• Positive Emotional States• Testing Personal Control – trigger seeking behaviour• Urges and Temptations

(External)

(Internal)

COGNITIVE – BEHAVIOURAL MODEL OF THE RELAPSE PROCESS

Decreased probability of

relapse

Increased self-efficacy

Effective coping response

High-risk situation

Ineffective coping response

Positive outcome expectancies (for

sophisticated coping mechanisms)

Decreased self-efficacy

Increased probability of

relapse

Lapse

FACILITATING CHANGE

MOTIVATIONAL INTERVIEWINGMotivational Interviewing is a style of ‘counselling’ that can be used in the therapeutic process with young people. However, specific motivational interviewing strategies are thought to be particularly useful during initial sessions with those who are ‘contemplators’ experiencing ambivalence about changing their behaviour.

SELF MOTIVATIONAL STATEMENTS• Willingness• Acknowledgement• Desire to change

COUNSELLING MICROSKILLSFundamental to the successful use of motivational interviewing strategies are a number of client centred micro skills.

Open ended questions, reflective listening, affirmation and summarising.

STAGES OF CHANGE AND THERAPIST TASK

STAGE

Pre-Contemplation

Contemplation

Determination

Action

Maintenance

Relapse

THERAPIST TASKRaise DoubtIncrease the clients perception of risks and problems with current behaviour.

Tip the balance – evoke reasons for change, risks of not changing.Strengthen the client’s self-efficacy for change of current behaviour.

Help the client to determine the best course of action to take in seeking change.

Help the client to take steps towards change.

Help the client to identify and use strategies to prevent relapse.

Help the client to renew the processes of contemplation, determination and action without becoming stuck or demoralised because of relapse.

Giving ADVICERemoving BARRIERSProviding CHOICESDecreasing DESIRABILITYPractising EMPATHYProviding FEEDBACKClarifying GOALSActively HELPING

FIVE GENERAL PRINCIPLES:

• Express Empathy

• Develop Discrepancy

• Avoid Argumentation

• Roll with Resistance

• Support Self Efficacy

Goals

In essence, the goal of motivational interviewing is to have the young person talk him/herself into deciding to change their behaviour.It emphasises the young persons right to choose and accept responsibility for the decision.

Method

KEY STRATEGIES

Exploring the Good Things and the Less Good Things.Exploring Concerns.SummarisingLife Satisfaction - Looking Back

- Looking ForwardSelf vs User - Psychological SquirmHelping with Decision making

Key Concepts

Motivational Interviewing Strategies avoid Confrontation.

Empathy

Style of listening so that comments are reflected back in a re-framed fashion to the client.

Non-judgemental attitude – not collusive, but allows the client the freedom to explore the possibility of change.

Ambivalence

It is a common and “natural” experience of feeling torn between wanting and not wanting to do something.

The closer to change the client is, the greater the feelings of conflict are likely to be.

The aim of Motivational Interviewing is to tip the balance of ambivalence in favour of action/determined change.

SUMMARYEXPRESS EMPATHY• Acceptance and respect for young person’s position facilitates change.• Skilful reflective listening is fundamental.• Ambivalence is normal.

DEVELOP DISCREPANCY• A discrepancy between present behaviour and important goals will motivate change.• The young person should present the arguments for change.

AVOID ARGUMENTATION• Arguments are counter productive.• Defending breeds defensiveness.• Resistance is a signal to change strategies.

ROLL WITH CLIENT RESISTANCE• Statements that a young person makes can be re-framed slightly to create a new

momentum towards change.

SUPPORT THE CLIENT’S SENSE OF ABILITY TO CHANGE• Belief in the possibility of change is an important motivator.• The young person is responsible for choosing and carrying out personal change.• There is hope in the range of alternative approaches available.

THANKS