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FALL 2013
MOTIVATING FOR CHANGE
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MOTIVATING FOR CHANGE
• Ray Caesar LPC, LADC-MH• Director of Addiction Specialty Programs• Oklahoma Department of Mental Health &
Substance Abuse Services• (405)522-3870• [email protected]
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OUTLINE
• Achievement Motivation Theory
• Self-Determination Theory
• Operant Conditioning
• Motivational Interviewing
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MOTIVATING INDIVIDUALS
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ROMAN LEGION
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DECIMATION
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AMERICAN MILITARY
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FRENCH REVOLUTION
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MOTIVATION
DEFINITION
• Motivation• The process of arousing and sustaining goal-
directed behaviors.
NEEDS DRIVES
DRIVES INCENTIVES
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MOTIVATION
WHAT IS MOTIVATION?
External motivation
Internal motivation
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WHY WE WORK
• Support ourselves and our families.• Pay bills.• Most people enjoy work.• Sense of purpose.• Social aspect of being with other people.
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MOTIVATION
MOTIVATION IS NOT
Directly observableSynonymous with satisfaction
Always consciousDirectly controllable
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ACHIEVMENT MOTIVATION THEORY
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ACHIEVEMENT MOTIVATION THEORY
LOW ACHIEVEMENT MOTIVATION
HIGH ACHIEVEMENT MOTIVATION
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ACHIEVEMENT MOTIVATION THEORY
LOW ACHIEVEMENT MOTIVATION
• Prefer very easy tasks• Failure is unlikely
• or very difficult tasks• Failure not embarrassing
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ACHIEVEMENT MOTIVATION THEORY
HIGH ACHIEVEMENT MOTIVATION
• Prefer moderately difficult tasks• Success is attainable• Success is attributable to skill and effort
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EXTRINSIC AND INTRINSIC MOTIVATION
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MOTIVATION
EXTRENSIC AND INTRINIC MOVIVATION
Extrinsic motivationA desire to perform based on external
reward or threat of punishment
Intrinsic motivationA desire to perform a behavior based on internal (personal) reward or
punishment
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MOTIVATION
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EXTERNAL VERSUS INTERNAL
Better to have intrinsic motivation.
Behave not because you fear punishment or expect reward (external),
but because you want to behave in a certain way(intrinsic).
Motivation from within
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COMPONENTS OF INTRINSIC MOTIVATION
Autonomy: self-governing
Competence: self-efficacy
Relatedness: support and affirmation from peers.
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INTERNAL MOTIVATION
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EXTRINSIC MOTIVATION
~ Needed when there are no intrinsic motivators. An example is paying taxes
~ Hopefully the behavior will alter to intrinsic motivation over time. An example is seat belt use.• At first extrinsic: avoid tickets, alarms, nagging
children• Over time this behavior becomes internalized
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EXTRINSIC MOTIVATION
Environment controls behavior
External rewards and punishments
Praise increases the likelihood of participation
Criticism decreases the likelihood of participation
Principles of operant conditioning are at work*
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MOTIVATION
• Exposure to commercial media prompt a focus on materialism which provides fleeting satisfactions.
• Individuals may seek extrinsic rewards in order to compensate for deficits in fulfilling basic psychological needs.
• Extrinsic rewards are insufficient and poor compensation.
• Ryan & Deci
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MOTIVATION
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MOVING FROM EXTERNAL TO INTERNAL MOTIVATION
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WHY WE WORK
• Support ourselves and our families.• Pay bills.• Most people enjoy work.• Sense of purpose.• Social aspect of being with other people.
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SAFER TO WEAR SEATBELTS.
• It is well-known that seatbelts save lives.• Compliance varies greatly.• 91% in California• 78% in Connecticut• 51% in Mass before law, now 76%.• Requirement and enforcement make a difference
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PUNISHMENT AND REINFORCEMENT.
• “Click it or ticket”• Threat of punishment.• Random checks.• Cars come with warning buzzers that stop if you buckle up.
• Reinforces compliance
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EVENTUALLY INTERNALIZED
• Starts extrinsic.• Not wearing seatbelt might lead to punishment.• Wearing reinforced by others and by vehicle.• Seat belt usage becomes a matter of habit.• Becomes intrinsic.
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SELF DETERMINATION
THEORY
Ryan and Deci
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SELF-DETERMINATION THEORY
A meta-theory of motivation incorporating multiple “mini-theories” into a unified whole.
