stripped back mi- intro to person centred social change
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STRIPPED BACK MIKelly Hill
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What are they? How can they be measured? Your client. Make a list…….
SOCIAL PROBLEMS
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MI IN PROFILE CONTEXT
INDIVIDUAL ‘PROFESSIONAL’
Isolated Ambivalent Willingness to change
Your professionalism Wanting to help Knowing ‘what is best’
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‘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?
INTRINSIC vs EXTRINSIC MOTIVATION
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Easy to assume. Sometimes people are unaware. How? Why? Pleasure vs pain.
ASSUMPTIONS ABOUT CHANGE
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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)
TRANSTHEORETICAL MODEL
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CYCLE OF CHANGE(Prochaska and DiClemente, 1984)
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Pre-contemplationHappy to maintain status-quo
Contemplation Question the present situation
STAGES OF CHANGE
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Decision/determinismChange talk/plan/strategy
Active changesStrategy implemented, steps taken
STAGES OF CHANGE (cont)
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MaintenanceChanged behaviour adopted and maintained
RelapseLearning from ‘failure’One step forward, two steps back…..Most people need more than one attempt.
STAGES OF CHANGE (cont)
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Rooted in work of Carl Rogers. ‘A collaborative, person-centred form of
guiding to elicit and strengthen motivation for change’
(Miller and Rollnick, 2009)
MI
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More than a set of techniques. Based on 3 key elements: ACE Autonomy (vs Authority) Collaboration (vs Confrontation) Evocation (vs Imposition)
‘SPIRIT’ OF MI
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Express Empathy (vs sympathy)Empathy because you have ‘been there’ vs sympathy when you have not.
Support Self-EfficacySupporting the belief that change is possible.Focus on previous successes.
4 PRINCIPLES OF MI
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Develop DiscrepancyMismatch between ‘where they are’ and ‘where they want to be’. Conflict between current behaviour and future goal. ‘Throw away’ comments.
Roll with ResistanceComes 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’.
4 PRINCIPLES OF MI (cont)
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Hesitance Uncertainty Indecision Irresolution Doubt Fickleness Being in two minds…
RESISTANCE/AMBIVALENCE-WHAT IS IT?
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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……..
RESISTANCE vs AMBIVALENCE
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http://www.youtube.com/watch?v=kN7T-cmb_l0
HOW NOT TO ‘DO’ MI
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What mistakes do you think were made in this clip?
YOUR VIEWS….
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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.
http://www.youtube.com/watch?v=xrbXMaiR_Ww example of reflective listening
MI SKILLS IN PRACTICE (OARS)
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Repeating
Re-phrasing
Paraphrasing
Reflection of feeling
REFLECTIONS (cont)
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Summaries-communicate interest and understanding. Shift attention/direction- ‘move on.’ Highlight both sides (but focus more on positives) of ambivalence therefore promote discrepancy.
OARS (cont)
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Seek to guide client to expressions of change talk.
Correlation between statements of change and change behaviour.
DARN CAT-types of change talk.
CHANGE TALK
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Desire (I want to change) Ability (I can change) Reason (Its important to change) Need (I should change)
Examples……..?
PREPARATORY CHANGE TALK
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Commitment (I will change) Activation (I am ready, prepared and willing
to change) Taking steps (I am taking specific action to
change)
IMPLEMENTING CHANGE TALK
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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
STRATEGIES FOR EVOKING CHANGE TALK
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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.
READINESS TO CHANGE
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Labelling. Blaming/judging. Resisting the ‘righting reflex’. Forgetting the answers lie within the
individual. Any more?
MI ‘TRAPS’
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http://www.youtube.com/watch?v=URiKA7CKtfc&feature=related
EFFECTIVE MI
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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.
8 THINGS THAT MI IS NOT
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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.
8 THINGS THAT MI IS NOT (Cont)
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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.
REFERENCES
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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.
REFERENCES (cont)