كيف تساعد احد علي التغيير

1. RAGHDA ELGAMIL
DIRECTOR OF ADDICTION
TREATMENT UNIT
GSMHAT

2.  Principles of Motivational Interviewing
 How To Use Motivational Skills in Clinical
Settings
 Strategies to Avoid

3. Motivate: v. To give an incentive for action.
Motivational interviewing is a directive, client-centred style of
interaction aimed at helping people explore and resolve their
ambivalence about their substance use and begin to make
positive changes.

4. You cannot force
someone to
change, but you can
encourage
and support them.

5. Change is HARD for everyone!

6. • No Self-Efficacy or Self-Esteem
• Current and/or Childhood Trauma and Violence
• Co-Occurring Mental Health Problems, PTSD
• Health Concerns, HIV status, Hepatitis C
• Low Literacy, Education, Job Experience
• Intergenerational Cycle
• Partners who Encourage Use
• No Healthy Role Models or People who Listen

7. • Low Self-Efficacy, Self-Esteem, Self-Image
• Self-Loathing, Guilt and Shame
• Reactive Thinking – Do not see options and
alternatives
• Poor Planning/Follow-Through – may have
cognitive impairments
• Little Discipline Accompanied by an Expectation of
Failure
• Manipulative Behavior and Lack of Trust

8. Ambivalence: Feeling two ways about something.
•All change contains an element of ambivalence.
•Resolving ambivalence in the direction of change
is a key element of motivational interviewing
9

9. Ambivalence is normal
clients usually enter treatment with fluctuating and
conflicting motivations
they “want to change and don’t want to change”
“working with ambivalence is working with the heart of the
problem”
10

10. giving ADVICE
removing BARRIERS
providing CHOICE
decreasing DESIRABILITY
practising EMPATHY
providing FEEDBACK
clarifying GOALS
active HELPING
11

12. Motivational interviewing is founded on 4 basic
principles:
◦ Express empathy
◦ Develop discrepancy
◦ Roll with resistance
◦ Support self-efficacy
14

13. The crucial attitude is one of acceptance
Skillful reflective listening is fundamental to the client
feeling understood and cared about
Client ambivalence is normal; the clinician should
demonstrate an understanding of the client’s perspective
Labelling is unnecessary
15

14. Clarify important goals for the client
Explore the consequences or potential consequences
of the client’s current behaviours
Create and amplify in the client’s mind a discrepancy
between their current behaviour and their life goals
16

15. Avoid arguing against resistance
If it arises, stop and find another way to proceed
Avoid confrontation
Shift perceptions
Invite, but do not impose, new perspectives
Value the client as a resource for finding solutions to problems
17

16. Belief in the ability to change (self-efficacy) is an
important motivator
The client is responsible for choosing and carrying out
personal change
There is hope in the range of alternative approaches
available
18

17. The OARS are skills that can be used by interviewers to
help move clients through the process of change.
Open-ended questions
Affirmation
Reflective listening
Summarising
19

18. 20
Open-ended questions:
“What are the good things about your substance use?” vs. “Are
there good things about using?”
“Tell me about the not-so-good things about using” vs. “Are
there bad things about using?”
“You seem to have some concerns about your substance use.
Tell me more about them.” vs. “Do you have concerns about
your substance use?”
“What most concerns you about that?” vs. “Do you worry a lot
about using substances?”

19. 21
“Thanks for coming today.”
“I appreciate that you are willing to talk to me about
your substance use.”
“You are obviously a resourceful person to have coped
with those difficulties.”
“That’s a good idea.”
“It’s hard to talk about....I really appreciate your
keeping on with this.”

20. 22
Reflective listening is used to:
 Check out whether you really understood the client
 Highlight the client’s own motivation for change about substance
use
 Steer the client towards a greater recognition of her or his
problems and concerns, and
 Reinforce statements indicating that the client is thinking about
change.

21. Listening
• For many clients, you are the only one they may talk to
• Put yourself in someone else's shoes
• Empathy is not the same as sympathy
• Non-judgmental
• Repeat what you hear (paraphrase)
• Nod, make statements like "Uh, huh“
• Be present
• Understand how the situation affects the participant.
What affects one person may not affect another the
same way. Help participant understand the available options
• Body language

22. Body Language
– Be aware of your facial expressions
– Be aware of tone, volume, cadence (i.e. "Is there something
bothering you?" is a statement that could be said with caring and
concern, or with an "attitude" which won't get you anywhere with
client).
– Be aware of your posture and stance
– Do not fold arms or clench fists; this represents an authoritative
position which might threaten the client
–– Personal space, Maintain 2-3 feet between you and participant for
safety
– Avoid the challenge position which is eye-to-eye, toe-to-toe

23. • Ask open-ended questions. Encourage clients to find
their own answers.
• Speak clearly, slowly and simply. People may
experience confusion and have difficulty remembering
or understanding what you are saying.
• Be direct, do not use jokes
• Avoid arguments about what the participant is
experiencing, seeing, feeling.

24. • Do not corner the client … let the client discover validity of your
suggestions on her/his own.
• Do not let client’s feelings of overwhelm and multiple
problems overwhelm you.
• Let the client be the expert on herself; repeat back what she
says to be sure you understand (and let her hear that you heard
her). Let her be resourceful in finding solutions. Offer a possible
menu of solutions to client-defined problems.
• Affirm, re-enforce positive efforts.