psy1105 lecture 4 motivational interviewing 2013-1
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Lecture 4 PowerPoint SlidesTRANSCRIPT
Motivational Interviewing
Department of PsychologyUniversity of Southern Queensland
Motivational InterviewingMotivational Interviewing
adopts a respectsclient-centred the person’s but directive right to style choose
(Miller & Rollnick, 1991; Saunders et al., 1996)
2 key elements
Conceptual LevelConceptual Level Appreciate where the person is now
assess change readiness respond to stage of change accordingly support forward momentum
Conceptualise absence of change at a process level simply a stage in the change process
a behaviour operating now NOT ‘failure’ or ‘non-compliance’ or
‘lack of motivation’
Transtheoretical Model of ChangeTranstheoretical Model of Change based on Prochaska’s search for
common principles in therapy and behaviour change (1979)
compared 18 major theories 9 processes identified
empirical analysis of ‘self-changers’ vs. people in professional treatment (with DiClemente, 1982)
The 9 Common FactorsThe 9 Common Factorsadapted from Prochaska & DiClemente, 1983adapted from Prochaska & DiClemente, 1983
consciousness raising
self-liberation
social liberation
self-re-evaluation
emotional arousal
I look for information related to ….
I tell myself I am able to change if I want to.
I notice social cues supporting the change
My current behaviour causes me distress.
Concern about my current behaviour effects me emotionally
Common factors, cont. environmental control
counter-conditioning
reward
helping relationships
I remove things from my immediate environment which support the problem behaviourI do something else (eg instead of smoking, if I need to relax)I am rewarded by friends/ family for change
I have someone I can talk to about problem behaviour / change
The 6 Stages The 6 Stages of Changeof Change
ActionAction PreparationPreparation
ContemplationContemplationMaintenanceMaintenance
RelapseRelapse
Pre-ContemplationPre-ContemplationPermanent Exit..?Permanent Exit..?
(Prochaska & Di Clemente, 1991)
Stages in the Change Model 1Stages in the Change Model 1
Pre-ContemplationPre-Contemplation not yet ready, willing and/or able
ContemplationContemplation currently weighing pro’s and con’s
PreparationPreparation decision made to change behaviour
Stages in the Change Model 2Stages in the Change Model 2
ActionAction practicing new behaviour 3-6 months
MaintenanceMaintenance continuing commitment to new behaviour
RelapseRelapse resumed old behaviour – “off the wagon” seen as learning spiral towards change
Working With Pre-ContemplationWorking With Pre-Contemplation
validate and clarify OK to be where they’re at choice for change remains theirs
support re-evaluation of behaviour explain the risk in terms that make
sense for the person in their world
Working With ContemplationWorking With Contemplation validate and clarify
OK to be where they’re at choice for change remains theirs
support re-evaluation of pro’s and con’s of behaviour change help to identify and advocate
positive expectations for change
Working With PreparationWorking With Preparation identify obstacles to change
assist in problem solving assist in identifying social support
check skills OK for change assess level of perceived efficacy identify and encourage first steps
towards change
Working With ActionWorking With Action re-frame cues that lead to
problem behaviour check continued social support
reinforce self-efficacy strategies for managing obstacles
to change reflect feelings of loss, grief reinforce long-term benefits
Working With MaintenanceWorking With Maintenance
plan for continued support ensure ongoing links
reinforce internal rewards validate persistence discuss relapse potential, prevention,
and post-relapse reactions
Working With RelapseWorking With Relapse
evaluate triggers re-evaluate motivation for change re-evaluate obstacles
identify new or stronger strategies normalise relapse as part of the change
process
Essence of MIEssence of MI
it’s not up to you to solve the problem your role is to help the person tell you
what they want to do (self motivation) if we push one way, they tend to go
another way as the person argues for one solution,
they become more committed (“I learn what I believe as I hear myself speak”)
Guiding Principles of MIGuiding Principles of MI when people are pushed they rebel when people argue, they consolidate
their own point of view So:
de-emphasise labelling and argumentation highlight difference btw behaviour and belief ambivalence is normal and OK accept the person’s choice
(Miller & Rollnick, 1991)
Elements of the ApproachElements of the Approach
establish rapport
clarify agenda
assess importance and confidence
explore importance build confidence
summarise and identify next steps (Saunders et al., 1996)
Clarify The AgendaClarify The Agenda
During discussion about perceived issues, write
each problem in a different circle -
Feel unfit & unhealthy
Moneyhassles!
Partner’s expectations!
“We can’t deal with all of these at once - which do you feel most ready to do something about ?”
Study deadlines!
Explore ImportanceExplore Importance
On a scale of 1-10, where 10 equals ‘very
important’, how important is it to you to be fit and healthy?
Why have you placed yourself there?
Why so high (low)? What would help you to move higher?
Can you think of anything that would help you move up a step?
Is there anything someone else can do to help you move up a step?
Build ConfidenceBuild Confidence
On a scale of 1-10 (1 = not confident, 10 = very confident), how confident are you that you can become fit and healthy?
Why have you placed yourself there? Why so high (low) ? What would help you to move higher?
Can you think of anything that would help you move up a step?
Is there anything someone else can do to help you move up a step?
More ‘Importance’ Q’sMore ‘Importance’ Q’s
Can you think of some good things about (the situation)?
What are the less good things about (the situation)?
And is there anything else? Where does that leave you now?
More ‘Confidence’ Q’sMore ‘Confidence’ Q’s Is there anything that you’ve already
found helpful? When did you manage better? Even if it was only easier for a short
time, what made it easier? Is there anything you can learn from
things you’ve already tried? Do you know what’s worked for others?
Your task now…Your task now… form dyads (‘client’ and counsellor) think of an aspect of your own behaviour
that you’re ambivalent about eg smoking not exercising procrastinating
assess ‘client’s’change readiness clarify the agenda use importance and and confidence
questions to arrive at a change strategy
Limitations of MILimitations of MI individual focus no attention to structural factors
affecting behaviour no attention to environmental factors
affecting behaviour descriptive rather than causative may not generalise to other populations