MotivationalInterviewing SAC

7/30/2019 MotivationalInterviewing SAC

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Introduction to Motivational

Interviewing

Ivan Zy Lim, MSocSc


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Differences in the Model

Most programs are designed for the action stage Sees cycling through the stages several times as

normal, not as failure

Interventions match the stage of the client Resistance is seen in terms of the clinician notunderstanding the stage of the client Workers focused on the process of change


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Relationship is Key

Unconditional PositiveRegard

It all starts with


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If you treat an individual as heis, he will stay as he is, but if

you treat him as if he were

what he ought to be and whathe could be, he will become

what he ought to be and could

be.

- Johann Wolfgang Von Goethe


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1. Pre-contemplation No perceived need to change

2. Contemplation Initial awareness of a problem Feelings of ambivalence about change

3. Preparation Stage Initial Movement away from ambivalence and toward action Statements reflect the beginnings of motivation

4. ActionThe person takes steps to bring about change

5. Maintenance StageThe person sustains the change accomplished by previous actions Steps for maintaining long-term change are different from steps for initial change

6. Relapse Stage Long-standing change often involves setbacks Person may relapse into previous problem behaviors

STAGES OF CHANGE


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STAGES OF CHANGE

MAINTENANCE RELAPSE

PRECONTEMPLATION

CONTEMPLATIONPREPARATION

ACTION

ENTER

TEMPORARY

EXIT

PERMANENT

EXIT


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Stage of Change

Motivational Tasks

Pre-contemplation Raise doubt Increase perception of risks and

problems

Contemplation Explore ambivalence Dont take sidesPreparation Create realistic plan Explore what if this doesnt work?

Stage of Treatment

Interventions

Engagement Outreach Practical help Crisis intervention Develop alliance AssessmentPersuasion Education Set goals Build awareness of problem

(motivational counseling)

Family support Peer support


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Stage of Change

Motivational TasksAction Encourage right sized steps Explore how is it working?" Develop new skills

Maintenance

Explore new behaviors Develop relapse prevention plan

Stage of Treatment

InterventionsActive Treatment Counseling Medication Treatment Skills Training Self-help groups

Relapse Prevention

Relapse prevention plan Continued skill development Expand recovery to other life

areas


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WHAT IS

MOTIVATIONAL

INTERVIEWING?


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A client-centered, directive intervention

focused on resolving ambivalence in the

direction of change.

not a series of techniques

but a way of being with clients.Information on MI adapted fromMotivational Interviewing. Miller and Rollnick, 1991


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MOTIVATIONAL INTERVIEWING

Based on Stages of Change. Assumes motivation is fluid and can be influenced. Motivation influenced in the context of a relationship. Principle tasks - to work with ambivalence and

resistance.

Goal - to influence change in the direction ofhealth.


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G.R.A.C.E.Five Principles of Motivational Interviewing

Generate a GapRoll with Resistance

Avoid Argumentation

Can Do

Express Empathy


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Principles of Motivational Interviewing:

Develop a discrepancy between individualscurrent behaviors andhis/her stated valuesand interests.

Let client present arguments for change.Acknowledge both the positives andnegatives

of behavioral change.

Generate a Gap


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Roll with resistance

Seek to clarify, understand. Invite consideration of new perspectives. Reinforce persons role as a problem-solver.


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Keep on your clients side.Arguing for change often promotes resistance,

thus causing the client to defend the behavioryou want them to change.


Avoid Argumentation


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Increase individuals perception of self as a capableperson.Affirm positive statements and behaviors. Offer options, instill hope. Encourage consideration of role models, past

successes.


Can Do


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Create a free and friendly space to exploredifficult issues.

Use reflective listening.

An accepting attitude facilitates change, pressureto change thwarts it (paradox).


Express Empathy


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Open-ended QuestionsAffirmations

Reflective Listening

Summaries

O.A.R.S.The Basic Skills of Motivational Interviewing


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OPEN ENDED QUESTIONS How can I help you? Would you tell me about ___? How would you like things to be different? What are the positive things and what are the less

good things about ___?

What will you lose if you give up ___? What have you tried before? What do you want to do next?


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AFFIRMATIONS

Statements of recognition of client strengths. Build confidence in ability to change. Must be congruent and genuine.


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REFLECTIVE LISTENING

Reflective listening is the key to this kind of work.

The best motivational advice we can giveis to listen carefully to your clients.

They will tell you what has worked and

what hasnt. What moved them forward and

shifted them backward. Whenever you arein doubt about what to do, listen.

- Miller & Rollnick, 1991


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LEVELS OF REFLECTION

1. SIMPLERepeating, rephrasing; staying close to the content

2.AMPLIFIEDParaphrasing, double-sided reflection; testing themeaning/whats going on below the surface

3. FEELINGSEmphasizing the emotional aspect of communication;deepest form


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TYPES OF

REFLECTIVE LISTENING

REPEATING OR REPHRASINGListener repeats or substitutes synonyms or phrases; stays close to

what the speaker has said.

PARAPHRASINGListener makes a major restatement in which the speakers

meaning is inferred.

REFLECTION OF FEELINGListener emphasizes emotional aspects of communication

through feeling statements- this is the deepest form of listening.


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SUMMARIZINGLet me see if I understand thus far

Special form of reflective listening. Ensures clear communication. Use at transitions in conversation. Be concise. Reflect ambivalence . Accentuate change talk.


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RAPPORT BREAKERS

Arguing for changeAssuming the expert role

Criticizing, shaming or blaming Labeling Being in a hurry Claiming pre-eminence


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Contact Info

LiveN Love Pte Ltd

Cognitive Behavioural Clinic

Ivan Zy Lim, MSocSc

Director/Princiapal Consultant+65 8233 2989

[email protected]


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MotivationalInterviewing SAC

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