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  1. Assessing Motivation Decisional Balance Benefits Concerns

  2. 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

  3. The Flow of Change Talk

  4. Resistance / sustain talk Take three minutes to write down resistant statements that you come across in your practice

  5. 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

  6. 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)

  7. 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

  8. STRATEGIES for DEALING WITH RESISTANCE • Simple reflection • Amplified reflection • Double sided reflection • Shifting focus • Agreement with a twist • Emphasising personal choice / control • Reframe • Paradox

  9. Therapist Style and Client ResponseMiller, Benefield & Tonigan (1993) JCCP 61: 455-461

  10. Avoid eliciting resistance

  11. 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

  12. 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

  13. Practice Responding to Resistance • Resistant client • Use some of the resistant statements you have already written down and in pairs practice responses

  14. Further Reading • motivationalinterview.org • Motivational Dialogue Raistrick & Tober (2007) • Motivational Interviewing Miller & Rollnick(2002) • Email contact: jon.mcgowan@leedspft.nhs.uk