Motivational Interviewing
D HASHEMPOUR
Definition
A client – centered, directive method for enhancing
intrinsic motivation to change by exploring and
resolving ambivalence.
It is focused on the person’s present interests and
concerns.
It is a method of communication rather than a set of
techniques
It is about eliciting the person’s motivation for
change
Brief Intervention
It is possible to speed or facilitate change, even
relatively brief interventions can trigger change.
Often one or two sessions of counseling yield greater
change than no counseling at all.
Faith/Hope – asking a person how likely they are to
change is a reasonable good predictor of outcome
Ambivalence
Ambivalence – Key issue
“with certain problems the part played by ambivalence is
more central’
To explore ambivalence is to work at the heart of the
problem of being stuck.
Paradoxical responses - increase in painful
consequences is not always successful.
Ambivalence is a common normal human experience and
part of the process of change.
It is the client that should be voicing the argument for
change - interpersonal
Conflict
Approach-Approach – person to choose between two
similar attractive alternatives (Sweet shop)
Avoidance – Avoidance – Having to choose between
two evils, (Devil and deep blue sea)
Approach – Avoidance - Person both attracted and
repelled by same object, person indulges then resists
the behaviour. (yo – yo)
Double approach avoidance – Person is torn between
two alternatives, both having negative and positive
indicators.
Conflict
Conflict arises when two people are motivated
towards different goals.
One person may think the other is poorly motivated.
Question
“ Why isn’t this person motivated”
“For what is this person motivated”
Building Motivation for change
Developing discrepancy between the actual present
and the desired future
Change is facilitated by communicating in a way that
elicits the person’s own reasons for and advantages
of change.
When done well, it is not the counselor but the client
who voices concerns, reasons for change, self
efficacy, and intentions to change.
Why does a person need to change ?
Society
Conditions
Is it possible to change for better/worse
Is every change good
Activity – consider something you have changed about
yourself in the last year, what did you gain from that change
and what did you have to give up
In order to change what type of things do you need to consider
What is your role in helping the person change
Do you act as a trigger/supporter/advisor/educator or do you
remain neutral
Which one of these pathways would have longer acting effect..
The stages of change model
(Prochaska and Di Clemente, 1986)
Pre-contemplation
If the identified goal is not perceived as a problem, there is no desire to
change
Contemplation
Some awareness of problems associated with the identified problem.
Some indications that change is being considered
Preparation/ Action
Actively attempting to change
Maintenance
Consolidating change, relapse prevention
Readiness to change is on a continuum
Change
Motivational interviewing prior to therapy!
Difficult people or difficult interaction
Unmotivated people don’t exist
It is not about the goal but about the means
Autonomy, meaningful relationship, physical and
psychological health
* Working together to find out is there a better way
to achieve your goal
Acceptance, Ambivalence and Change
A positive change requires acceptance of loss.
Appreciation and understanding of ambivalence
towards labelling, diagnosis, drug misuse,
medication.
Any change involves gains and losses.
Therapist role (process; acceptance of loss and focus
on gains and consolidation)
Cause of Dissonance
Resistance is something that occurs only within the
context of a relationship or a system.
Dissonance within the relationship – it requires two
people to not cooperate and create dissonance.
Two different agendas
Different goals
Lack of agreement about roles in the relationship
Ou role to recognise it, understand it,s source and
find ways to restore consonance.
Building Motivation for Change
Importance and Confidence are both components of
intrinsic motivation for change. (measure)
Use questioning carefully following through with a
reflective question as often as possible to allow client
opportunity to answer themselves. Do not put in
road blocks at this stage.
Case studies; possible strategies
Mike : 27 year old with depression, low confidence
and drinking problem.
Terry: 42 year old with relationship difficulties, wife
has sent him to counseling.
Helen: 37 year old, low self esteem, volatile
relationship.
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