Petersilia 2000

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We point out discrepancies between how customers would like things to be and how they are now. When they realize that their current behaviors are not leading toward some important future goal, they become more motivated to change. Following is a possible example of pointing out a discrepancy.

“You would like to be able to support your family better. At the same time, you are finding it difficult to take the steps necessary to make that happen.” (“What do you think might be going on?”)

We listen to customers to get an idea of their concerns and their reasons for behaving as they do. We view the world through their eyes, thinking as they think, feeling as they feel, and experiencing the world as they experience it. We put ourselves in their place. We continually ask, “If I were in their shoes, what would I be thinking? How would I be feeling? How would I be handling ambivalence about change? How would I want others to respond to me?”

Our ability to demonstrate empathy, i.e., to understand and feel what customers are experiencing, has a major impact on their willingness and ability to change.

Ambivalence is normal. However, it can become paralyzing and cause people to remain “stuck.” We help customers acknowledge their ambivalence, discuss it with them, explore the two “sides” they are dealing with, and help them work through it. If this does not occur, long-lasting behavior change becomes less probable.

Like ambivalence, resistance is a normal behavior that should be expected when people are being asked to change. Arguing with a customer, or creating a power struggle by threatening or trying to assert control, will likely make matters worse. We encourage customers to come up with their own solutions to situations as they define them. We invite them to examine new perspectives without badgering, lecturing or imposing new ways of thinking on them.

A person’s belief that change is possible is an important motivator in making change. In MI, there is no “right way” to change. If a specific plan for change doesn’t work, customers can come up with other plans. However, for this to occur, they must believe that change is possible, i.e. that they are capable of making the changes necessary to improve their current situation. We engage customers in conversations to help them believe that change is possible.

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These cannot be answered with a ‘yes’ ‘no’ or ‘five times in the past month’. Commonly most sessions commence with an open-ended question, ‘What’s been going on since we last got together?’ This type of question allows the client an opportunity to move forward and whilst closed questions undoubtedly have their place, they do not create the same opportunity.

Example: “I assume, from the fact that you are here that you have something you would like to talk over. What would you like to discuss?”

There are really no better ways of building rapport with a client than offering affirmation. This is particularly relevant to clients suffering from addictions as affirmation for this group has been a historically rare occurrence. Remember that affirmation has to be commensurate with the step achieved as the client may feel that the counselor is being insincere if they are over praising them. This can lead to rapport being seriously damaged rather than built.

Examples: “Thanks for coming in on time.” / “I must say, if I were in your position, I might have a hard time dealing with that amount of stress.”

The best motivational advice a counselor can give to himself is to listen attentively to the client. All the information a counselor requires will come from the client, what works, what has failed them etc. However this is a directive approach. The counselor will actively guide the client by this technique; focusing more on change talk and less on non-change talk. For example “You are unsure about your readiness to change but you are aware that your drinking has damaged your relationships and your health”.

If that is correct the intensity of the session deepens, if wrong the client will correct you (or the client may not be ready to deal with this) and the session moves on regardless.

Summaries are a specialized form of reflective listening and are an effective way to communicate that you have been listening by calling attention to central points and moving attention and concentration. When you are about to summarize let the client know that that is what is going to occur and invite the client to correct you where he/she feels necessary. If you feel that there were points that were not clear during this period, inform the client of that when you announce your intention to summarize.

Example: “So, this heart attack has left you feeling really vulnerable. It’s not dying that scares you, really. What worries you is being only half alive, living disabled or being a burden to your family.”

PresentationMovies\Motivational Interviewing Evoking Commitment to Change.flv

PresentationMovies\Practice Demonstration

Video-Motivational Counseling.flv

PresentationMovies\Practice Demonstration Video-Stages of Change & Treatment.flv

http://www.sedgwickcounty.org/corrections/Motivational%20Interviewing/Motivational%20Interviewing%20Desk%20REFERENCE%20Guide.pdf