Motivational interviewing aims to facilitate behavior change in young people. It emphasizes expressing empathy, developing a discrepancy between current behavior and goals, avoiding argumentation, rolling with resistance, and supporting self-efficacy. Key strategies include exploring the positives and negatives of behavior, reflecting on life satisfaction, and helping with decision-making, all while maintaining a non-judgmental attitude and acknowledging normal ambivalence about change. The goal is to have young people decide to change by talking through their own motivations, with the therapist accepting whatever decision is made.
6. (COGNITIVE) GAMES PEOPLE PLAY
1. “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)
7. HIGH RISK
SITUATION
Interpersonal Determinants
• Interpersonal conflict
• Social Pressure
Interpersonal Determinants
• Negative Emotional States
• Positive Emotional States
• Testing Personal Control – trigger seeking behaviour
• Urges and Temptations
(External)
(Internal)
8. 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
10. MOTIVATIONAL
INTERVIEWING
Motivational 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 MICROSKILLS
Fundamental to the successful use of motivational interviewing strategies are a
number of client centred micro skills.
Open ended questions, reflective listening, affirmation and summarising.
11. STAGES OF CHANGE AND
THERAPIST TASK
STAGE
Pre-Contemplation
Contemplation
Determination
Action
Maintenance
Relapse
THERAPIST TASK
Raise Doubt
Increase 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 ADVICE
Removing BARRIERS
Providing CHOICES
Decreasing DESIRABILITY
Practising EMPATHY
Providing FEEDBACK
Clarifying GOALS
Actively HELPING
13. 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.
Summarising
Life Satisfaction- Looking Back
- Looking Forward
Self vs User - Psychological Squirm
Helping with Decision making
14. 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.
15. SUMMARY
EXPRESS 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.
