Motivational Interviewing Chapter 1 - Why People Change

Why do people change? People change because they want to and they change for what they value.

Why do people change? Your job is to increase motivation for change by decreasing resistance and identifying what they value then showing them how change can get them MORE of what they value.

People don't change for what YOU value. You can't "make" anyone change But you can facilitate change.

Why do people change? People don't change because they "should" or because it makes sense.

Why do people change? For example: Medication and treatment compliance problems are the norm Obese people continue to overeat Diabetics continue to eat sugar Smokers continue smoking even after they get cancer or emphysema Addicts continue to use

People change when they are ready, willing and able to. Why do people change?

Treatment doesn't "make" people change. (YOU don’t “make” people change). In many problem areas, positive change often occurs without formal treatment.

Take a deep breath and let yourself off the hook. Hang up your "world savior" crown. ;) Helping and Listening to someone is different than “fixing” or “saving” them.

Why do people change? Stages and processes by which people change seem to be the same with or without treatment

Why do people change? Treatment can be thought of as facilitating what is a natural process of change However….

Why do people change? It is possible to speed or facilitate change…. But proceed with caution, because….

Why do people change? It's also possible to create resistance to change in another person by being pushy, bossy or insistent that things must be your way

Effects of faith and hope Placebo Effect: The effect of believing is so strong that placebo is the standard against which new medications must be tested.

Effects of faith and hope The counselor, doctor, or teacher also holds beliefs that are powerful and can create self-fulfilling prophecies.

Effects of faith and hope Perceived prognosis influences real outcomes.

Counselor Effects Findings are typically inconsistent about patient characteristics. However, certain characteristics of therapists are associated with successful treatment.

Counselor Effects Characteristics predicting high patient dropout rates can be as subtle as the doctor's tone of voice. The way in which one interacts with people appears to be at least as important as the specific approach or school of thought from which he or she operates.

Carl Rogers Carl Rogers and his Person-Centered Theory is part of the influence behind Motivational Interviewing. Person Centered Therapy is about- accurate empathy, nonpossessive warmth and genuineness. These counselor traits seem to be effective in building rapport and creating lasting change.

Counselor Effects A recent personal history of the same problem area (e.g., alcoholism) may compromise a counselor's ability to provide critical conditions of change because of over-identification.

Counselor Effects Confrontational counseling has been associated with a high dropout rate and relatively poor outcomes. The more a counselor confronted during treatment, the more the person drank.

Change-Talk Effects Ask people how confident they are that they can succeed in making a particular change, and their answer is a reasonably good predictor of what will happen.

Change-Talk Effects Change talk and resistance are substantially influenced by counseling style. Counsel in a directive, confrontational manner and client resistance goes up.

Change-Talk Effects Counsel in a reflective, supportive manner, and resistance goes down while change-talk increases.

Why People Change People who believe that they are likley to change do so. People whose counselors believe that they are likely to change do so. Those who are told that they are not expected to improve indeed do not.

Why People Change What people say about change is important. Statements that reflect motivation for and commitment to change do predict subsequent behavior. Part of your job is to listen for those statements (called 'Change Talk') and reflect them back to the client so they can hear what they just said.

Ready, Willing and Able Ready: A Matter of Priorities One can be willing an able to change, but not ready to do so. Relative priorities are a part of normal human functioning

Ready, Willing and Able Willing: The importance of change The extent to which the person wants, desires and wills change

Ready, Willing and Able Willingness is influenced by the degree of discrepancy between status and goal, between what is happening at present and what one values for the future. Thermostat Develop discrepancy - To enhance the perceived importance of change

Ready, Willing and Able Able: Confidence for Change Sometimes a person feels willing but not able to change (i.e. I need to move but I don’t have the money)

If a person becomes alarmed by a discrepancy but perceives no way to change, however, then something else happens. Instead of changing behavior, people reduce their discomfort by shifting their thought process and perceptions in a way that is often called "defensive". (i.e. Defense Mechanisms)