Elements of Motivational Interventions & Principles of Motivational Interviewing
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This document discusses elements of motivational interventions and principles of motivational interviewing. It defines motivation as a dynamic state influenced by emotional, cognitive, social and environmental factors. The document outlines six characteristics of motivation and identifies the three critical elements of motivation as willingness, ability and readiness. It reviews five principles of motivational interviewing and five elements of motivational approaches, including the FRAMES model. Various activities and techniques for enhancing client motivation are provided, such as decisional balance exercises, developing discrepancies between goals and behavior, and maintaining personal contact.
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Elements of Motivational Interventions & Principles of Motivational Interviewing
- 1. Elements of Motivational Interventions & Principles of Motivational Interviewing Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 1
- 2. Objectives Learn how motivation is dynamic Explore reasons and methods for enhancing motivation Identify 3 critical elements of motivation Delineate the 5 elements of motivational approaches Review the FRAMES model Identify ways to deal with resistance Review how to use decisional balance exercises AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 2
- 3. Why Enhance Motivation? Inspiring change Preparing clients to enter treatment Engaging and retaining clients in treatment Increasing participation and involvement Improving treatment outcomes Encouraging a rapid return to treatment if symptoms recur Creates a therapeutic partnership AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 3
- 4. 6 Characteristics of Motivation Motivation is positive and a key to change Motivation “harnesses” energy to use to accomplish a task What happens when you are not motivated– To clean, exercise, work AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 4
- 5. 6 Characteristics of Motivation Motivation is multidimensional 1. Emotional 2. Mental 3. Physical 4. Social Support and Pressures 5. Legal 6. Financial Cube activity #1 On a large box identify all the reasons to NOT change on each face Can include drawbacks to change and benefits to staying the same Discuss ways to eliminate those drawbacks #2 Get small-ish square boxes for clients to decorate On each face of the cube, have them identify motivations for change AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 5
- 6. 6 Characteristics of Motivation Motivation is multidimensional Scale Activity Get at least 10-20 regular marbles and 10 shooter marbles (bigger) Get (or fashion a scale) One side is labeled “change” the other side is labeled “same” Write on the white board 2 columns Benefits to Staying the Same (and drawbacks to change) Benefits to Change (and drawbacks to staying the same) Have clients complete each list Then talk about how some “reasons” carry more weight. Bring out the scale and stones. Have clients assign a “weight” to each reason and deposit it in the appropriate side Goal is to see that it is about the total weight that tips the balance AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 6
- 7. 6 Characteristics Motivation is dynamic and fluctuating Is a dynamic state that can fluctuate over time and in relation to different situations rather than a static personal attribute Can vacillate between conflicting objectives Differs between objectives Varies in intensity, faltering in response to doubts and increasing as doubts are resolved and goals are envisioned more clearly. Example: Getting Healthy Nutrition Exercise Sleep What conditions would make you motivated and what conditions would undermine your motivation? AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 7
- 8. 6 Characteristics Motivation is dynamic and fluctuating SMART Goals increase efficacy Specific Measurable Achievable Relevant Time Limited Examples Get healthy to reduce my risk of cancer Lose weight to get my partner to pay attention to me AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 8
- 9. Goal Setting Activities Out of the Hat Write goals on strips of paper and put them in a hat or box Have clients draw a strip and restate the goal in specific, measurable, Achievable, Relevant and Time limited terms The strip might say: Lose Weight The client might say: Lose 10 pounds in 2 months so I am more comfortable in my clothes The strip might say: Not be depressed The client might say: Increase my overall happiness to a rating of 4 out of 5 at least 5 days per week in the next 8 weeks. The strip might say: Improve my relationship The client might say: Reduce arguments with my partner to less than 2 per week and spend at least 1 day per week together doing something enjoyable. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 9
- 10. 6 Characteristics Motivation can be modified/changed Social Influences (Media, friends, who you are doing it for) Emotional Mental Physical Legal Financial Environmental Pressures (nonsmoking buildings, custody) Distress Levels (Raising the bottom) Critical Life Events (loved one dying of cancer) Activity Use the same goals as in the Goal Setting Exercise to identify ways to increase motivation (Weight loss, depression…) AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 10
