What makes changing so difficult?
Obstacles:
* Demoralisation
* Effort and Time
* Resistance
* Automatic cognitive processes
* Environmental factors
why you should acknowledge the reasons for sustaining the behaviour in the initial phase
- Behaviour has a function or a ‘special meaning’
- Resistance often arises out of fear
What is Motivation
degree of willingness/readiness to change
Three components of motivation
- Will to change
- Confidence in own ability to change
- Readiness to change
what is ambivalence and what role does it play in motivation
- conflicting motivations
- Ambivalence evokes discomfort and is often the start of change (cognitive dissonance)
What is Motivational Interviewing?
A client centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
Principles of Motivational Interviewing
- Show Empathy
- Unconditional acceptance (of the person, not necessarily the behaviour)
- Avoid discord/discussion
- Roll with resistance (judo)
- Affirmation
- Develop disbalance (cognitive dissonance)
the spirit of MI
collaboration(partnership)
compassion
acceptance
evocation
CACE or PACE
what is the righting reflex
repair reflex/ for your own good reflex
the urge to “fix” the problem by offering
solutions or advice that hasn’t been asked for.
what are the processes of MI
engaging
focusing
evocating
planing
what are the stages of change
pre-contemplation
contemplation
preparation
action
maintenance
relapse
engaging
entering therapeutic alliance/agenda setting with OARS
focusing
1 goal
-what change are we talking about
determining goal/direction
evocation
why change
explore and increase ambivalence and evoke change talk
what is DARN Cat and what is it a sighn of
sign of change talk
desire
ability
reason
need
commitment
activation
taking steps
how to evoke change talk
OARS
open questions
affirmations
reflections (complex)
summary (of the change talk)
planning
how to change
SMART goals
what are the 4 things to prepare your mind before MI
RULE
Resist, Understand, Listen, Empower.
What are 6 additional ways to elicit change talk
- Asking for it; evocative questions
- Asking for elaboration
- Querying extremes; best/worst things that could happen if they (don’t) change behavior
- Looking back; ask about a time in the past when things were different
- Looking forward; ask about imagined time in the future if change would or would not occur
- Exploring values and goals; ask how target behavior fits with values and goals
OARS
Open questions = more directed than in engagement phase, let people elaborate on the disadvantages of continuing and advantages of quitting
Affirmations = compliment, reframe, validate; statements that recognize strengths
Reflections = content, emotion, ambivalence; simple reflections (at the start); more provoking/complex (further in the session) —> order of the reflection is important, end with change talk
Summaries = not summarizing everything; use this to transition to new topic, highlight some motivational statements, connect different things, check understanding, use when you feel stuck
key questions
aim to prompt the client to articulate their goals motivations and plans for change
What is the difference between resistance and discord
Resistance = function/characteristic of the interaction styles between client and counselor (social interaction view)
Discord = different from sustain talk, includes disagreement, not being on the same wavelength, disturbance in the relationship