• Self-Determination Theory addresses both intrinsic and extrinsic sources of motivation.
• Self-Determination Theory focuses on • Autonomy• Competence • Relatedness
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COMPONENTS OF INTRINSIC MOTIVATION
Autonomy: self-governing
Competence: self-efficacy
Relatedness: support and affirmation from peers.
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SELF-DETERMINATION THEORY
Self-Determination Theory proposes that the degree to which autonomy, competence or relatedness are supported and enhanced will have a significant positive effect on the individual within the specific context.
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SELF-DETERMINATION THEORY
Self-Determination Theory proposes that the degree to which autonomy, competence or relatedness are unsupported or hindered will have a significant negative effect on the individual within the specific context.
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SELF-DETERMINATION THEORY
Autonomy, competence and relatedness are recognized as basic psychological needs.
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PSYCHOLOGICAL NEEDS
Not necessary for survival like biological needs.
People engage in all kinds of activities unrelated to basic needs.
Make life worth living.
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MASLOW
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SELF-DETERMINATION THEORY
THE FIVE MINI-THEORIES OF
SELF-DETERMINIATION THEORY
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SELF-DETERMINATION THEORY
COGNITIVE EVALUATION THEORY
ORGANISMIC INTEGRATION THEORY
CAUSALITY ORIENTATIONS THEORY
BASIC PSYCHOLOGICAL NEEDS THEORY
GOAL CONTENTS THEORY
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SELF-DETERMINATION THEORY
Cognitive Evaluation Theory
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SELF-DETERMINATION THEORY
Cognitive Evaluation Theory
Intrinsic motivation
What are the effects of social contexts on intrinsic motivation?
Highlights competence and autonomy.
Explores reward, ego-involvement, controls
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SELF-DETERMINATION THEORY
Organismic Integration Theory
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SELF-DETERMINATION THEORY
Organismic Integration Theory
Extrinsic motivation
Explores the determinants, properties and consequences of extrinsic motivation
Identifies a continuum from external to
internal
Degree autonomy will be enhanced or hindered
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SELF-DETERMINATION THEORY
Causality Orientations Theory
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SELF-DETERMINATION THEORY
Causality Orientations Theory
Intrinsic/extrinsic motivation
Identifies how individual differences alter how the environment is perceived.
Identifies three orientations – autonomy, control (rewards) and impersonal (amotivational).
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SELF-DETERMINATION THEORY
Basic Psychological Needs Theory
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SELF-DETERMINATION THEORY
Basic Psychological Needs Theory
Intrinsic/extrinsic
Optimal well being is predicated on autonomy, competence and relatedness. All three are required.
Contexts that support or thwart these needs must be considered.
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SELF-DETERMINATION THEORY
Goal Contents Theory
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SELF-DETERMINATION THEORY
Goal Contents Theory
Intrinsic/extrinsic
Compares and contrasts the effects of internal and external motivators.
Goals have varying effects on need satisfaction.
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SELF-DETERMINATION THEORY
LEVELS OFSELF-DETERMINATION
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SELF-DETERMINATION THEORY
AMOTIVATION
The individual does not pursue a behavior as success is seen as unlikely or impossible – there is no point in trying
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SELF-DETERMINATION THEORY
EXTERNAL REGULATION
The individual pursues a behavior for a reward (pay) or due to coercion.
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SELF-DETERMINATION THEORY
INTROJECTED REGULATION
The individual pursues a behavior because of an internalized guilt or shame related sense of “ought to” or “should”.
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SELF-DETERMINATION THEORY
IDENTIFIED REGULATION
The individual pursues a behavior because the outcomes are important to the individuals goals
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SELF-DETERMINATION THEORY
INTEGRATED REGULATION
The individual pursues behaviors because they symbolize what is important to the person’s sense of worth.
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SELF-DETERMINATION THEORY
TRUE INTRINSIC MOTIVATION
The individual pursues behaviors for the pleasure of accomplishing, knowing, or for the stimulation.
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SELF-DETERMINATION THEORY
I TRUE INTRINSIC MOTIVATIONII INTEGRATED MOTIVATIONIII IDENTIFIED MOTIVATIONIV INTROJECTED MOTIVATIONV EXTERNAL REGULATIONVI AMOTIVATION
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REGULATORY STYLES
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AMOTIVATION
• Non-regulation• Don’t care about rewards and punishments.• Lack of control.• “They pretend to pay us and we pretend to
work.”