- 11. 6 Characteristics Motivation is influenced by clinician’s (and client’s) style Nonpossessive warmth & friendliness Genuineness Respect Validation Empathy Talk about the successes as well as the challenges Motivation is purposeful and intentional AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 11
- 12. Help Increase Motivation Counselor Techniques OARS Open ended questions Respect the client's autonomy Affirm their ability to succeed Recognize co-occurring disorders, acknowledge difficulties Employ client centered treatment Reflective listening Using empathy more than authority. Validate client experience Summarize Focus on client strengths, successes and personal power AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 12
- 13. CRAVE Check In Compassion—I am human. I am here. Report how the week went Acknowledge difficulties Validate Explain how they used their strengths and personal power to create successes (even if it is just to try again the next day) AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 13
- 14. Critical Elements of Motivation (WAR) Willingness involves the importance a person places on changing—how much a change is wanted or desired. Activity: Yes, but…. Write a goal on the board and have clients think of as many yes, buts for getting started on that goal as possible. When you are finished, discuss ways to deal with those objections. Ability refers to the extent to which the person has the necessary skills, resources, and confidence to carry out a change. Activity: Review the SMART goals the group created (or start with new ones). Discuss what skills and resources a person needs to accomplish the goal and how to acquire those. Readiness represents a final step in which the person decides to change a particular behavior. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 14
- 15. 5 Principles of Motivational Interviewing Express empathy through reflective listening. Develop discrepancy between clients' goals or values and their current behavior. Avoid argument and direct confrontation. Adjust to client resistance rather than opposing it directly. Support self-efficacy and optimism. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 15
- 16. Elements Of Current Motivational Approaches The FRAMES approach Decisional balance exercises Discrepancies between personal goals and current behavior Flexible pacing Personal contact with clients in treatment AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 16
- 17. Help Increase Motivation Help clients Develop discrepancy between their goals and actions Address the drawbacks to change Address the benefits to staying the same Feel competent to change Developing a plan for change Begin to take action Continue to use strategies that discourage a return to the old behavior AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 17
- 18. A Note About Resistance Resistance and yes, buts are signs that what you are asking is Too threatening Not sufficiently rewarding Already known to fail Activity: Have clients identify activities that they resist doing. Dieting, ending a relationship, medication, entering treatment AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 18
- 19. FRAMES Feedback regarding personal risk or impairment Responsibility for change is placed squarely and explicitly on the client Advice is clearly given to the client by the clinician in a nonjudgmental manner. Menus of self-directed change options and treatment alternatives are offered to the client. Empathic counseling Self-efficacy is engendered in the client to encourage change. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 19
- 20. Feedback Feedback should help a client Understand the information Interpret the meaning Gain a new perspective about the personal impact of the behavior Consider changing. Recognize a discrepancy or gap between future goals and current behavior. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 20
- 21. Responsibility Give individuals the responsibility and opportunity to decide when and whether they will change their behavior Encourage clients to choose their treatment and be responsible for changing Do not impose views or goals on clients. When clients are free to choose whether to change, they Feel less need to resist or dismiss the clinician’s ideas Feel empowered and more invested in treatment May be more willing to negotiate common treatment goals with the clinician. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 21
- 22. Advice The most appropriate time to give advice is when a client requests it. As with feedback, the manner in which the clinician advises clients determines how the advice will be used. Suggesting yields better results than telling clients what they should do. If a client requests direction, the clinician can— First clarify what the client wants Give simple advice that is matched to the client’s level of understanding and readiness, the urgency of the situation, and the client’s culture. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 22
