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Enhancing Motivation
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Transtheoretical Model of the Stages of Change
History Motivational Interviewing Transtheoretical Model of the Stages of Change Mostly Theoretical Prochaska & DiClemente Mostly Application Miller & Rollnick
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Change Talk OARS MI Spirit MI Principles
Help clients articulate reasons for change. Open-ended Questions Affirmation Reflective Listening Summaries OARS Change Talk MI Spirit MI Principles Evocation Collaboration Autonomy Resist righting reflex Understand motivation Listen Empower
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1 Practice MI Upset Husband: I’m just furious that she lied to me and had this affair behind my back. I can’t believe I didn’t see it. I feel like such an idiot. Response: In retrospect, what signs did you overlook?
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2 Practice MI Rehab Client: They told me that I have to have this surgery right away. But I don’t trust them, so I haven’t scheduled it yet. Response: Why take the chance? They’re the experts. Let’s call from this phone right now. Maybe you can get int this week.
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Eliciting Change Talk
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Change Talk Represents statements about change
Linked to a specific behavior or goal Comes from the client Refers to present situation
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Continuum of Change I wish things were different Desire
I know how to change Ability It would be great if I changed Reason I really need to change Need I am going to change Commitment/Taking Steps
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Evocative Questions In what ways does this concern you?
How would you like things to be different? How would things be better if you changed?
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Elaboration Tell me about a time you (engaged in maladaptive behavior) What does it look like when you Tell me about a time before you . . .
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Using Extremes Worst outcome vs. best outcome What concerns you the most? What is the worst that could happen? What do you hope for the most? What would a perfect outcome be?
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Looking Back Do you remember a time when things were going well? What has changed? What did you want to do when you graduated from high school? What is the difference between you now and you twenty years ago?
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Looking Forward If nothing changes, what do you see happening in 5 years? If you decide to change, what will it be like? What are your hopes for the near future?
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Exploring Goals Use value card sort What are some things you regard as important? How does drinking fit in with that? What sorts of things do you want to accomplish in your life?
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Use Feedback Your scores on the Cognistat indicate that you have moderate deficits in problem solving and memory. How does that fit with your own experience?
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Readiness Rulers On a scale of 1-10, how confident* are you – if you made a decision to change – that you could change, when 1=not at all confident and 10= extremely confident? What led you to choose 6 rather than a 3? What would it take to move from a 6 to a 7 or 8? * or important
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Skill Practice
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Reinforcing Change Talk Handout
I wish things were different Desire I know how to change Ability It would be great if I changed Reason I really need to change Need I am going to change Commitment/Taking Steps
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Identifying Readiness
1 Identifying Readiness So, what do other people say about this? I just can’t believe that people just cave in when they hear recommendations sending them to a halfway house. Signs? Your reasoning:
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Identifying Readiness
2 Identifying Readiness I agree it would be good to make some different choices that have less risk, but I also like to have fun with my friends. I have too much fun with them. Signs? Your reasoning:
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Identifying Readiness
3 Identifying Readiness You don't understand. These guys aren't going to take "No, thanks" for an answer. They're going to hound me. I've got to come back with something stronger. Signs? Your reasoning:
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Identifying Readiness
4 Identifying Readiness I don't see any point in talking about it. Signs? Your reasoning:
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Ambivalence Strategies: ICAN
1 Ambivalence Strategies: ICAN "I don't want my mother brought into this. I don't see why she would need to be. I know some things need to change, and I have been talking about this with my dad. I live with him and he pays the bills, so I think it makes sense to talk with him. I know I need to get some things going, if I'm going to graduate. I've been talking with my teachers-more or less-and I think I know what I need to do. I am a little worried about all of the things that I have to do between now and the end of the year."
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Ambivalence Strategies: ICAN
2 Ambivalence Strategies: ICAN "I didn't like the way I felt on the medications. There were just too many side effects. So, I stopped. I haven't taken anything since I was 18. But I think I need to do something. Nothing feels good. I'm always anxious. I can never get comfortable. Sometimes I just sit at home because it just feels like too much of an effort to go out. But then I start getting depressed and nothing feels good. That's where I'm at now. This is my first time out of the house in 3 weeks."
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Ambivalence Strategies: ICAN
3 Ambivalence Strategies: ICAN "I have made a decision to eat healthier. I just think it would be better for my health if I did that. My follow-through isn't always as good as my intentions, and I do have a sweet tooth. But I've tried to be more judicious in my eating of those things generally. I would like to eat more salads. Breakfast and lunch, and even dinner, for that matter, are generally OK. I have one problem area -snacking at night. I like ice cream, and that is a problem. I'm not crazy about fruit as a substitute, even though I know it would be better for me. I can manage those other areas, but that nighttime stuff needs some work."
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Continuing on as Before
Making a Change Benefits Costs Helps me relax Feel like I fit in Don’t worry about the bills Love the buzz I get Legal Trouble Can’ see my kids – wife won’t let me Paying for my attorney and court costs People don’t trust me Won’t have a way to relax What about my friends? Life will be boring Family would trust me again Marriage would go better Better at my job More Money Get off probation sooner
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References www.motivationalinterview.org
Miller, W. & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press. Rosengren, D. (2009). Building motivational interviewing skills. New York: Guilford Press.
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