Equipoise wagner

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Equipoise wagner

  1. 1. Client-centered Direction: No Dichotomy, No Oxymoron Or, how to get there when you don’t know where you’re going. Chris Wagner, Ph.D. Virginia Commonwealth University
  2. 2. Direction in MI <ul><li>Establishing therapeutic direction in MI does not require that the practitioner hold aspirations for specific client behavior changes </li></ul>
  3. 3. Client-centered Direction in MI <ul><li>Collaboration is a hallmark of MI spirit </li></ul><ul><ul><li>Direction can be developed collaboratively by evoking client values, desires, needs, hopes, and goals. </li></ul></ul><ul><ul><li>Practitioners may initially aspire to help clients find better lives … </li></ul></ul><ul><ul><li>… narrow the focus to discrete change goals when specific behaviors are collaboratively identified as obstacles to achieving a better life… </li></ul></ul><ul><ul><li>or when absence of behaviors is collaboratively identified as inhibiting progress toward it. </li></ul></ul>
  4. 4. Motivation <ul><li>Elements of Motivation (Arnold) </li></ul><ul><ul><li>Direction – Which way? </li></ul></ul><ul><ul><li>Effort – How much energy? </li></ul></ul><ul><ul><li>Persistence – How long? </li></ul></ul><ul><li>Types of Motivation </li></ul><ul><ul><li>Extrinsic </li></ul></ul><ul><ul><li>Intrinsic </li></ul></ul><ul><ul><li>Autonomous </li></ul></ul><ul><li>Focus in Motivational Theories </li></ul><ul><ul><li>Content oriented – What motivates (e.g., Maslow’s Need Hierarchy) </li></ul></ul><ul><ul><li>Process oriented – How motivation is unlocked and enhanced (e.g., reinforcement theory) </li></ul></ul>
  5. 5. Motivation <ul><li>The Role of Goals – Lessons from Organizational Psychology </li></ul><ul><ul><li>Goals can establish direction, increase effort & persistence </li></ul></ul><ul><ul><li>Best goals are clear, precise, challenging (but not perceived as impossible), with participation in goal-setting, commitment to achieve, feedback on progress </li></ul></ul><ul><ul><li>May be better to avoid performance goals when learning new tasks (instead, emphasize intent & effort) </li></ul></ul><ul><ul><li>Perception that goals are being imposed can negate them </li></ul></ul><ul><ul><li>Important goals may be ignored in the presence of other more important goals </li></ul></ul>
  6. 6. Client-centeredness, Direction <ul><li>Essence of being client-centered is working within the client’s perspective </li></ul><ul><li>Rogers used “ non-directive ” to mean that practitioners do not direct clients toward practitioners’ own aspirations </li></ul><ul><li>Pairing of client-centered and non-directive elements in Rogerian therapy has conflated them </li></ul>
  7. 7. Client-centeredness, Direction <ul><li>MI advanced Rogerian thinking by pairing perceived opposites - client-centeredness, direction </li></ul><ul><li>Development of linguistic model of MI advanced focus on direction in micro-interactions while (perhaps) inadvertently reformulating direction as practitioner-centered </li></ul><ul><li>Concept of client-centered direction incorporates both linguistic reinforcement model of MI & client as source of direction </li></ul>
  8. 8. What is MI? <ul><li>Motivational Goals </li></ul><ul><ul><li>Increase interest/importance, confidence, readiness and commitment to change </li></ul></ul><ul><li>Global Orientation </li></ul><ul><ul><li>Empathy, Direction, Collaboration, Autonomy, Evocation </li></ul></ul><ul><li>Communication Processes </li></ul><ul><ul><li>Selective OARS, Information Exchange, Optional advice w/permission </li></ul></ul><ul><li>Content Strategies </li></ul><ul><ul><li>Looking back/forward, Remembering successes, Exploring strengths and supports, Scaling exercises, Change planning </li></ul></ul>
  9. 9. Motivation and Change in MI <ul><li>Change is broader than behavior </li></ul><ul><ul><li>Includes thinking & feeling as well as behavior </li></ul></ul><ul><li>Change often starts before goal is conceived </li></ul><ul><ul><li>Clients may first open up to vague possibility of betterness </li></ul></ul><ul><ul><li>Clients may feel it before they think it </li></ul></ul><ul><li>Direction is broader than goals or aspirations </li></ul><ul><ul><li>Equipoise is not synonymous with non-direction </li></ul></ul><ul><ul><li>Direction does not require practitioner outcome aspirations </li></ul></ul>
  10. 10. Motivation and Change in MI <ul><li>Efficient process meets clients where they are on pathway toward change </li></ul><ul><li>Direction is “built in” ” to the MI process, even in absence of practitioner aspirations for client goals </li></ul><ul><li>Practitioners can aspire for broad positive change while being in equipoise about specific narrower change possibilities </li></ul><ul><li>Practitioners can selectively focus on broad category of change and narrow focus toward specific behaviors along the way </li></ul>
  11. 12. Therapeutic Focus
  12. 13. Consider personal habits/issues? Therapeutic Focus
  13. 14. Consider personal habits/issues? Discuss personal habits/issues? Therapeutic Focus
  14. 15. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Therapeutic Focus
  15. 16. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? Therapeutic Focus
  16. 17. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Therapeutic Focus
  17. 18. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? Therapeutic Focus
  18. 19. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? Therapeutic Focus
  19. 20. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? Therapeutic Focus
  20. 21. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? Therapeutic Focus
  21. 22. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Therapeutic Focus
  22. 23. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Therapeutic Focus
  23. 24. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Provider Aspirations Therapeutic Focus
  24. 25. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Provider Aspirations Therapeutic Focus
  25. 26. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Provider Aspirations Therapeutic Focus
  26. 27. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Explore Provider Aspirations Therapeutic Focus
  27. 28. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Provider Aspirations Therapeutic Focus
  28. 29. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Provider Aspirations Therapeutic Focus
  29. 30. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Provider Aspirations Therapeutic Focus
  30. 31. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination Provider Aspirations Therapeutic Focus
  31. 32. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Provider Aspirations Therapeutic Focus
  32. 33. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Provider Aspirations Therapeutic Focus
  33. 34. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Provider Aspirations Therapeutic Focus
  34. 35. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Do Provider Aspirations Therapeutic Focus
  35. 36. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Do Provider Aspirations Therapeutic Focus Express Empathy
  36. 37. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Do Provider Aspirations Therapeutic Focus Express Empathy Develop Discrepancy
  37. 38. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Do Provider Aspirations Therapeutic Focus Express Empathy Develop Discrepancy Roll with Resistance
  38. 39. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Do Provider Aspirations Therapeutic Focus Express Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy
  39. 40. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Do Provider Aspirations Therapeutic Focus Thoughts Attitudes Beliefs Emotions Perspectives Values Desires Needs Hopes Actions
  40. 41. Consider personal habits/issues? Discuss personal habits/issues? Current situation? Future situations? How could things be better? Are there things you could/should change? Why? What are your goals? What are you willing to give up? What are you willing to do? How to go about it? Ready? Focus Share Imagine Explore Envision Inventory Define destination --Commit-- Plan Do Provider Aspirations Therapeutic Focus Reinforce Reinforce Reinforce Reinforce
  41. 42. References <ul><li>Arnold, Silvester, Patterson, Robertson, Cooper & Burnes (2009) Work Psychology (5 th edition), Pearson. </li></ul>

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