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Stripped back MI- intro to person centred social change
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Stripped back MI- intro to person centred social change

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  • Easy to make assumption that people want to change
  • Where does MI ‘fit’ into this diagram?
  • Pre-contemplation-seeds of change Contemplation-possibility of change
  • People who are ready for change do not need MI. It is designed for the resolution of ambivalence with a tip in one direction

Transcript

  • 1. Kelly Hill
  • 2.  What are they? How can they be measured? Your client. Make a list…….
  • 3.  Isolated  Your professionalism Ambivalent  Wanting to help Willingness to change  Knowing ‘what is best’INDIVIDUAL ‘PROFESSIONAL’
  • 4.  ‘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?
  • 5.  Easy to assume. Sometimes people are unaware. How? Why? Pleasure vs pain.
  • 6. 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)
  • 7. (Prochaska and DiClemente, 1984)
  • 8. Pre-contemplationHappy to maintain status-quoContemplationQuestion the present situation
  • 9. Decision/determinismChange talk/plan/strategy Active changesStrategy implemented, steps taken
  • 10. MaintenanceChanged behaviour adopted and maintainedRelapseLearning from ‘failure’One step forward, two steps back…..Most people need more than one attempt.
  • 11.  Rooted in work of Carl Rogers. ‘A collaborative, person-centred form of guiding to elicit and strengthen motivation for change’ (Miller and Rollnick, 2009)
  • 12.  More than a set of techniques. Based on 3 key elements: ACE Autonomy (vs Authority) Collaboration (vs Confrontation) Evocation (vs Imposition)
  • 13. Express Empathy (vs sympathy)Empathy because you have ‘been there’ vssympathy when you have not.Support Self-EfficacySupporting the belief that change is possible.Focus on previous successes.
  • 14.  Develop DiscrepancyMismatch between ‘where they are’ and ‘wherethey want to be’. Conflict between currentbehaviour 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 onclient define problem results in more ‘dancing andless wrestling’.
  • 15.  Hesitance Uncertainty Indecision Irresolution Doubt Fickleness Being in two minds…
  • 16.  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……..
  • 17.  http://www.youtube.com/watch?v=kN7T- cmb_l0
  • 18.  What mistakes do you think were made in this clip?
  • 19.  Open ended questions: Affirmations-support self-efficacy. Must becongruent 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
  • 20.  Repeating Re-phrasing Paraphrasing Reflection of feeling
  • 21.  Summaries-communicate interest and understanding. Shift attention/direction- ‘move on.’ Highlight both sides (but focus more on positives) of ambivalence therefore promote discrepancy.
  • 22.  Seek to guide client to expressions of change talk. Correlation between statements of change and change behaviour. DARN CAT-types of change talk.
  • 23.  Desire (I want to change) Ability (I can change) Reason (Its important to change) Need (I should change)Examples……..?
  • 24.  Commitment (I will change) Activation (I am ready, prepared and willing to change) Taking steps (I am taking specific action to change)
  • 25.  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
  • 26.  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.
  • 27.  Labelling. Blaming/judging. Resisting the ‘righting reflex’. Forgetting the answers lie within the individual. Any more?
  • 28.  http://www.youtube.com/watch?v=URiKA7CK tfc&feature=related
  • 29.  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.
  • 30.  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.
  • 31.  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.
  • 32.  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.