Motivating People to change
Sustainable, meaningful change for
children and their families
Seminar outline
• Introduction and housekeeping
• Stories of motivation
• What we know about motivation – incentives
and sanctions– what really works?
• Coffee break
• John’s talk
• Exercise
• Summing up
Think about it
• artificial change environments
• embedded change
• how humans respond to change – what
motivates them to do something different
from what they have always done.
Recycling
Bill Strickland
Elements that enabled change
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A person who was interested in him
A vision that the future could be different
A belief that he could make a choice
A belief that he could learn to do something
he valued.
What makes therapy successful?
Therapeutic Technique
15%
Client Hopefulness
30%
15%
Client Characteristics &
Social Support
40%
Relationship between
client and therapist
Kieran McKeowan A guide to what works in family support services
for vulnerable families (Dublin, 2000)
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Seven steps to determination
1.
2.
3.
4.
5.
6.
7.
I accept there is a problem
I have some responsibility for the
problem
I have some discomfort about the
problem and my part in it
I believe that things must change
I can make a choice
I can see that I can be part of the
solution
I can see the first steps towards
the change
Problem tree
Maslow hierarchy of needs
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Cycle of change
The typical social work response to
creating change
Artificial change
Embedded change
What journey’s are you helping people
take?
Motivating people to change
Workshop materials
Motivational Interviewing
A person-centered,
goal-oriented
method of communication
for enhancing intrinsic motivation to change
by exploring and resolving ambivalence.
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De-motivating
How might resistance show itself?
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By only being prepared to consider 'safe'
or low priority areas for discussion.
By not turning up for appointments
By being overly co-operative with
professionals.
By being verbally/and or physically
aggressive.
By minimising the issues.
(Egan, 1994)
What might we be doing to make it worse?
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Becoming impatient and hostile
Doing nothing, hoping the resistance will
go away
Lowering expectations
Blaming the family member
Absorbing the family member's anger
Allowing the family member to control
the assessment inappropriately
What might we be doing to make it worse?
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Becoming unrealistic
Believing that family members must like
and trust us before assessment can
proceed.
Ignoring the enforcing role of some
aspects of child protection work and
hence refusing to place any demands on
family members.
(Egan, 1994)
What It Is Not
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Skills training
Confrontive denial breaker
Simply sitting there listening and reflecting
The solution to all client issues and clinician
headaches
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The Problem With Them Is….
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They don’t see (insight, denial)
They don’t know
They don’t know how
They don’t care
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So The Answer is…..
• Give them Insight……if they just see they will
change.
• Give them Knowledge….. if they just know
they will change.
• Give them Skills….. if you can just teach them
how to change, then they will change.
• Give them Hell….. if you can make them feel
bad or afraid enough they will change.
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And Yet…..
Sometimes Insight, Knowledge,
Skills, And Feeling Bad Or Fearful Is
Still Not Enough
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What Is Happening?
Issues of……
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Ambivalence
Motivation
Readiness
Confidence
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Key Assumptions
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Motivation is interpersonal
Resistance is interpersonal
Clinician approach and behaviors matter
Persuasion is usually not an effective method
to increase motivation and change
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MI: How it Works
Clinician manages important in-session behaviors
of client using MI spirit, principles and skills
Interaction of
clinician and client
Increase Change talk
Leads to
and
Decrease Resistance
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Change Talk
Desire
Ability
Reasons
Need
Commitment
Behavior
Strength
Change
Taking Steps
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Resistance
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Arguing
Interrupting
Denying
Ignoring
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Basic MI Principles
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D = Develop Discrepancy
R = Roll with Resistance
E = Express Empathy
S = Support Self-efficacy
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Develop Discrepancy
• Change is motivated by a perceived
discrepancy between present behavior and
important personal goals or values
• The person rather than the counselor should
present the arguments for change
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Roll with Resistance
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Avoid arguing for change
Resistance is not directly opposed
Resistance is a signal to respond differently
The person is a primary resource in finding
answers and solutions
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Express Empathy
• Acceptance facilitates change
• Skillful reflective listening is fundamental
• Ambivalence is normal
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Support Self-Efficacy
• A person’s belief in the possibility of change is
an important motivator
• The person, not the counselor, is responsible
for choosing and carrying out change
• The counselor’s own belief in the person’s
ability to change becomes a self-fulfilling
prophecy (HARP)
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Strategies
OARS
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Open Questions
Affirming
Listen Reflectively
Summarizing
Dunn/MINT
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Change Talk
Original idea from Bem’s theory
“I learn what I believe from what I
hear myself say.”
