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Stripped back Motivational Interviewing
 

Stripped back Motivational Interviewing

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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

Stripped back Motivational Interviewing Stripped back Motivational Interviewing Presentation Transcript

  • Kelly Hill
  •  What are they?  How can they be measured?  Your client.  Make a list…….
  • INDIVIDUAL ‘PROFESSIONAL’  Isolated  Ambivalent  Willingness to change  Your professionalism  Wanting to help  Knowing ‘what is best’
  •  ‘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?
  •  Easy to assume.  Sometimes people are unaware.  How?  Why?  Pleasure vs pain.
  •  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)
  • (Prochaska and DiClemente, 1984)
  •  Pre-contemplation Happy to maintain status-quo  Contemplation Question the present situation
  •  Decision/determinism Change talk/plan/strategy  Active changes Strategy implemented, steps taken
  •  Maintenance Changed behaviour adopted and maintained  Relapse Learning from ‘failure’ One step forward, two steps back….. Most people need more than one attempt.
  •  Rooted in work of Carl Rogers.  ‘A collaborative, person-centred form of guiding to elicit and strengthen motivation for change’ (Miller and Rollnick, 2009)
  •  More than a set of techniques.  Based on 3 key elements: ACE  Autonomy (vs Authority)  Collaboration (vs Confrontation)  Evocation (vs Imposition)
  •  Express Empathy (vs sympathy) Empathy because you have ‘been there’ vs sympathy when you have not.  Support Self-Efficacy Supporting the belief that change is possible. Focus on previous successes.
  •  Develop Discrepancy Mismatch between ‘where they are’ and ‘where they want to be’. Conflict between current behaviour and future goal. ‘Throw away’ comments.  Roll with Resistance Comes from conflict between view of ‘problem’ and ‘solution’. Non-confrontation using de- escalation techniques. ‘Yes, but….’ MI focus on client define problem results in more ‘dancing and less wrestling’.
  •  Hesitance  Uncertainty  Indecision  Irresolution  Doubt  Fickleness  Being in two minds…
  •  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……..
  •  http://www.youtube.com/watch?v=kN7T- cmb_l0
  •  What mistakes do you think were made in this clip?
  •  Open ended questions:  Affirmations-support self-efficacy. Must be congruent 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
  •  Repeating  Re-phrasing  Paraphrasing  Reflection of feeling
  •  Summaries-communicate interest and understanding. Shift attention/direction- ‘move on.’ Highlight both sides (but focus more on positives) of ambivalence therefore promote discrepancy.
  •  Seek to guide client to expressions of change talk.  Correlation between statements of change and change behaviour.  DARN CAT-types of change talk.
  •  Desire (I want to change)  Ability (I can change)  Reason (Its important to change)  Need (I should change) Examples……..?
  •  Commitment (I will change)  Activation (I am ready, prepared and willing to change)  Taking steps (I am taking specific action to change)
  •  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
  •  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.
  •  Labelling.  Blaming/judging.  Resisting the ‘righting reflex’.  Forgetting the answers lie within the individual.  Any more?
  •  http://www.youtube.com/watch?v=URiKA7CK tfc&feature=related
  •  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.
  •  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.
  •  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.
  •  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.