MI & Stages Change

Question 1

MOTIVATIONAL INTERVIEWING

Answer 1

MI a counselling technique designed to promote change.

Change is a ‘natural process’ although many people have a strong resistance to change.

MI promotes change but allows for change to occur within the person’s own time frame.

Directive, Client centred counselling style that supports change by helping clients resolve their own ambivalence to change.

Question 2

HOW does MI help change?

What are the aims? What does it involve?

Answer 2

A series of questions designed to increase the importance of change from a clients perspective.

Creates a conversation about change

1. Collaborative partnership (therapeutic alliance is key)
2. Therapist does not advocate for change, or push in any way.
3. Calls forth clients own motivations and desires for well-being

•Involves a process and can include assessment of where the client is at in the stages of change model

ATTITUDE OF MI?
I wonder if? speculation? Non-judgemental. Open.

Question 3

Therapeutic Alliance

AND STUDY***

Answer 3

The provider–patient relationship more like a partnership.

A good therapeutic alliance consistent with better results from motivational interviewing.

STUDY*** One study found that the interpersonal skills displayed moderate effect sizes in degree of change through motivational interviewing.

Question 4

Assessing Readiness to Change

Answer 4

working with clients “where they’re at”

Is the client sufficiently motivated to make such a change? the clinician orients to understand the client’s current level of readiness to change, and then to work accordingly at facilitating the client’s successful movement through these stages

***Often transient from week to week ; may switch even within a session.

Question 5

Stages of Change Model

Answer 5

Precontemplation 
Comtemplation 
Preparation 
Action 
Maintenance 

Progress VS Relapse

Question 6

The process of MI (5 principles of MI)

Answer 6

1.Empathy and reflective listening
Ask open questions to elicit the patient’s own reasons for change
empathetic and supportive

2. Develop a discrepancy between clients goals/ values and behaviour
   Problem solving or decision making matrix may help with the ambivalence
   Clearly list the pros not changing and the cons for changing (include short and long term consequences)
   Reflect in terms of life goals
   Allow the client to generate reasons for change
3. Avoid argumentation and confrontation
   Respect Autonomy - up to patient to decide whether or not to change. DO NOT PRESSURE: DO NOT ARGUE.
4. Accept resistance
   Do not put pressure on the person to change
   A decision not to change at this point is legitimate
   Invite them to consider other points of view
5. Support self-efficacy
   Emphasise personal responsibility
   Allow the client time to decide
   *** If the client reaches a decision to change then you can proceed with the following steps

Question 7

Precontemplation

Answer 7

Unaware of problem 
Not really ready to change
Ambivalence about change 
May not believe change is necessary 
Admitting to a problem may be revealing a weakness.

Give info in a neutral manner.. there is a danger to consider
Accept
Develop Trust

• • How will you know when it is time to think about changing?
• • What qualities in yourself are important to you?
• • What connection is there between those qualities and not changing?

Question 8

Comtemplation - stage only

Answer 8

Recognised that there is a problem
•Considering the possibility of change
•Open to new information in an attempt to understand the problem
•Ambivalent about change and struggling with the benefit of change versus the negative of change
Lacks urgency or motivation ;People can be stuck in contemplation for years
Looking for easy solutions

Question 9

Contemplation Approach and Questions

Answer 9

Postive reinforcement
MI KEY
Acknowledge the ambivalence
Allowing them to struggle..

• • What is one barrier to change?
• • What are some things that could help you overcome this barrier?

How would you like things to be different?

Why do you think you need to make a change?

What may be stopping you?

Explore the options..
- decision or problem solving tools
Clearly list the pros not changing and the cons for changing (include short and long term consequences)

Question 10

Preparation

Answer 10

Making plan

Encourage small steps
Build skills
Problem solve

psycho-education about change

• • What would be a good result of changing?
• What are the good things about the way you are currently trying to change?
• • What are the things that are not so good?

Question 11

Action

Answer 11

Taking action

Enhance coping
Planning
Avoid risk
Social support

•What made you decide on that particular step?
•• What has worked in taking this step?
•• What helped it work?
•• What could help it work even better
MORE CBT

Question 12

Maintenance (or relapse)

Answer 12

Continuation; repeating steps

assist coping, relapse prevention, reminders

•Detailed plans for relapse
•How to manage what situations will cause problems, how to deal with other people assertively.
•If the person has “relapsed”:
•• Don’t be hard on yourself. Change is hard and may take time.
•• What worked for a while?
•• What did you learn that will help when you give it another try?
MORE CBT and OTHER

Question 13

MI and SoC Summary

Answer 13

1. counselling around ambivalence
2. no advocacy, calls forth clients Motivation and works in collaborative partnership
3. Uses conversation
4. Meets Client where they are at (respects clients own time line)
5. uses SoC to asses where at today
6. stages of change and questions
7. 5 guiding principles for MI
8. Empirical Evidence