MOTIVATIONAL INTERVIEWING

1. MOTIVATIONAL INTERVIEWING Motivation can be defined as a concept used to describe the factors within an individual which arouse, maintain, and direct behaviour towards a pre-defined goal.

2. MOTIVATIONAL INTERVIEWING TO ASSIST PEOPLE IN ACCEPTING REPONSIBILITY FOR THEIR CONDITION WE MUST FIRST ACKNOWLEDGE THEIR INERTIA, MANIFEST IN THE PASSIVITIES. I.E. THE WAY MOST PEOPLE SOLVE THEIR PROBLEMS.

3. PASSIVITIES DO NOTHING, WAIT AND SEE WHAT HAPPENS. WAIT AND SEE WHAT OTHERS DO BEFORE DOING ANYTHING. THEN DO NOTHING. NOTHING CAN CHANGE THE OUTCOME SO WHY BOTHER DOING ANYTHING?

4. PASSIVITIES KEEP DOING WHAT DOESN’T WORK, BUT EXPECT THINGS TO IMPROVE. DO EVERYTHING BUT WHAT IS RECOMMENDED BY YOUR TREATING HEALTH CARE PROFESSIONAL. SOMEONE ELSE WILL SOLVE MY PROBLEM. SHE’LL BE RIGHT MATE.

5. QUESTION? HOW DO YOU DEFINE “MOTIVATION”? HOW DO YOU RECOGNISE IT IN AN INDIVIDUAL? HOW WOULD YOU KNOW IF A PERSON IS MOTIVATED?

6. MOTIVATIONAL INTERVIEWING If we see MOTIVATION As a CHARACTERISTIC OR PERSONALITY TRAIT It establishes a SELF FULLFILLING PROPHECY which is ultimately a DISEMPOWERINGBELIEF for the treating professional and client alike.

7. MOTIVATION THE LEVEL OF MOTIVATION WITHIN A PERSON IS OPEN TO INFLUENCE. MOOD STATES ALONE WILL DO THAT. IT IS CERTAINLY OPEN TO THE INFLUENCE OF THE TREATING PROFESSIONAL.

8. MOTIVATIONAL INTERVIEWING Motivation levels fluctuate as a consequence of INTRAPERSONAL EVENTS (e.g. cognitions, tiredness, depression, illness, fear) and INTERPERSONAL EVENTS (e.g. professional contact, objective information, personal advantage.)

9. MOTIVATIONAL INTERVIEWING PEOPLE CHANGE BEHAVIOURS WHEN THEY COGNITIVELY RE-EVALUATE THE IMPACT ON THEIR LIVES. WHEN THE ACTUAL CONSEQUENCES OUT WEIGH THE PERCEIVED BENEFITS BEHAVIOURAL CHANGE IS MUCH MORE LIKELY TO OCCUR.

10. The most important behavioural characteristics that influencethe level of motivation in the patient are: THE “PERSON CENTERED” APPROACH. THE SKILL OF REFLECTIVE LISTENING. BEING OPTIMISTIC. EXPRESSING WARMTH.

11. BEING SUPPORTIVE. EXPRESSING EMPATHY. BEING SYMPATHETIC. BEING ATTENTIVE. AN ACTIVE INTEREST IN THE PERSON’S WELL BEING.

12. Think of motivation as COMPLIANCE,recognisable in ORIENTATION TO THE PROBLEM. RECOGNISING IT AS A PERSONAL PROBLEM. SEARCHING FOR A SOLUTION. APPLYING THE SOLUTION. MAINTAINING THE GAINS.

13. Directing a cognitive re-evaluation of the problematic behaviour. Bring into awareness the DISCREPANCY between REAL SELF v’s IDEAL SELF. VALUES v’s BEHAVIOUR. HEALTHY v’s UNHEALTHY BEHAVIOUR. CURRENT STATE OF LIFE v’s IDEAL STATE OF LIFE.

14. Discrepancy produces psychological tensionwhich can result in:- RISK REDUCTION • a move to reduce unwanted consequences of the problematic behaviour. FEAR REDUCTION - a move to reduce the unwanted emotional state by a cognitive reversal, i.e. a return to precontemplation.

