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.