- 23. Menu of Options When clients make independent decisions, they are likely to commit to them. Offering a menu of options decreases dropout rates and resistance to treatment and increases overall treatment effectiveness. Provide accurate information about each option and a best guess about the implications of choosing one particular path Elicit from clients what clients think would be effective or what has worked for them in the past Reinforce clients’ ability to make informed choices. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 23
- 24. Empathy Empathic counseling can be particularly effective with clients who are angry, resistant, or defensive. Explore the reasons why the client might be angry, afraid or resistant Allow the client to do most of the talking in a safe environment Allow the client’s change process to unfold, rather than directing or interrupting it Communicates respect for and acceptance of clients and their feelings Encourages a nonjudgmental, collaborative relationship AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 24
- 25. Self-Efficacy Clients must— Believe they are capable of undertaking specific tasks Have the skills and confidence needed to change. Clinicians help clients develop self-efficacy by— Reinforcing clients’ beliefs in their capacities and capabilities Believing in clients’ ability to change Helping clients identify how they have coped successfully with problems in the past and build on those successes Reinforcing small steps and positive changes Foster hope and optimism in clients Reframing past “failures” as partial successes Using questions beginning with “What else” AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 25
- 26. Failure Activity Failure is virtually inevitable sometimes. Look up quotes about failure. Create a Failure Flag On each stripe write a sentence that gives meaning to failure… Failure means… Discuss how this applies to prior failures AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 I took a risk I learned what not to do I got outside my comfort zone I grew as a person 26
- 27. Flexible Pacing and Personal Contact Pacing Meet clients at their levels Use as much time as necessary with the essential tasks of each stage of change. Personal Contact: letters or telephone calls Effective for encouraging clients to— Return for another clinical consultation Return to treatment following a missed appointment Stay involved in treatment Adhere to a plan for change. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 27
- 28. Personal Contact Activity Write letters to themselves To remind them to reflect on how far they have come To reflect on what they have learned (from themselves of each other) To encourage them to keep going To remind them of all the reasons they wanted to make the change To congratulate them on progress This can also be done as a group activity in which group members write letters to each other Old fashioned mail is often better for this because it is more personal and the letters can be decorated. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 28
- 29. Summary Motivation is dynamic, influenced by multiple types of motivation including emotional, cognitive, social, environmental Motivational Interviewing increases client’s hope and enhances treatment participation 3 critical elements of motivation: Ability, willingness and readiness 5 elements of motivational approaches The FRAMES approach Decisional balance exercises Discrepancies between personal goals and current behavior Flexible pacing Personal contact with clients in treatment AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 29
Editor's Notes
- A belief inherent in the view of motivation as dynamic is that— The client ultimately is responsible for change. This responsibility is shared with the clinician through a therapeutic partnership the concept of the clinician “healing” the client is not part of motivational enhancement approaches.
- motivational enhancement approaches view motivation as dynamic rather than static and as something that is— n Purposeful; n Intentional; n Positive; and n Changeable.
- motivational enhancement approaches view motivation as dynamic rather than static and as something that is— n Purposeful; n Intentional; n Positive; and n Changeable.
- motivational enhancement approaches view motivation as dynamic rather than static and as something that is— n Purposeful; n Intentional; n Positive; and n Changeable.
- motivational enhancement approaches view motivation as dynamic rather than static and as something that is— n Purposeful; n Intentional; n Positive; and n Changeable.
- motivational enhancement approaches view motivation as dynamic rather than static and as something that is— n Purposeful; n Intentional; n Positive; and n Changeable.
- motivational enhancement approaches view motivation as dynamic rather than static and as something that is— n Purposeful; n Intentional; n Positive; and n Changeable.
- motivational enhancement approaches view motivation as dynamic rather than static and as something that is— n Purposeful; n Intentional; n Positive; and n Changeable.