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INTERNAL REGULATION
• Synthesis with self-congruence.• Agreement conforms to beliefs
• Goal is to get people to accept goals as their own.• Move from compliance to self-regulation.
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FACILITATING INTERNALIZATION
• Relatedness• Desire to belong and feel connected.• Group projects, share tasks
• Self-efficacy• Improves chances of success• Work to avoid early failures
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PSYCHOLOGICAL NEEDS
• Self-determination theory relates to psychological needs.• Extrinsic motivation is not strongly related
to well-being• Wealth, fame and image.
• Well-being not enhanced by achievement of extrinsic goals.
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MASLOW
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SELF ACTUALIZING
• Promotes autonomy and competence.
• Encourages natural potential for growth.
• Facilitates human achievement and well-being
• Provides the social environment to support growth.
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OPERANT CONDITIONING
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MOTIVATION
OPERANT CONDITIONINGAlso referred to as Instrumental Conditioning
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EXTRINSIC MOTIVATION
Environment controls behaviorExternal rewards and punishmentsPraise increases the likelihood of
participationCriticism decreases the likelihood of
participationPrinciples of operant conditioning are at
work
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EFFECTS ON BEHAVIOR
Reinforcement• Leads to an increase in behavior.Punishment• Leads to a decrease in behavior.
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TYPES OF REINFORCEMENT
Positive reinforcement (reward): behavior leads to reward.
Negative reinforcement (reward): behavior removes pain or anxiety
The goal is to increase a wanted behavior
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TYPES OF PUNISHMENT
Behavior leads to unpleasant outcome or takes away something pleasant.
The goal of punishment is a decrease in unwanted behavior.
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MOTIVATION
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REWARDS AND PUNISHMENTS
Add to Take away from
Pleasant
Unpleasant
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REWARDS AND PUNISHMENTS
Add to Take away from
Pleasant Positive reinforcement
Negative punishment
Unpleasant Positive punishment
Negative reinforcement
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PROBLEMS WITH PUNISHMENT
I Negative feelings towards person giving punishment.
II Physical or psychological pain.
III Escalate in severity.
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INTRINSIC MOTIVATION
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MOTIVATIONAL INTERVIEWING
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Hope ExpectancyThe belief that one can change and will be successful at making changes.
15%
Therapeutic RelationshipThe degree to which counseling conveys a nonjudgmental, empathic, accepting, warm environment.
30%
Client TraitsStrengths, temperament, resources, and skills.
40%
Technique/Orientation The skills and counseling orientation.
15%
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EVALUATING MI
Set goals Report &discuss Create planfindings
Evaluate ImplementChanges
Measure satisfaction Identify issues && assess Adjust componentsimplementation
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MOTIVATIONAL INTERVIEWING
• Encourages a respectful counselor-client relationship.• Aids in resolving discrepancies in client
values & behaviors promoting homeostasis.• Emphasizes consultation not confrontation.• Honors the clients ability to use personal
strengths in recovery.• Engages client in the recovery process.
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STAGES OF CHANGE
“I don’t have a problem.”
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STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
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STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
“I need to do something different.”
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STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
“I need to do something different.”
“I am taking action.”
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STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
“I need to do something different.”
“I am taking action.”
“I’m living differently.”
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MOTIVATIONAL INTERVIEWING
Directive
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MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
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MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
Elicits positive behavior change
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MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
Elicits positive behavior change
Addresses client ambivalence
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MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
Elicits positive behavior change
Addresses client ambivalence
Respects Autonomy
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MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
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MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
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MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
Roll with resistance
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MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
Roll with resistance
Support Self-efficacy
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ASSESSING READINESS
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MOTIVATIONAL INTERVIEWING
PHASE 1:
Building Motivation
PHASE 2:
Strengthening Commitment to Change
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PHASE ONE
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MI SKILLS AND STRATEGIES
PHASE I
• Open-Ended Questions
• Affirmations
• Reflective Listening
• Summarizing
• Eliciting Change Talk
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MI SKILLS AND STRATEGIES
PHASE II
• Recognizing Readiness
• Transitional Summary
• Key Question(s)
• Information and Advice
• Negotiating Plans for Change
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MI PHASE ONE STRATEGIES
OARS
Open-Ended Questions
Affirmation
Reflective Listening
Summary
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MOTIVATIONAL INTERVIEWING
CLOSED vs OPEN QUESTIONS• Open• Requires more than a yes or no response• Eliciting—more person-centered• Aids individual cognitions
• Closed• Quick, easy, & efficient• Less client-centered• Less engaging
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AFFIRMATIONS
• Compliments.
