STRIPPED BACK MIKelly Hill

What are they? How can they be measured? Make a list……. Your client.

SOCIAL PROBLEMS

MI IN PROFILE CONTEXT

INDIVIDUAL ‘PROFESSIONAL’

Isolated Ambivalent Willingness to change

Your professionalism Wanting to help Knowing ‘what is best’

‘Movere’ Latin for ‘to move’ Energy and direction. Goals. Sources of motivation? Think of a behaviour of yours that you have

thought about changing;Eg: drinking/smoking/studying/untidiness Where has the motivation to change

originated from? External or internal?

INTRINSIC vs EXTRINSIC MOTIVATION

Easy to assume. Sometimes people are unaware. How? Why? Pleasure vs pain.

ASSUMPTIONS ABOUT CHANGE

Informed by 7 distinct theories:1) Conflict and ambivalence (Orford, 1985)2) *Decisional balance (Janis and Mann, 1977)3) Health beliefs (Rogers, 1975)4) Reactance (Bremm and Bremm, 1981)5) Self-perception (Bem, 1967)6) Self-regulation theory (Kanfer, 1987)7) Rokeach’s value theory (Rokeach, 1973)

TRANSTHEORETICAL MODEL

CYCLE OF CHANGE(Prochaska and DiClemente, 1982)

Pre-contemplationHappy to maintain status-quo

Contemplation Question the present situation

STAGES OF CHANGE

Decision/determinismChange talk/plan/strategy

Active changesStrategy implemented, steps taken

STAGES OF CHANGE (cont)

MaintenanceChanged behaviour adopted and maintained

RelapseLearning from ‘failure’One step forward, two steps back…..Most people need more than one attempt.

STAGES OF CHANGE (cont)

Rooted in work of Carl Rogers. ‘A collaborative, person-centred form of

guiding to elicit and strengthen motivation for change’

(Miller and Rollnick, 2009)

MI

More than a set of techniques. Based on 3 key elements: ACE Autonomy (vs Authority) Collaboration (vs Confrontation) Evocation (vs Imposition)

‘SPIRIT’ OF MI

Express Empathy (vs sympathy)Empathy because you have ‘been there’ vs sympathy when you have not.

Support Self-EfficacySupporting the belief that change is possible.Focus on previous successes.

4 PRINCIPLES OF MI

Develop DiscrepancyMismatch between ‘where they are’ and ‘where they want to be’. Conflict between current behaviour and future goal. ‘Throw away’ comments.

Roll with ResistanceComes from conflict between view of ‘problem’ and ‘solution’. Non-confrontation using de-escalation techniques. ‘Yes, but….’ MI focus on client define problem results in more ‘dancing and less wrestling’.

4 PRINCIPLES OF MI (cont)

Hesitance Uncertainty Indecision Irresolution Doubt Fickleness Being in two minds…

RESISTANCE/AMBIVALENCE-WHAT IS IT?

Exploration and resolution of ambivalence. Ambivalence is preferred to resistance in

order to explore the dynamic interrelationship (Arkowitz et al, 2008)

Approach-Avoidance-moving betwixt and between e.g. just one more drink, play on the gaming machine, slab of chocolate……..

RESISTANCE vs AMBIVALENCE

http://www.youtube.com/watch?v=kN7T-cmb_l0

An example of how not to do it

HOW NOT TO ‘DO’ MI

What mistakes do you think were made in this clip?

YOUR VIEWS….

Open ended questions: Affirmations-support self-efficacy. Must be congruent and genuine. Reflections. Has 2 purposes; help to express

empathy and resolution of ambivalence by focusing on negatives of maintenance and positives of change.

http://www.youtube.com/watch?v=xrbXMaiR_Ww example of reflective listening

MI SKILLS IN PRACTICE (OARS)

Repeating

Re-phrasing

Paraphrasing

Reflection of feeling

REFLECTIONS (cont)

Summaries-communicate interest and understanding. Shift attention/direction- ‘move on.’ Highlight both sides (but focus more on positives) of ambivalence therefore promote discrepancy.

OARS (cont)

Seek to guide client to expressions of change talk.

Correlation between statements of change and change behaviour.

DARN CAT-types of change talk.

CHANGE TALK

Desire (I want to change) Ability (I can change) Reason (Its important to change) Need (I should change)

Examples……..?

PREPARATORY CHANGE TALK

Commitment (I will change) Activation (I am ready, prepared and willing

to change) Taking steps (I am taking specific action to

change)

IMPLEMENTING CHANGE TALK

Ask evocative questions Explore decisional balance (pros/cons) Good/not so good about behaviour Ask for examples Look back Look forward Query extremes Use change rulers Explore goals/values

STRATEGIES FOR EVOKING CHANGE TALK

Decreasing resistance/ambivalence.

Less emphasis on the problem.

Change talk; person gives off increasing resolve.

S/he is posing her own questions about her own change process.

Envisioning-how the future might look, could look.

READINESS TO CHANGE

Labelling. Blaming/judging. Resisting the ‘righting reflex’. Forgetting the answers lie within the

individual. Any more?

MI ‘TRAPS’

http://www.youtube.com/watch?v=URiKA7CKtfc&feature=related

EFFECTIVE MI

MI not based on the TTM. What is the difference?

MI not a way of tricking people into change behaviour. ALWAYS in the persons best interests. You do not ‘MI’ someone. You cannot do MI ‘on’ or ‘to’ someone.

MI is not a technique. Not simple with steps to follow. More complex.

MI is not a decisional balance. Exploring pros AND cons can sometimes avoid influencing direction of choice.

9 THINGS THAT MI IS NOT

MI is not CBT. MI is a brief intervention-new skills are not learned. NOT ‘I have what you need’ rather ‘you have it already.’

MI is not just client centred counselling. Goal focused.

MI is not what you were already doing. Communication style rather then problem solving.

MI is not a panacea. Not suitable for all health related problems. Short term sessions required.

9 THINGS THAT MI IS NOT (Cont)

REFERENCES