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
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-quoContemplationQuestion the present situation
9. Decision/determinismChange talk/plan/strategy Active changesStrategy implemented, steps taken
10. MaintenanceChanged behaviour adopted and maintainedRelapseLearning 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?
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.