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Assessing Motivation . Decisional Balance Benefits Concerns. Using scales. Readiness 0 1 0 20 30 40 50 60 70 80 90 100 Importance

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assessing motivation
Assessing Motivation

Decisional Balance

Benefits Concerns

using scales
Using scales

Readiness

0 1 0 20 30 40 50 60 70 80 90 100

Importance

0 10 20 30 40 50 60 70 80 90 100

How much better life will be

0 10 20 30 40 50 60 70 80 90 100

Confidence

0 10 20 30 40 50 60 70 80 90 100

resistance sustain talk
Resistance / sustain talk

Take three minutes to write down resistant statements that you come across in your practice

responding to resistance
How have you felt in the past when working with resistant clients?

What responses have not worked well?

What responses have worked well?

Responding to Resistance
dealing with resistance
DEALING with RESISTANCE

THERAPISTS ROLE

  • Not to assume it is wholly a client characteristic
  • Greater resistance = less chance of change
  • Lower levels of resistance is a good sign (change talk)
  • Resistance should be a therapist concern
  • Same therapist switching styles can affect outcome (Patterson & Forgatch, 1985)
slide7
Cont…

RECOGNISING RESISTANCE

  • Anything inconsistent with change
  • Suggests the client and therapist are not at the same point.
  • Change talk is the opposite to resistance
  • Resistance may be normal initially. Therapist task is not to elicit more but to manage effectively
strategies for dealing with resistance
STRATEGIES for DEALING WITH RESISTANCE
  • Simple reflection
  • Amplified reflection
  • Double sided reflection
  • Shifting focus
  • Agreement with a twist
  • Emphasising personal choice / control
  • Reframe
  • Paradox
slide11
Cont…
  • Confrontation is likely to elicit resistance
  • At 24 month follow up lower levels of alcohol consumption were noted in the group that had least in-session conflict

Miller, W.R., Benefield, R.G. and Tonigan, J.S. (1993) ‘Enhancing motivation for change in problem drinking: a controlled comparison of the two therapist styles’ Journal of Counselling and Clinical Psychology, 61: 455-461

research resistance
Research & Resistance
  • Level of client resistance during counseling predicted absence of change in drinking (Miller, Benefield & Tonigan, 1993)
  • Verbal commitment to drug use during MI predicted continued drug use (Amrhein et al., 2003)
  • Resistance / poor outcome relationship replicated in several other studies
practice responding to resistance
Practice Responding to Resistance
  • Resistant client
  • Use some of the resistant statements you have already written down and in pairs practice responses
further reading
Further Reading
  • motivationalinterview.org
  • Motivational Dialogue Raistrick & Tober (2007)
  • Motivational Interviewing Miller & Rollnick(2002)
  • Email contact: jon.mcgowan@leedspft.nhs.uk