The Basics

Clinician role – PersuasionExplain why s/he should make this changeGive 3 specific benefits of making the changeTell him/her how to changeEmphasize importance of the changeTell the client to do it!

Debrief Readiness is not static

Importance of matching strategies to readiness

Role of Ambivalence

AmbivalenceIs normalOccurs throughout the change processReflects costs and benefits of change and

status quoIs uncomfortableMay become chronic Resolved by client

Righting ReflexBorn of concern and caringThere’s a problem? Let’s fix it!Fails to consider ambivalence in change

processMay engender resistance

Therapeutic TrapsQuestion-Answer TrapTrap of Taking SidesExpert TrapLabeling TrapPremature Focus TrapBlaming Trap

Talk about something real that you:Want to changeNeed to changeShould changeHave been thinking

about changingBut, haven’t yet

changed.Not your deepest,

darkest secret!

Listen carefully - goal to understand the dilemma

Ask these four questions:Why would you want to make

this change?How might you go about it, in

order to succeed?What are the three best

reasons to do it?On a scale of 1-10, how

important would you say it is to make this change? And why are you a ___ and not zero?

ChangeChange is more similar than

different across behaviorsChange is a process that is

continuous like a dimmer switch, not discrete like an on/off switch

Change depends on MOTIVATION which is a state not a trait. It’s a probability, a likelihood.

Because of this, there are multiple ways and times that change can derail

Fortunately, there are multiple ways and times to facilitate the process

Stages of ChangeProchaska & DiClemente

PrecontemplationAwareness of need to change,

increased concern

ContemplationIncreasing the Pros for

Change and decreasing the Cons, Confidence

ActionImplementing and Revising the Plan

Stages of Change Model

Relapse andRecycling

MaintenanceIntegrating Change

into Lifestyle

PreparationCommitment &

Planning

COGNITIVE/EXPERIENTIAL BEHAVIORAL Consciousness Raising Self-Liberation Self-Revaluation Counter-conditioning Environmental Reevaluation Stimulus Control Arousal/Dramatic Relief Contingency- Management Social Liberation

Activities initiated or experienced by an individual in modifying thinking feeling

and behavior related to a particular problem

To Sum UpChange is continuousThis continuity can be “broken up” into

stagesAssessment is about getting a sense of stagePeople rely on change process to move

through stagesCounselors can help and hinderMultiple spirals are the ruleMotivation is the fuel

MotivationThe probability of engaging in and

maintaining a behavior over time.What are the three key words?

Probability (0 – 1) not (0 or 1).EngageMaintain

Motivation is continuous not dichotomousFluctuating motivation can increase or

decrease based on your behavior

Factors Influencing MotivationClient Factors

HealthPerseverance/Task PersistenceTask difficultyBelief in the efficacy of the programInterest levelImportanceConfidenceExternal barriersValues

Counselor FactorsMuch The Same………….

Motivational Interviewing: A Definition

“MI is a collaborative, goal oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”

http://www.motivationalinterview.org/

Spirit of MIAutonomy

Personal responsibilityNeither imposition nor coercion

Collaboration Meeting of aspirationsNeither exhortation nor persuasion

Evocation Drawing outNeither instilling nor installing

MI PrinciplesExpress Empathy

Empathy alone is predictive of change

Roll w/ResistanceVerbal judo

Develop DiscrepancyGoals and values

contrasted with current behavior

Support Self-Efficacy

R – Resist the righting reflex

U – Understand you client’s motivation

L – Listen to you client

E – Empower your client

MI Fundamental ProcessesThese are the “phases” of the overall process of

engaging in MI with a client. These phases are not rigid and we often move back and forth between the phases as we work with clients.Engaging – The Relational FoundationFocusing – The Strategic FocusEvoking – The Meat and PotatoesPlanning – The Bridge to Change

Often MI is about knowing how to skillfully and artfully move back and forth between each process

How Does MI WorkEmpathy allows clients to reduce resistance and

resolve ambivalenceLooking at the situation from their perspective

People feel understood; less resistant

Selective reinforcement of change talk Focus on change talk We learn what we believe when we hear ourselves speak Therapist reinforces change talk that is consistent with

therapeutic goals (person’s values) Reinforcement further increases change talk and allows

of client to experience build in motivation to change

Empathic Counseling Style and Patient ResponseMiller, Benefield & Tonigan (1993) JCCP 61: 455-461

Change TalkClient utterances that favor change, are linked to a

specific behavior(s), come from client (in most cases), and are in the present tense. Preparatory Language (DARN)

Desire“I want”

AbilityI’m able”

Reasons (for change)“Here’s why”

Need (disadvantages of status quo)“If I don’t”

Change TalkImplementing Language (ACT)

Activation (prepared, willing)Commitment

“I’m going to” “I will” “I plan to”

Taking Steps “I did” “I went” “I started”

It is the change in this talk over the course of the session that predicts change

Commitment Language Pattern A

Outcomes for Pattern A Group

Commitment Language Pattern B

Amrhein et al., Journal of Consulting & Clinical Psychology 2003 71:862-878

Outcomes for Pattern B Group