The Basics

Clinician role – Persuasion Explain why s/he should make this change Give 3 specific benefits of making the change Tell him/her how to change Emphasize importance of the change Tell the client to do it!

Debrief Readiness is not static Importance of matching strategies to readiness Role of Ambivalence

Ambivalence Is normal Occurs throughout the change process Reflects costs and benefits of change and status quo Is uncomfortable May become chronic Resolved by client

Righting Reflex Born of concern and caring There’s a problem? Let’s fix it! Fails to consider ambivalence in change process May engender resistance

Therapeutic Traps Question-Answer Trap Trap of Taking Sides Expert Trap Labeling Trap Premature Focus Trap Blaming Trap

Talk about something real that you: Want to change Need to change Should change Have been thinking about changing But, haven’t yet changed. Not your deepest, darkest secret! Listen carefully - goal to understand the dilemma Ask these four questions: Why would you want to make this change? How might you go about it, in order to succeed? What are the three best reasons to do it? On a scale of 1-10, how important would you say it is to make this change? And why are you a ___ and not zero?

Change Change is more similar than different across behaviors Change is a process that is continuous like a dimmer switch, not discrete like an on/off switch Change depends on MOTIVATION which is a state not a trait. It’s a probability, a likelihood. Because of this, there are multiple ways and times that change can derail Fortunately, there are multiple ways and times to facilitate the process

Stages of Change Prochaska & DiClemente

Precontemplation Awareness of need to change, increased concern Contemplation Increasing the Pros for Change and decreasing the Cons, Confidence Action Implementing and Revising the Plan Stages of Change Model Relapse and Recycling Maintenance Integrating Change into Lifestyle Preparation Commitment & Planning

Processes of Change COGNITIVE/EXPERIENTIALBEHAVIORAL Consciousness RaisingSelf-Liberation Self-Revaluation Counter-conditioning Environmental Reevaluation Stimulus Control Arousal/Dramatic ReliefContingency- Management Social Liberation Activities initiated or experienced by an individual in modifying thinking feeling and behavior related to a particular problem

To Sum Up Change is continuous This continuity can be “broken up” into stages Assessment is about getting a sense of stage People rely on change process to move through stages Counselors can help and hinder Multiple spirals are the rule Motivation is the fuel

Motivation The probability of engaging in and maintaining a behavior over time. What are the three key words? Probability (0 – 1) not (0 or 1). Engage Maintain Motivation is continuous not dichotomous Fluctuating motivation can increase or decrease based on your behavior

Factors Influencing Motivation Client Factors Health Perseverance/Task Persistence Task difficulty Belief in the efficacy of the program Interest level Importance Confidence External barriers Values Counselor Factors Much The Same………….

Motivational Interviewing: A Definition “ MI is a collaborative, goal oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”

Spirit of MI Autonomy Personal responsibility Neither imposition nor coercion Collaboration Meeting of aspirations Neither exhortation nor persuasion Evocation Drawing out Neither instilling nor installing

MI Principles Express Empathy Empathy alone is predictive of change Roll w/Resistance Verbal judo Develop Discrepancy Goals and values contrasted with current behavior Support Self-Efficacy R – Resist the righting reflex U – Understand you client’s motivation L – Listen to you client E – Empower your client

MI Fundamental Processes These are the “phases” of the overall process of engaging in MI with a client. These phases are not rigid and we often move back and forth between the phases as we work with clients. Engaging – The Relational Foundation Focusing – The Strategic Focus Evoking – The Meat and Potatoes Planning – The Bridge to Change Often MI is about knowing how to skillfully and artfully move back and forth between each process

How Does MI Work Empathy allows clients to reduce resistance and resolve ambivalence Looking at the situation from their perspective People feel understood; less resistant Selective reinforcement of change talk Focus on change talk We learn what we believe when we hear ourselves speak Therapist reinforces change talk that is consistent with therapeutic goals (person’s values) Reinforcement further increases change talk and allows of client to experience build in motivation to change

Empathic Counseling Style and Patient Response Miller, Benefield & Tonigan (1993) JCCP 61:

Change Talk Client utterances that favor change, are linked to a specific behavior(s), come from client (in most cases), and are in the present tense. Preparatory Language (DARN) Desire “I want” Ability I’m able” Reasons (for change) “Here’s why” Need (disadvantages of status quo) “If I don’t”

Change Talk Implementing Language (ACT) Activation (prepared, willing) Commitment “I’m going to” “I will” “I plan to” Taking Steps “I did” “I went” “I started” It is the change in this talk over the course of the session that predicts change

Commitment Language Pattern A

Outcomes for Pattern A Group

Commitment Language Pattern B Amrhein et al., Journal of Consulting & Clinical Psychology :

Outcomes for Pattern B Group