Swk3017 stripped down social change mi

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  • 1. Provoking (non-oppressive) social change One to one client interchange
  • 2. STATUS QUO VERSUS CHANGE• Active listening, open questions, and summarising; being reflective-exploring the client‟s current behaviour i.e. pros and cons.• Subsequently, engaging in the same process in respect of the pros and cons of him/her changing behaviour.• Remember the approach is non moralising and non confrontational.• Explicitly change oriented -delineation from Counselling. {Consider}
  • 3. MI IN PROFILE CONTEXT• Individual as isolated and ambivalent.• Your professionalism: His/Her willingness to change {recessed}.• Eliciting the change potential within the client.• Risk of temptation to know what‟s best for him or her. {relate to issues around values- whose; claiming to know the truth…}.
  • 4. EXTRINSIC-INTRINSIC DIALECTIC• Miller and Rollnick {2002} Preparing People for Change.• Client centred/directive approach.• “enhancing intrinsic motivation to change.”• Exploration and resolution of ambivalence.
  • 5. CYCLE OF CHANGE Pre- Relapse contemplationMaintenance Contemplation Active Changes Decision
  • 6. STAGES OF CHANGE• [1] PRE CONTEMPLATION: avoidance/resistance/denial.• [*] Moving On: the seeds of change?• [2] CONTEMPLATION: embryonic consideration/midst resistance.• [*] Moving On: signs of cognitive & affective arousal.
  • 7. S of C {cont}• [5] MAINTENANCE: by now process in train/dynamics of personal change.• [*]Moving On: emphasis on nurturing and enhancing hard won changes; keeping clear of old environments/influences.• [6] TERMINATION or RECYCLING: „the new life‟ or recognition of relapse as a manifestation of imperfection. Uncertainty as learning.
  • 8. S of C {cont}• [7] CONTINUING TO GROW: the individual as free from….or else relapse. Freedom via painful journey versus relapse as learning.
  • 9. [8] RELAPSE: one step back two steps forward?• Learning the lessons of relapse.• Most people need more than one attempt, and to budget more time, energy and money.• Being prepared for complications.• Being aware that small decisions lead to big ones.• Being aware that distress precipitates relapse.
  • 10. FOUR GENERAL PRINCIPLES OF PRACTICE• Express Empathy: the capacity of the facilitator to be as if in the other person’s boots.• Develop Discrepancy: working assuredly, but without resorting to moralising, with the contradictions in what the client is saying to you, as facilitator.
  • 11. • Roll with Resistance: clients are likely to resist change; effectiveness in this context is about not getting sucked into providing them with your solutions/knowing what‟s good for them.• Support Self Efficacy: in pursuing the previous 3 stages a practitioner using MI is helping create a safe space for the individual to renew and grow.
  • 12. CENTRALITY OF AMBIVALENCE• A seeming yearning to move beyond an addictive behaviour yet retaining an attraction to it {Miller and Rollnick, 2002. Ch1].• Yet at the same time it can be taken as a normal component of human behaviour [ibid.].• As the authors contend: “Ambivalence is a reasonable place to visit, but you wouldn‟t want to live there.”•
  • 13. • 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……..• Eclipsed by Double Approach-Avoidance i.e. moving away from option A only for it to become again attractive as B looms closer.
  • 14. MI HEALTH CONTEXT• Rollnick, Miller & Butler {2008, p.4.}-twenty first century emphasis on „those things that people can do to improve their health.‟• p.5 „MI works by activating patients‟ own motivation for change and adherence to treatment.‟• P.5. Assumptions can be readily made in relation to a person being unwilling to change i.e. that they are the matter and things are stuck: „These assumptions are usually false.‟• p.7. Instead of being prescriptive re client lack MI seeks to activate what they already have. This may include recognition of his right not to change.
  • 15. SOME DANGEROUS ASSUMPTIONS• This person ought to change; wants to change.• This person is essentially motivated by „xyz.‟• The intervention is only a success if s/he agrees to change.• „I‟m the expert, it‟s up to her to follow my advice.‟• „S/he needs a tough approach, these people respond best to it.‟
  • 16. In practice
  • 17. OPENING APPROACHES• Open Questions• Reflective Listening• Summarising• Affirming• Eliciting Change Talk
  • 18. REFLECTION AS CORE• Repeating• Re-phrasing• Paraphrasing• Reflection of feeling• Double sided reflection• Amplified Reflection
  • 19. AMBIVALENCE• I don‟t want to change………I ought to change• Don‟t want to talk about it…..I want to talk about it• It‟s not necessary……………I could put my mind to it and…
  • 20. BELIEFS THAT OPEN THE DOOR• My current behaviour is bad for me {person gives emphasis}.• I would be better off if I change {again person giving emphasis}.• If I try to change I can be successful {here person draws on own confidence reserves}.• This is a good time to do it. {person seizes on the moment/drawing on own confidence}.
  • 21. RESPONDING TO CHANGE TALK• Reflect it back to the person.• Encourage more change talk.• Encourage person to illustrate with examples.• Affirm her in efforts, highlighting change oriented values and behaviours.• Summarise to affirm where „she‟s at‟, to hold clarity.
  • 22. BUILDING CONFIDENCE• Key art/skill of brainstorming, using permissive questions.• Accent on enabling person to develop clarity with review ongoing.• What has worked/not worked for you in the past/previous attempts?• Have you been impressed by anything that has worked for someone else?
  • 23. DEVELOPING DISCREPANCY• All of us exhibit discrepancies between where we are and where we want to be in our development processes.• Facilitate the person to affirm her key values.• Identify gaps in consistency in a non judgemental fashion.• Encourage the person to look at the consequences.• Remember arguments for change must belong to the person herself.
  • 24. READINESS TO CHANGE [signs of]• Decreasing resistance.• 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.• Genuine experimentation.
  • 25. References• Arkowitz, H. Westra, H, Miller, W. & Rollnick, S {Eds} {2008} Motivational Interviewing in the Treatment of Psychological Problems. The Guilford Press: New York.• Edward L. Deci and Richard M. Ryan. The “What” and “Why” of Goal Pursuits:Human Needs and the Self- Determination of Behavior. Psychological Inquiry 2000, Vol. 11, No. 4, 227–268.• Fuller, C & Taylor, P {2nd Ed. 2005} A Toolkit of Motivational Skills. John Wiley & Sons Ltd.• Miller, W. { Second Edition} {2002} Motivational Interviewing: Preparing People for Change. The Guilford Press: New York.
  • 26. References {Cont}Prochaska, J. Norcross, J. and Di Clemente, C. {1994}Changing for Good: The Revolutionary Program That Explainsthe Six Stages of Change and Teaches You How to FreeYourself from Bad Habits . William Morrow and Co.Rollnick, R. Miller, W. & Butler, C. {2008} MotivationalInterviewing in Health Care. Helping Patients ChangeBehaviour. The Guilford Pres: New York.Richard M. Ryan and Edward L. Deci. Self-DeterminationTheory and the Facilitation of Intrinsic Motivation,SocialDevelopment, and Well-Being. January 2000 • AmericanPsychologist