- Affirming clients— Supports and promotes their sense of self-efficacy; Acknowledges their difficulties; Validates their experiences and feelings; and Increases their confidence to take action and change their behavior. Emphasizing experiences that demonstrate strength, success, or power prevents discouragement. For some clients, affirming their inner guiding spirit and their faith helps resolve their ambivalence. Examples of affirming statements from the list below: I appreciate how hard it must have been for you to decide to come here. You took a big step. I think it’s great that you want to do something about this problem. That must have been very difficult for you. You’re certainly a resourceful person to have been able to live with the problem this long and not fall apart. It must be difficult for you to accept a day-to-day life so full of stress. If I were in your position, I also would find that difficult. Note that reflective listening— Keeps coming up because it is a critical skill in motivational approaches; and Is particularly necessary in the early stages of counseling. Reflective listening involves the counselor’s— Making a reasonable guess about what the client means; and Rephrasing the client’s statement to reflect what the counselor thinks he or she heard. Explain that reflective listening— Provides clients a different way of considering what they have said; Reduces the likelihood of resistance; Encourages the clients to talk; Communicates respect; Cements the therapeutic alliance; Clarifies exactly what clients mean; and Reinforces motivation. True reflective listening requires— Continuous tracking of the client’s verbal and nonverbal responses and their possible meanings; Understanding of the communication style of the client’s culture; Formulation of reflections at the appropriate level of complexity; and Ongoing adjustment of the clinician’s hypotheses about the client’s behavior. Summarize Note that most clinicians find it useful to summarize occasionally what has occurred in a counseling session. Explain that summarizing consists of— Distilling the essence of what clients have expressed; and Communicating it back to them. Note that summaries help clients by— Reinforcing what they said; Demonstrating that the clinician has been listening carefully; Helping clients consider their responses and experiences; and Preparing clients to move forward. A summary that links the client’s positive and negative feelings about substance use can promote an understanding of ambivalence and the recognition of discrepancy. Summarizing is a good way to review previous sessions and to end a current counseling session and provides a natural bridge when the client transitions between stages of change. The clinician should encourage the client to correct summaries. Emphasize that summarizing serves a strategic purpose; in presenting a summary, the clinician selects what information to include and what to minimize or leave out.
- Affirming clients— Supports and promotes their sense of self-efficacy; Acknowledges their difficulties; Validates their experiences and feelings; and Increases their confidence to take action and change their behavior. Emphasizing experiences that demonstrate strength, success, or power prevents discouragement. For some clients, affirming their inner guiding spirit and their faith helps resolve their ambivalence. Examples of affirming statements from the list below: I appreciate how hard it must have been for you to decide to come here. You took a big step. I think it’s great that you want to do something about this problem. That must have been very difficult for you. You’re certainly a resourceful person to have been able to live with the problem this long and not fall apart. It must be difficult for you to accept a day-to-day life so full of stress. If I were in your position, I also would find that difficult. Note that reflective listening— Keeps coming up because it is a critical skill in motivational approaches; and Is particularly necessary in the early stages of counseling. Reflective listening involves the counselor’s— Making a reasonable guess about what the client means; and Rephrasing the client’s statement to reflect what the counselor thinks he or she heard. Explain that reflective listening— Provides clients a different way of considering what they have said; Reduces the likelihood of resistance; Encourages the clients to talk; Communicates respect; Cements the therapeutic alliance; Clarifies exactly what clients mean; and Reinforces motivation. True reflective listening requires— Continuous tracking of the client’s verbal and nonverbal responses and their possible meanings; Understanding of the communication style of the client’s culture; Formulation of reflections at the appropriate level of complexity; and Ongoing adjustment of the clinician’s hypotheses about the client’s behavior. Summarize Note that most clinicians find it useful to summarize occasionally what has occurred in a counseling session. Explain that summarizing consists of— Distilling the essence of what clients have expressed; and Communicating it back to them. Note that summaries help clients by— Reinforcing what they said; Demonstrating that the clinician has been listening carefully; Helping clients consider their responses and experiences; and Preparing clients to move forward. A summary that links the client’s positive and negative feelings about substance use can promote an understanding of ambivalence and the recognition of discrepancy. Summarizing is a good way to review previous sessions and to end a current counseling session and provides a natural bridge when the client transitions between stages of change. The clinician should encourage the client to correct summaries. Emphasize that summarizing serves a strategic purpose; in presenting a summary, the clinician selects what information to include and what to minimize or leave out.