Effecting Change through the use of Motivational Interviewing - PowerPoint PPT Presentation

Loading...

PPT – Effecting Change through the use of Motivational Interviewing PowerPoint presentation | free to view - id: 6fb089-NDBkZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Effecting Change through the use of Motivational Interviewing

Description:

Effecting Change through the use of Motivational Interviewing Jeanne L. Obert, MFT, MSM Executive Director, Matrix Institute UCLA Integrated Substance Abuse Programs – PowerPoint PPT presentation

Number of Views:382
Avg rating:3.0/5.0
Slides: 60
Provided by: Thoma496
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Effecting Change through the use of Motivational Interviewing


1
Effecting Change through the use of
Motivational Interviewing
  • Jeanne L. Obert, MFT, MSM
  • Executive Director, Matrix Institute
  • UCLA Integrated Substance Abuse Programs

2
One Way of Thinking
The Stick
  • Change is motivated by discomfort.
  • If you can make people feel bad enough, they will
    change.
  • People have to hit bottom to be ready
  • Corollary People dont change because they
    havent suffered enough

3
Assumptions in working with people who clearly
need to change
You better ____ or ________!
If the stick is big enough. There is no need for
a carrot.
4
Assumptions in working with people who clearly
need to change
  • People change only when they have to.
  • If the consequences are negative enough,
  • people will change to avoid them.

5
BUT DO THEY ALWAYS ?
6
Motivational Interviewing, 2nd Edition. Miller
and Rollnick
  • We cant help wondering, why dont people change?
    You would think
  • that having had a heart attack would be enough to
    persuade a man to quit smoking, change his diet,
    exercise more, and take his medication

7
You would think..
  • that hangovers, damaged relationships, an auto
    crash, and memory blackouts would be enough to
    convince a person
  • to stop drinking

8
You would think..
  • that the very real threats of blindness,
    amputations and other complications from diabetes
    would be enough to motivate weight loss and
    glycemic control

9
You would think..
  • that time spent in the dehumanizing privations of
    prison would dissuade people from re-offending

10
AND YET
  • Addictive behaviors persist despite overwhelming
    evidence of their destructiveness.

11
What has occurred
  • The field of addictions has provided a natural
    arena to study the process of change.
  • What causes change to occur?
  • How does the process unfold?
  • Is it possible to push the river?
  • What is the best way to do that?

12
Another Way of Thinking
The Carrot
  • People are ambivalent about change
  • AMBIVALENCE is the key issue to be resolved
    for change to occur.
  • Lack of motivation can be viewed as
  • unresolved ambivalence.

13
Ambivalent people may not respond in predictable
ways.
  • Increasing the negative consequences (using the
    stick) does not always decrease the
    attractiveness of the behavior.
  • It can sometimes exacerbate it rather than
    diminish it.

14
The Theory of Psychological Reactance(one
possible explanation)
  • This theory predicts an increase in the rate and
    attractiveness of a behavior IF the person
    perceives a challenge or infringement to his or
    her personal freedom.

15
What facilitates change
The Carrot
  • Constructive behavior change comes from
    connecting with something valued, cherished and
    important
  • Intrinsic motivation for change comes out of an
    accepting, empowering, safe atmosphere where the
    painful present can be challenged

16
The Process of Change
  • Positive change often occurs without formal
    treatment.
  • Treatment can be viewed as facilitating what is a
    natural process of change.

17
Most Change Happens Early
  • A little counseling can lead to significant
    change.
  • Dozens of studies from many different countries
    document the effectiveness of brief interventions
    for many problems.

18
Perceived Efficacy
  • People who believe that they are likely to change
    do so. People whose counselors believe that they
    are likely to change do so. Those who are told
    that they are not expected to improve or who do
    not believe they will improve indeed do not.
  • Beliefs about possibility of change become
    self-fulfilling prophecies. (Waiting list
    effects in control groups.)

19
Beyond the Initial Sessionin Drug Abuse Treatment
  • What factors influence whether
  • a patient stays in treatment and
  • does well following treatment?
  • Factor that seems to make the biggest difference
    is the professional to whom the patient is
    assigned.

20
Back to Where we Started
  • Ideal atmosphere for change within the
    therapeutic relationship (Carl Rogers, 1959)
  • Accurate empathy
  • Non-possessive warmth
  • Genuineness

21
Some things weve learned
  • Caregiver empathy can be a significant
    determinant of persons response to treatment.
  • Directive, confrontational counseling
  • styles increase patient/client resistance.
  • Empathic counseling styles facilitate change.

22
More things weve learned
  • Level of MOTIVATION is often a good predictor of
    outcome.
  • MOTIVATION can be influenced by naturally
    occurring factors and by specific interventions.

23
What Causes a Person to be Judged Motivated
  • The person agrees with us
  • Is willing to comply with our recommendations
    and treatment prescriptions
  • States desire for help
  • Shows distress, acknowledges helplessness
  • Has a successful outcome

24
Definition of Motivation
The probability that a person will enter into,
continue, and comply with change-directed
behavior
25
Motivational Interviewing
Elicit behavior change
Respect autonomy
A patient-centered directive method for enhancing
intrinsic motivation to change by exploring and
resolving ambivalence.

