Understanding the factors that determine the behaviours of young people A talk by Karim Ghalmi 25.06.15 South Oxfordshire Food and Education Academy Didcot

Setting the Scene

Factors that determine Behaviour

Culture Family Social Group Lifestyle Environment Behavioural Skills Thoughts Feelings Physical factors

Start Exit Lapse Premature Exit Cycle of Change Contemplative   Relapse Contemplative Pre-Contemplative Decision Active Change Maintenance Lapse (After Prochanska & Di Clemente, 1982)

(Cognitive) Games People Play “I can’t help – I’m ill” (Justification by using the disease model) “My wife made me do it” (Abdication of responsibility) “That will show them” (Relapse as punishment for perceived injuries) “I can control it this time” (Planned relapse on the basis of ill-founded prediction) “I’ve earned it” (Relapse as an unlikely vehicle of positive reinforcement for sustained abstinence!) “Life’s hell anyway” (The devaluation of abstinence as a vehicle for relapse) “See? You can’t make me stop” (Relapse as an assertive gesture or attempt to establish autonomy) “Me? I’m not relapsing” (Denial) “I’ll never relapse – I’ve got it cracked” (Unrealistically optimistic predictions) “Everyone relapses – It’s just a matter of time” (Unrealistically pessimistic predictions)

High Risk Situation (External) Interpersonal Determinants Interpersonal conflict Social Pressure Negative Emotional States Positive Emotional States Testing Personal Control – trigger seeking behaviour Urges and Temptations (Internal)

Cognitive – Behavioural Model of the Relapse Process Effective coping response Increased self- efficacy Decreased probability of relapse High-risk situation Decreased self- efficacy Positive outcome expectancies (for sophisticated coping mechanisms) Ineffective coping response Increased probability of relapse Lapse

Facilitating change

Motivational Interviewing Motivational Interviewing is a style of ‘counselling’ that can be used in the therapeutic process with young people. However, specific motivational interviewing strategies are thought to be particularly useful during initial sessions with those who are ‘contemplators’ experiencing ambivalence about changing their behaviour. SELF MOTIVATIONAL STATEMENTS Willingness Acknowledgement Desire to change COUNSELLING MICROSKILLS Fundamental to the successful use of motivational interviewing strategies are a number of client centred micro skills. Open ended questions, reflective listening, affirmation and summarising.

Stages of Change and Therapist Task STAGE Pre-Contemplation Contemplation Determination Action Maintenance Relapse THERAPIST TASK Raise Doubt Increase the clients perception of risks and problems with current behaviour. Tip the balance – evoke reasons for change, risks of not changing. Strengthen the client’s self-efficacy for change of current behaviour. Help the client to determine the best course of action to take in seeking change. Help the client to take steps towards change. Help the client to identify and use strategies to prevent relapse. Help the client to renew the processes of contemplation, determination and action without becoming stuck or demoralised because of relapse. Giving ADVICE Removing BARRIERS Providing CHOICES Decreasing DESIRABILITY Practising EMPATHY Providing FEEDBACK Clarifying GOALS Actively HELPING

FIVE GENERAL PRINCIPLES: Express Empathy Develop Discrepancy Avoid Argumentation Roll with Resistance Support Self Efficacy

Goals In essence, the goal of motivational interviewing is to have the young person talk him/herself into deciding to change their behaviour. It emphasises the young persons right to choose and accept responsibility for the decision. Method KEY STRATEGIES Exploring the Good Things and the Less Good Things. Exploring Concerns. Summarising Life Satisfaction - Looking Back - Looking Forward Self vs User - Psychological Squirm Helping with Decision making

Key Concepts Motivational Interviewing Strategies avoid Confrontation. Empathy Style of listening so that comments are reflected back in a re-framed fashion to the client. Non-judgemental attitude – not collusive, but allows the client the freedom to explore the possibility of change. Ambivalence It is a common and “natural” experience of feeling torn between wanting and not wanting to do something. The closer to change the client is, the greater the feelings of conflict are likely to be. The aim of Motivational Interviewing is to tip the balance of ambivalence in favour of action/determined change.

Summary EXPRESS EMPATHY Acceptance and respect for young person’s position facilitates change. Skilful reflective listening is fundamental. Ambivalence is normal. DEVELOP DISCREPANCY A discrepancy between present behaviour and important goals will motivate change. The young person should present the arguments for change. AVOID ARGUMENTATION Arguments are counter productive. Defending breeds defensiveness. Resistance is a signal to change strategies. ROLL WITH CLIENT RESISTANCE Statements that a young person makes can be re-framed slightly to create a new momentum towards change. SUPPORT THE CLIENT’S SENSE OF ABILITY TO CHANGE Belief in the possibility of change is an important motivator. The young person is responsible for choosing and carrying out personal change. There is hope in the range of alternative approaches available.

Thanks