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Eliciting Change Talk:
A Technique For The Road
Assessing Importance
• How important on a scale of 1-10?
1---x--------------y-------------10
• Why X and not 1?
• What would have to happen for you to go
from X to Y?
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Confronting the difficulties
Confrontation
In child welfare services, the Children’s
Service Worker must be a skilled confronter.
Confrontation is, basically, facing the client
with the facts in the situation and with the
probable consequences of behaviours
(Texas Department of Human Resources)
Confrontation
Client: The doctor is telling lies about me. I
didn't hurt Angie, she fell downstairs. She is
always having accidents.
Worker: I understand that children have
accidents. Angie's injuries could not have been
the result of a fall down stairs. There are two
partially healed fractures in addition to the new
head injury. Angie's buttocks and back are
marked with bruises in the shape of a hand.
(Texas Department of Human Resources)
Confrontation
• Client: I know we haven't been to
counselling in three weeks. Get off my back!
My husband and I have other things to do.
• Worker: Going to counselling regularly is a
part of your agreement with us to regain
custody of your children. If the agreement is
not followed, we can't recommend that the
children come home.
(Texas Department of Human Resources)
Effective work involves
•Logical discussion
•Focusing
•Prioritising
•Summarising
•Setting realistic limits
Effective work involves
•Universalising
•Confronting
•Educating
•Modelling behaviour
Effective work involves
•Recognising difference
•Accepting
•Allowing ventilation
•Relating to feelings
•Direct intervention in the environment
A scale for assessing motivation
1. Shows concern and has realistic
confidence.
2. Shows concern, but lacks confidence.
3. Seems concerned, but impulsive or
careless
4. Indifferent or apathetic about problems
5. Rejection of parental role.
Shows concern and has realistic confidence.
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Parent is concerned about children’s
welfare; wants to meet their physical,
social, and emotional needs to the extent
he/she understands them.
Parent is determined to act in best
interests of children
Has realistic confidence that he/she can
overcome problems and is willing to ask
for help when needed
Is prepared to make sacrifices for
children.
Shows concern, but lacks confidence
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Parent is concerned about children’s
welfare and wants to meet their needs,
but lacks confidence that problems can be
overcome
May be unwilling for some reason to ask
for help when needed. Feels unsure of
own abilities or is embarrassed
But uses good judgement whenever
he/she takes some action to solve
problems.
Seems concerned, but impulsive or careless
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Parent seems concerned about children’s
welfare and claims he/she wants to meet their
needs, but has problems with carelessness,
mistakes and accidents. Professed concern is
often not translated into effective action.
May be disorganised, not take enough time, or
pays insufficient attention; may misread ‘signals’
from children; may exercise poor judgement.
Does not seem to intentionally violate proper
parental role; shows remorse.
Indifferent or apathetic about problems
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Parent is not concerned enough about
children’s needs to resist ‘temptations’, eg
competing demands on time and money. This
leads to one or more of the children’s needs not
being met.
Parent does not have the right ‘priorities’ when
it comes to child care; may take a ‘cavalier’ or
indifferent attitude. There may be a lack of
interest in the children and in their welfare and
development.
Parent does not actively reject the parental role.
Rejection of parental role
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Parent actively rejects parental role,
taking a hostile attitude toward child care
responsibilities.
Believes that child care is an ‘imposition’,
and may ask to be relieved of that
responsibility. May take the attitude that
it isn’t his or her ‘job’.
May seek to give up the responsibility for
children
(Magura et al,1987)