Introduction to
Motivational Approach
Social Services Forum
for First Nations of Quebec
January 30, 2014
By Barbara Bouchard & Sophie Pelletier
Presentation outline
• Workshop objectives and targeted
participants
• Background and philosophy of the approach
• Motivation to change
• The stages of change
• Relevance of the approach for the
intervention
• Intervener's tasks
Workshop objectives
1- Learn about the motivational approach and
its relevance for the intervention
2- Identify the various stages of change
3- Decide if you whish to learn more about the
motivational approach
Targeted participants
Interveners in health and social services:
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Psychosocial services
Addictions
Mental health
Childhood/ youth/ family
Mother and child health
Etc.
BACKGROUND AND PHILOSOPHY
OF THE APPROACH
Background and philosophy
• Developed by Miller & Rollnick, 1991
(Helping relation & process of change )
• Gives interveners the tools needed to create a
positive environment for change and to
increase motivation for people who are
ambivalent or who show little interest in
change
Background and philosophy (cont’d)
• Moving away from the confrontation models
prevalent in the 80’s
• Identifying the crucial elements of a brief
intervention in order to increase motivation to
change: six crucial elements
Background and philosophy (cont’d)
Six crucial elements
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FEEDBACK
FREE WILL
OPINIONS
OPTIONS MENU
EMPATHY
SENSE OF SELF-EFFICACY
Background and philosophy (cont’d)
“FEEDBACK”
• The person is given objective information on the
current state of his personal life situation.
EXAMPLE:
• Intervener: This week you didn’t drink any alcohol four
days out of seven and you did activities with your loved
ones on the days you didn’t drink alcohol.
Background and philosophy (cont’d)
“FREE WILL”
• It is important to remind people that they have freedom
of choice and action. No one can decide or change for
them.
EXAMPLE:
A person does not want to go to a treatment centre but
is willing to talk about his difficulties with an intervener
at the health centre.
Background and philosophy (cont’d)
“OPINIONS”
• Opinions shall be delivered in a professional and
objective manner to help a client change his behaviour
(at his request).
EXAMPLE:
• Client: What should I do to sleep better?
• Intervener: Have you thought of reading before going to
bed to help you relax?
Background and philosophy (cont’d)
“OPTIONS MENU”
• An options menu allow people to choose the therapeutic means
that best suit their needs.
• People are more likely to engage in a treatment plan in which they
participated.
EXAMPLE:
• Therapeutic methods: diary, AA meetings, traditional methods, etc.
Background and philosophy (cont’d)
“EMPATHY”
• Empathetic therapists get better results with their clients
• Confrontation as an intervention strategy brings about
resistance in the client
EXAMPLE:
• Intervener: “I understand your fear that your child might fail
his school year” versus “you do not seem to help your child
deal with his problems at school”
Background and philosophy (cont’d)
“SELF-EFFICACY”
• This technique is about a person’s beliefs regarding
his power to change and the impact of his actions
(power over his life)
EXAMPLE:
• Client: The possibility to use my money to take care
of myself gives me the feeling of being engaged in a
journey for my well-being
THE MOTIVATION TO CHANGE
Reflection and exchange
QUESTIONS?
1- Can everyone change / modify their behaviour?
2- Do you think most individuals need professional
help to change / modify their behaviour?
3- Can a client with little interest in changing his
behaviour become motivated to change?
Motivation to change
The motivation to change is all the forces which
determine:
• The decision to change one’s behaviour
• The implementation of change strategies
• Maintaining the new behaviour
Motivation to change (cont’d)
• Motivation evolves (not stable, not a
characteristic of the individual)
• Motivation is specific to a particular behaviour
• Motivation is influenced by the interveners and
the environment with which the person interacts
(interveners can influence and create an
environment favourable to change)
Motivation’s three components
1- The importance of change from the person’s
perspective (wanting to change)
2 - Confidence in the change (feeling able to
change)
3 - Readiness to change (being ready to change)
THE PROCESS OF CHANGE
Stages of change
Stages of change
• Inspired from the model “stages of change”
from Prochaska and DiClemente (1984) and
adapted by Miller and Rollnick (1991)
• Change is a step by step dynamic process.
Events happen before, during and after the
change.
Stages of change
-Pre-contemplationAt this stage, the person:
• Doesn’t think he has a problem
• Doesn’t want to change his behaviour
• Alludes to an external motivation: justice system,
family, etc.
• Doesn’t see the negative impacts on his life even
though his entourage sees and feels them
Stages of change (cont’d)
-Contemplation• Is characterized by a state of ambivalence (e.g.
yes I consume everyday but ...)
• Gradually recognizes the difficulties
experienced but isn’t ready to commit to a
concrete process of change (e.g. I may
consume too much but I'm not sure I want to
change my consumption)
Stages of change (cont’d)
-Decision / PreparationAt this stage, the person:
• Admits his problem
• Decides to change his behaviour
• Thinks of ways to change and plans how he will
implement the change
• Is ready to develop an action plan
Stages of change (cont’d)
-ActionAt this point, the person:
• Is engaged in action, tries different strategies
to change
• Makes the right choices for the desired change
to happen
• Increases his confidence in his ability to
change
Stages of change (cont’d)
-MaintainAt this point, the person:
Has made the changes he wanted and works
towards consolidating them
 Remains vigilant about potential situations
that could get him back to his old habits
 Has planned strategies to cope with any risky
situations
 Is motivated to maintain his gains
MOTIVATIONAL APPROACH
Relevance for interveners and
application
Motivational approach
Relevance for interveners:
 To intervene right from the client’s motivational
stage using tools and intervention strategies
 To reduce interveners’ fatigue and powerlessness
(we don’t argue with clients but we don’t give up on
them either)
 To foster a client’s perseverance, his commitment
and open mind towards specialized services, if
needed
Motivational approach (cont’d)
Relevance for interveners:
 Clients with little or no interest in changing their
behaviour (e.g. reference by the court, the Youth
Protection, etc.)
 Clients who are ambivalent about changing their
behaviour (I want to change but ..)
 Clients surprised about professionals’
recommendations (e.g. a client consults for his
physical pain but not for his daily alcohol consumption)
INTERVENER’S TASKS
and stages of change
Intervener’s tasks
and stages of change
STAGES OF CHANGE
INTERVENER’S TASKS
Pre-contemplation
- Make the client aware of the risks and
difficulties that his behavior brings about
- Seeding doubt
Contemplation
- Discuss the pros and cons of change as
well as pros and cons of status quo
- Influence the decision
Decision/Preparation
- Help the person to identify the steps and
actions he wants to take
Action
- Help the client make the first step
- Develop the change plan with the client
Maintain
- Help the client to identify and put in place
prevention strategies of relapse and
recognize risky situations
THANKS!
ANY QUESTIONS???
Barbara Bouchard: bbouchard@cssspnql.com
Sophie Pelletier: spelletier@cssspnql.com