Tolerate patient ambivalence
Explore consequences
26
Stages of ChangeProchaska DiClemente
Precontemplation
Contemplation
Maintenance
Preparation
Action
27
What Research Tells Usabout Patients with C-O
Disorders
  • Patients are often demoralized and unwilling
    to consider alcohol and drug abstinence (or
    manage their dual disorders ) due to
  • Severe and disabling symptoms
  • Frequent failed treatment episodes
  • Poor functional adjustments

28
What Research Tells Usabout Patients with C-O
Disorders
  • Extensive literature references the low
    motivation for change in this population
  • Emphasis has been on primary importance of
    engagement and motivational enhancement strategies

29
Treatment Enhancements for C-ODisordered Patients
  • Necessary because
  • These patients are notorious for treatment
    noncompliance
  • Noncompliance can lead to adverse consequences
    such as poor outcomes, violent behavior,
    increased rates of re-hospitalization and
    utilization of emergency services and jails

30
A Three Part Process
Taking Medications
Staying Clean and Sober
Participating in Dual Diagnosis Specialty Program
31
Precontemplation StageNot yet considering change
or is unwilling or unable to change
  • Offer factual information.
  • Explore the meaning of events that brought the
    person in and the results of previous efforts
  • Explore pros and cons of targeted behaviors

32
Contemplation StageSees possibility of change
but is ambivalent and uncertain
  • Talk about the persons sense of self-efficacy
    and expectations regarding what the change will
    entail.
  • Summarize self-motivational statements.
  • Continue exploration of pros and cons.

33
Determination StageCommitted to making change
but is still considering what to do.
  • Offer a menu of options for change or treatment
  • Negotiate a change (treatment) plan and behavior
    contract

34
Determination StageCommitted to making change
but is still considering what to do.
  • Identify and lower barriers to change
  • Help person enlist social support
  • Encourage person to publicly announce plans to
    change

35
Action StageTaking steps to change but hasnt
reached a stable state
  • Support a realistic view of change through small
    steps.
  • Help person identify high-risk situations and
    develop appropriate coping strategies.

36
Action StageTaking steps to change but hasnt
reached a stable state
  • Assist person in finding new reinforcers of
    positive change.
  • Help access family and social support.

37
Maintenance StageHas achieved goals and is
working to maintain them.
  • Help person identify and try alternative
    behaviors (drug-free sources of pleasure)
  • Maintain supportive contact

38
Maintenance StageHas achieved goals and is
working to maintain them.
  • Encourage person to develop fire-escape plan
  • Work to set new short and long term goals.

39
RecurrenceHas experienced a recurrence of
symptoms and must cope with CONSEQUENCES and
DECIDE WHAT TO DO NEXT
  • Explore with person the meaning and reality of
    recurrence as a learning opportunity.
  • Explain Stages of Change and encourage him/her to
    stay in the process.

40
RecurrenceHas experienced a recurrence of
symptoms and must cope with CONSEQUENCES and
DECIDE WHAT TO DO NEXT
  • Help person find alternative coping strategies.
  • Maintain supportive contact.

41
Four Principles ofMotivational Interviewing
1. Express empathy 2. Develop discrepancy 3. Avoi
d argumentation 4. Support self-efficacy
42
Express Empathy
  • Acceptance facilitates change
  • Skillful reflective listening is fundamental
  • Ambivalence is normal

43
Motivational InterviewingIntervention
Elicit Pros and Cons of Target Behavior
44
Develop DiscrepancyReady, Willing and Able
  • Discrepancy between present behaviors and
    important goals or values motivates change
  • Awareness of consequences is important
  • Goal is to have the PERSON present reasons for
    change

45
Motivational InterviewingIntervention
Facilitate discussion of lifestyle satisfaction
(compared to that once envisioned)
46
3. Avoid Argumentation
  • Resistance is signal to change strategies
  • Labeling is unnecessary
  • Shift perceptions
  • Peoples attitudes shaped by their words, not
    yours

47
Motivational InterviewingInterventions
Elicit individuals stated concerns (rather than
stating yours) Emphasize and reflect areas of
greatest concern and discrepancy
48
Support Self-EfficacyReady, Willing and Able
  • Belief that change is possible is important
    motivator
  • Person is responsible for choosing and carrying
    out actions to change
  • There is hope in the range of alternative
    approaches available

49
Motivational InterviewingIntervention
Elicit and support realistic intended behavior
change
50
Building MotivationOARS
  • Open-ended questioning
  • Affirming
  • Reflective listening
  • Summarizing

51
Open-ended Questions
  • An open-ended question is one with more than a
    yes or no response
  • Helps person elaborate own view of the problem
    and brainstorm possible solutions

52
Affirmations
  • Focused on achievements of individual
  • Intended to
  • Support persons persistence
  • Encourage continued efforts
  • Assist person in seeing positives
  • Support individuals proven strengths

53
Reflective Listening Key-concepts
  • Listen to both what the person says and to what
    the person means
  • Check out assumptions
  • Create an environment of empathy (nonjudgmental)
  • You do not have to agree
  • Be aware of intonation (statement, not question)

54
SUMMARIZING
  • Summaries capture both sides of the ambivalence
  • (You say that ___________ but you also
    mentioned that ________________.)
  • Summaries also prompt clarification and further
    elaboration from the person.

55
Change Talk
  • Recognizing the problem
  • Expressing concern
  • Stating intention to change
  • Being optimistic about change

56
Providing Feedback
  • Elicit (ask for permission)
  • Give feedback or advice
  • Elicit again (the persons view of how the advice
    will work for him/her)

57
Signs of Readiness to Change
  • Less resistance
  • Fewer questions about the
    problems
  • More questions about change
  • Self-motivational statements
  • Resolve
  • Looking ahead
  • Experimenting with change

58
You are using MI if you
  • Talk less than your client does
  • On average, reflect twice for each question
  • Reflect with complex reflections more than half
    the time
  • Ask mostly open ended questions
  • Avoid getting ahead of your clients stage of
    readiness (warning, confronting, giving unwelcome
    advice, taking good side of the argument

59
JLObert_at_matrixinstitute.org
www.matrixinstitute.org www. uclaisap.orghttp/
/motivationalinterview.orgEnhancing Motivation
for Change in Substance Abuse TreatmentTIP 35
About PowerShow.com