15. RISK REDUCTION occurs when five factors are present. I WANT TO DO IT. I CAN DO IT. IT WILL BE AN ADVANTAGE TO ME OR I CAN AVOID A DISADVANTAGE. I WILL WORK AT IT. I WILL BE DETERMINED AND PERSIST AT IT.

16. 5IVE Let us understand the five factors.

17. WANT TO? What are the reasons for the person to do what is required to improve their lives? BECAUSE, BECAUSE, BECAUSE! Use the freakin word!

18. BECAUSE PROVIDES REASON, AND REASON MOTIVATES.

19. SEASON OF REASON People are much more likely to be motivated to be compliant when they REASONS to do so.

20. Never forget, the human brain tries to MAKE SENSE OF, to UNDERSTAND, to FIND MEANING. TO MOTIVATE PEOPLE OFTEN ALL WE HAVE TO DO IS PROVIDE MEANING.

21. GOOD REASON YOU ARE SUBTLY FORCING THEM TO THINK ABOUT IT BY GIVING THEM REASONS TO DO SO, AND IS ESPECIALLY POWERFUL WHEN WE PROVIDE THEM WITH A GOOD REASON.

22. IT IS AT ITS MOST POWERFUL WHEN THE PERSON IS MOTIVATED BY THEIR GOOD REASON.

23. HIERARCHY. PERSON’S GOOD REASON TO BE MOTIVATED. YOUR GOOD REASON. (STRIVE FOR MAXIMAL CONGRUENCE, I.E. SAME REASONS) YOUR REASONABLE REQUEST AS TO HOW IT WILL BE DONE.

24. CAN DO IT. IF A PERSON DOES NOT BELIEVE THAT THEY CAN CARRY OUT THE STEPS AND INFLUENCE THE OUTCOME, THEY WON’T EVEN TRY. OR, AS SOON AS THEY HIT AN OBSTACLE, THEY GIVE UP. S.F.P.

25. ADVANTAGES / CATASTROPHE. HELP THE PERSON IDENTIFY THE ADVANTAGES OF BEING COMPLIANT AND THE CATASTROPHES IN NOT BEING COMPLIANT.

26. MOTIVATIONAL INTERVIEWING Avoid the creation of RESISTANCE RELUCTANCE REACTANCE to the natural change process by arguing that there is a problem.

27. KEY PRINCIPLES IN MOTIVATIONAL INTERVIEWING. ROLE WITH THE RESISTANCE. FACILITATE THE PERSON CONVINCING THEM SELF. THIS THEY WILL DO IN RESPONSE TO THE FOCUSSED QUESTIONS YOU ASK.

28. KEY PRINCIPLES IN MOTIVATIONAL INTERVIEWING. PEOPLE LEARN WHAT THEY BELIEVE AS THEY HEAR THEMSELVES SAY IT BECAUSE I BELIEVE WHAT I TELL MYSELF IS TRUE.

29. 1. GAIN PERMISSION. DON’T ASSUME THAT THE PERSON IS READY TO DISCUSS THE ISSUE OR HEAR YOUR CONCERNS. ASK. “YOU WOULDN’T MIND IF WE DISCUSS (ISSUE) NOW?” “I AM SURE THAT YOU WOULD LIKE TO HELP ME IDENTIFY AND REDUCE YOUR HEALTH RISKS”

30. WHAT PURPOSE DOES THE ACTIVITY SERVE IN THEIR LIVES? HUMAN BEHAVIOUR IS MOTIVATED. WHAT IS THE MOTIVATION BEHIND THE ACTIVITY TO BE ESTABLISHED OR REMOVED?

31. 2. UNDERSTAND POSITIVE EXPECTANCIES “TELL ME WHAT IT IS YOU ENJOY ABOUT…. (E.G. SMOKING)” “WHAT DO YOU GET OUT OF…?” “HOW DOES….FIT INTO YOUR LIFESTYLE?” ACKNOWLEDGE, BUT DON’T REINFORCE REASONS FOR ACTIVITY.

32. 3. FOCUS THE NEGATIVES. (I.E. THE UNWANTED CONSEQUENCES OF THE BEHAVIOUR) “YOU HAVE GIVEN ME THE UPSIDE, WHAT ABOUT THE OTHER SIDE OF IT, TELL ME A BIT ABOUT THAT.” “WHAT ARE YOUR CONCERNS ABOUT…. (E.G. SMOKING)?” GOOD THINGS v’s LESS GOOD THINGS

33. THE SUM OF ALL FEARS. SUMMARISE THE NEGATIVES ADDITIVELY. (A; A+B; A+B+C; A+B+C+D). THIS IS LIKELY THE FIRST TIME THAT THEY HAVE ASSEMBLED AND HEARD ALL THEIR CONCERNS.

