CHANGE TALK AND MOTIVATIONAL INTERVIEWING. Adopted from Overcoming Obstacles to Change presentation by Dr. Deborah Dobson, Ph.D., R.Psych. For Presentation at Supportive Living Program Team Meeting. April 21, 2011, Marguerite House. CHANGE.
CHANGE TALK AND MOTIVATIONAL INTERVIEWING
Adopted from Overcoming Obstacles to Change presentation by Dr. Deborah Dobson, Ph.D., R.Psych.
For Presentation at Supportive Living Program Team Meeting. April 21, 2011, Marguerite House.
ANY EXAMPLES ………BRAINSTORMING….
WHAT INTERNAL AND EXTERNAL OBSTACLES CAN YOU MENTION???..
Two minutes of Brainstorming Session.
INTERNAL / INTRNSIC
Lack of readiness
Lack of motivation
Lack of skills involved
Belief about self/others. Liking the statuesque, relative comfort, self defeating thought
Avoidant behavior procrastination, indecision
Fear and anxiety……
Mental Illness …….
Lack of resources, finance,
Other peoples attitudes- stigma (could be internal too).
Poor reinforces (AISH, EI Benefits..).
The cost for change is too high.
Excessive work pressure involved.
FEAR OF THE UNKNOWN:
The fear that when change occurs, one will lose control, feeling of uncertainty.
FEAR OF FAILURE:
The fear that change entails a chance for failure.
FEAR OF COMMITMENT:
The fear that fear demands increased work pressure, and dedication and increased hard work beyond ones abilities.
FEAR OF DISAPPROVAL:
The fear that after change, significant others would show rejection/ isolation/ or be critical of ones behavior.
FEAR OF SUCCESS:
If I change, other people expect too much from me.
Feeling worthlessness, helplessness or hopelessness, having difficulty concentrating or making decisions, loss of interest in taking part in activities, avoiding other people, overwhelming feelings of sadness or grief, loss of energy, feeling very tired, thoughts of death or suicide.
MANIC STATE extreme optimism, exaggerated self-esteem, racing thoughts • Extreme irritability, Impulsive and potentially reckless behaviour
Feelings of apprehension or dread, trouble concentrating, feeling tense and jumpy, anticipating the worst, irritability, restlessness, watching for signs of danger, Feeling like ones mind’s gone blank
Delusions and/or hallucinations, lack of motivation, social withdrawal, thought disorders, ccognitive and intellectual barriers,
PRECONTEMPLATION STAGE- I HAVE NO PROBLEM
In this stage, a client is unaware that he or she has a problem, or is under-aware of the problem. There is no expressed desire to make any changes, and no real concern or immediacy for anything to be different. If asked, clients might say that things are fine, and that if nothing is different a year from now, it would be okay.
CONTEMPLATION STAGE- I THINK I SHOULD CHANGE
In this stage, a client has become aware that there may be a problem, and one has begun considering doing something about it.
COMMITMENT STAGE: I WILL CHANGE
Clients have become more than aware that they have a problem or a situation that demands change. Clients are motivated to do something to change it. Clients go beyond saying “I should” and begin saying “I will.” Interestingly, this is a difficult stage to get to. Clients often enter this stage and commit to change only when the alternative is no longer tolerable. The thought of NOT changing is unbearable. It is in this stage that change—and progress—are born.
PREPARATION: YES I CAN CHANGE, READY TO TAKE STEPS
This is a “could” stage. Clients think of every possible alternative and resources. Clients look at options, and they choose the ones that will work for them. Clients devise a plan, and are intent on following it through. Clients are ready.
Clients are committed. Clients have prepared. Clients are physically, emotionally, and spiritually ready to embark on a journey by which it will improve their lives. Clients take steps.
Clients feel proud. They love the change . Clients hold their head higher. Clients have more self confidence. SUCCESS.
When a client falls or slides back into a former state.This will imply the start up of the whole cycle all over again:
THE MAIN QUESTION IS
HOW DO WE BRING ABOUT
A SUCCESSFUL CHANGE?
MOTIVATIONAL INTERVIWING, A STRATEGY FOR BRINGING FORTH SUCCESSFUL CHANGE.
Emphasis on coercion, persuasion, constructive confrontation and the use of external contingencies go against the spirit of motivational interviewing.
While tempting to be helpful by offering persuasive arguments for change, therapists usually create resistance to change in their clients. Never argue with a client. Help the client become engaged as a primary resource to find hi/her own solution to the problem
The therapist respects the client’s right to make choices about behaviour and consequences of the chosen behaviour. Client centered trust relationship.
Clarify the target behavior about which there is ambivalence.
- In what ways?
- How do you see this happening?
- What have you changed in the past that you can relate to this issue?
- What may happen if things continue as they are (status quo).
- If you were 100% successful in making the changes you want, what would be different?
- How would you like your life to be in the future?
- What do you want in life?
- What values are most important to you?
- How does this change into your value system?
Simple Reflection: Simple acknowledgement of the client’s disagreement emotion, or perception.
Double- sided Reflection: Acknowledge what the client has said and add to it the other side of the client’s ambivalence.
Clarification: Verify your understanding matches the client’s perspective.
Shifting Focus: Shift the client’s attention away from what seems to be a stumbling block.
Emphasizing Personal Choice and Control: Assure the person that in the end, it is the client who determines what happens.
THANK YOU so much.
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