1. Motivational INTERVIEWING
CHAPTER 4
UZM PSK OZLEM ATAOGLU

2. Any activity that leads to change in your cognitions, emotions and behaviours is the beginning of a change process
In order to make any change in your life, you have to have a motivation because irrational/dysfunctional or not, every thought, emotion and behaviour has a function in your life
Especially you need to create a motivation for substance abuse patients because this is a life style for them
Regardless of their mood/situation, anything can create a reason for substance use

3. Motivation is not a personality trait, it appears with attraction
So, as a therapist your job is to create that attraction in your patient – show the positive and negative outcomes of that specified behaviour and their reflections on his/her life
The assumption in motivational interviewing is that the responsibility for change belongs the person, him/herself and that capability lays within that person
All you need to do is to find that capability, show it to the patient and make him/her take his/her actions’ responsibility  create some circumstances so that the patient becomes motivated for change

4. What do you have to do as a therapist?
Create empathy and show it: You, as a therapist, need to show empathy without criticism, accusation, judgment and to listen actively, trying to understand the patient’s situation and perspective
The patient probably is not ready for change at the beginning, even if s/he has consulted. You need to first create a therapeutic bond and alliance with your patient.
Instead of suggesting change, give the notion that s/he will be there for him/her all the way as a support

5. Show incompatibilities: One of the main aims of the motivational interviewing is to show the incompatibility between the past behaviours & their consequences and the future goals of the patient
You can do this by discussing the outcomes of substance use; evaluating the pros & cons of change
We aim here to make the patient discuss the change and understand how it can be done

6. Avoid arguments: Since these patients are labeled as alcoholics and/or drug addicts, you as a therapist should absolutely avoid these kind of labeling words in order to be a different person in their lives
If you realize a resistance then it is time to change your way of intervention
The key point here is that many people are not motivated or lose motivation if their efforts are not supported and/or are put in a situation that they need to defend their behaviours

7. Deal with resistance: When you face with resistance, you should not suppress this but instead let it out because otherwise you may miss some very important information that your patient may give about this lack of motivation
You need to reflect your patient’s questions and concerns in order your patient to take into account all of the possible choices
By this way the patient probably find the possible answers by him/herself, for the next time sharing concerns and emotions will not be a scary experience

8. Support for individual effectiveness: Give the idea that you believe your patient is able to do this by him/herself
To give this idea, you may show him/her some previous positive experiences/changes that s/he has succeeded individually
Another way is to show the importance of taking responsibilities
At the end, since the patient feel there is a warm, supportive, trustworthy, strong relationship with the therapist, the belief and confidence of individual effectiveness will increase
Your first aim in motivational interviewing is not force people for change but prepare for change, provide motivational situations

9. CHANGE PHASE
Awareness: Learning information about the self and the problem itself. Increasing knowledge raise awareness and create motivation for change
Affective - commitment: It flows with awareness. You need to stimulate emotions to create affective - commitment. Films, informative ads, etc. can be used. We aim here to increase the emotional depth and lead to actions.
Reevaluation of self: The aim here is to foresee the outcome when the patient has overcome this problem. Reevaluation makes the patient see how this behaviour contradicts with personal values. The questions can be asked: Kendimi şişman biri olarak nasıl hissediyorum? Davranışımı değiştirmek nasıl olurdu? Ne uğruna böyle bir değişime girebilirim? Getiri ve götürüler neler olabilir?

10. Action: When you decide for change, you take its responsibility
Action: When you decide for change, you take its responsibility. Responsibility is a burden, as well. It’s accepting that the actions that are done for the self, not for anyone else. First step is to tell yourself that “Değişmeyi seçiyorum.” Second step is to tell your close ones that you have decided for change. This will create a pressure on the self to stand behind that decision.
Defiance: Generally we have unhealthy reactions. We tend to consume alcohol when we are anxious, we are in need to smoke when bored, eat more food when we are out, etc. What we aim is to try to create healthy reactions to the situations.
Control the outer world: This is also action – oriented. This is restructure our outer world and connections that triggers the problem. In defiance, we regulate our reactions to specific stimuli but in this, we control probable triggers.

11. Find communal support: These are the choices that the outer environment offers the patient in order to maintain the change – non smoking areas
Reward: People can punish themselves for problematic behaviours and can also give reward for performed desired behaviours. It is actually more effective for change than punishment. Praising the self, celebrating, approving are the easiest ways of rewarding. Buying a present with that money for yourself is another way or someone else can buy a present.
Have supportive relationships: The big responsibility is on the patient but s/he can always (sometimes need to) take support from others. The patient can ask for help and tell what s/he is expecting from them in this journey. Only listening and reflecting can be really effective for them.