34. 4. CREATE THE DISCREPANCY. “YOU OBVIOUSLY HAVE CONCERNS ABOUT THE WAY…. IS AFFECTING YOUR HEALTH, RELATIONSHIP, CAREER, LIFESTYLE, ETC. PERHAPS THE SITUATION IS NO LONGER ACCEPTABLE TO YOU?” “WHAT DO YOU WANT TO DO ABOUT YOUR… IT IS SOMETHING YOU DO, NOT WHO YOU ARE.”

35. 5. ESTABLISH PRIORITIES. “WHEN YOU THINK ABOUT (ISSUE) AND YOUR HEALTH, WHICH ONE IS MOST IMPORTANT TO YOU?” “IF YOU HAD TO MAKE A CHOICE BETWEEN A AND B WHICH ONE WOULD IT BE? I DON’T MIND WHICH ONE YOU CHOOSE, BUT I NEED TO KNOW IN ORDER TO BEST ASSIST YOU.”

36. 6. CLARIFY OBSTACLES TO CHANGE. “HAVE YOU EVER TRIED TO DO SOMETHING ABOUT THIS BEFORE? WHAT HAPPENED?” “WHEN YOU THINK ABOUT STOPPING (CHANGING) WHAT COULD PREVENT YOU FROM ACHIEVING IT?” “WHAT DID YOU LEARN FROM PREVIOUS ATTEMPTS TO CHANGE?”

37. 7. NEGOTIATE SOLUTIONS. “WHAT DO YOU WANT TO DO ABOUT THIS? “WHAT WOULD YOU LIKE TO TRY FIRST, NICOTINE GUM, NICOTINE PATCHES, OR XYBAN TO HELP YOU QUIT?” WHERE POSSIBLE GIVE THREE CHOICES.

38. 8. GET COMMITMENT. NEGOTIATE THE GOALS OF TREATMENT, BE SPECIFIC, AND USE CONTRACTS. REMIND THAT SUCCESS IS PREDICATED UPON PERSISTENCE AND DETERMINATION. FOLLOW UP AND SUPPORT!

39. RULE OF THUMB. To progress a person from Precontemplation to Contemplation INCREASE THE REASONS FOR THEM TO DO SO.

40. RULE OF THUMB. To progress a person from Contemplation to Action DECREASE THE COSTS.

41. RULE OF THUMB. To support a person in Action INCREASE THE REASONS TO DO SO, DECREASE THE COSTS.

42. RULE OF THUMB. TWICE AS MUCH EFFORT SHOULD BE PUT INTO ESTABLISHING THE REASONS TO CHANGE AS IN REDUCING THE COSTS.

43. OTHER COUNSELLING STRATEGIES USED WITHIN THE M.I. FRAMEWORK. RETROSPECTION. What was life like before the emergence of the problematic behaviour? What does the person remember, what plans, dreams did they have? The goal is to assist the person to see how things have deteriorated over time because of the problematic behaviour.

44. FUTURESPECTION The person in treatment has to envision two futures 5 – 10 years hence. The first will be the future in which they continue with the problematic behaviour. The second will be the possible future should they decide to change. Don’t argue for one or the other, Ask the client to comment.

45. IMPORTANCE AND CONFIDENCE. Whilst people may indicate a preference for the best of all possible futures, how important is it to them and how confident are they that they can achieve it? Explore what makes the change important, how it would fit in to other aspects of their life, what could occur to make it more important?

46. FRAMES. Feedback. Responsibility. Advice. Menu of options (3). Empathy. Self efficacy.

47. BATTLE PLAN. As people are being supported in making changes it is essential to identify obstacles. Their diary becomes their best friend with agreed strategies in place. Assist them in planning the next sixty days, what it is that they want to achieve and how they are going to achieve it, “the big plan”.

48. THE BIG PLAN. They need to implement a system that will keep bringing them back on track. One that will keep re-orienting them towards their goals again and again. If there is no reminder system, then old habits will always triumph over new intentions and motivation.