• Statements of appreciation.
•Highlights strengths.
• A form of Reflective Listening.
• Client-focused.
• Accurate.
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ROADBLOCKS
• Order and, direct • Warn or threaten• Advise, suggest and
solve• Persuade, argue and
lecture• Moralize, preach -
“shoulds”• Disagree, judge and
blame
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ROADBLOCKS
• Agree, approve and praise• Shame, ridicule or label• Interpret and analyze• Reassure, sympathize and
console• Question or probe• Withdraw or distract with
humor or change subject
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COMMUNICATION MODEL
The words the The words the speaker listener hears says
What the speaker What the listenerreally means thinks the speaker means
Thomas Gordon
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REFLECTIVE LISTENING
• Hearing the meaning behind client words
• Building hypothesis vs. making assumptions
• A non-judgmental, accepting environment
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REFLECTIVE LISTENING
SimpleRepeat Rephrase
ComplexParaphraseReflection of FeelingsSummary, Metaphors
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REFLECTIVE RESPONSES
•Simple
•Amplified
•Double-Sided
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SUMMARIZING
• This is a special form of reflection.
• Counselor chooses what to include and emphasize.
• Include client’s concerns about change, problem recognition, optimism about change and ambivalence toward change.
• Let client know you are listening.
• Invite the client to respond to the summary.
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CHANGE TALK
• What are the advantages of change
• What are the disadvantages of the status quo
• Stating optimism for change
• Stating an intention to change
• Stating a commitment
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CHANGE TALK STRATEGIES
• Evocative QuestionsDesires, Ability, Reasons, Needs & Commitment for Change (DARN-C)
• Elaboration• Importance• Confidence Rulers
• Decisional Balance
• Looking Forward– Looking Back
• Exploring Goals and Values
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MI CHANGE TALK STRATEGY PROCESS
ASK FOR ASSESS HEAR THE SEE THECOMMITMENT CHANGE
Desires Readiness Strong self-talk positive Abilities behaviorsReasonsNeeds
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PHASE ONE TRAPS
• Question/Answer Trap
• Taking Sides
• Expert/Labeling
• Premature Focus
• Blaming
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OARS AND CHANGE TALK
• Open-ended questions• Affirmation• Reflective
Listening• Summary• Eliciting change
talk
• Evocative question• Elaboration• Important
Confidence rulers• Decisional balance• Looking forward—
looking back• Exploring goals
and values
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CLIENT RESISTANCEI N V O LV E S F E E L I N G S , A C T I O N S , A N D B E H AV I O R S O F A N I N T E R P E R S O N A L
N AT U R E W H E R E T H E R E I S A L A C K O F C O L L A B O R AT I O N .
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RESISTANT BEHAVIORS
• Arguing
• Denying
• Blaming
• Interrupting
• Taking over
• Not responding
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MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
Roll with resistance
Support Self-efficacy
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STRATEGIC RESPONSES
• Shifting focus
• Agreement with a twist
• Emphasizing personal choice
• Reframing
• Siding with the negative
• Supporting self-efficacy
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REFLECTIVE & STRATEGIC RESPONSES
TO RESISTANCE
• Shifting focus• Agreement with a
twist • Emphasizing personal
choice
• Reframing• Siding with the
negative• Support self-efficacy
Simple Amplified Double-Sided
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PHASE TWO
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PHASE 2 STRATEGIES
Recognizing Readiness
Transitional Summary
Key Questions
Information and Advice
Negotiating Plans for Change
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CHANGE PLAN ELEMENTS
• Negotiating the plan• Identify the barriers to change• Implement the plan• Enlist support• Identify outcome measures• Measure success and revise the plan if
necessary
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PHASE TWO HAZARDS
• Underestimating Ambivalence
• Over Prescription
• Insufficient Direction
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MOTIVATING FOR CHANGE
• Ray Caesar LPC, LADC-MH• Director of Addiction Specialty Programs• Oklahoma Department of Mental Health &
Substance Abuse Services• (405)522-3870• [email protected]