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Motivating People to change. Sustainable, meaningful change for children and their families. Seminar outline. Introduction and housekeeping Stories of motivation What we know about motivation – incentives and sanctions– what really works? Coffee break John’s talk Exercise Summing up.
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Motivating People to change Sustainable, meaningful change for children and their families
Seminar outline • Introduction and housekeeping • Stories of motivation • What we know about motivation – incentives and sanctions– what really works? • Coffee break • John’s talk • Exercise • Summing up
Think about it • artificial change environments • embedded change • how humans respond to change – what motivates them to do something different from what they have always done.
Elements that enabled change • A person who was interested in him • A vision that the future could be different • A belief that he could make a choice • A belief that he could learn to do something he valued.
What makes therapy successful? Kieran McKeowan A guide to what works in family support services for vulnerable families (Dublin, 2000)
Seven steps to determination • I accept there is a problem • I have some responsibility for the problem • I have some discomfort about the problem and my part in it • I believe that things must change • I can make a choice • I can see that I can be part of the solution • I can see the first steps towards the change
Motivating people to change Workshop materials
Motivational Interviewing A person-centered, goal-oriented method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.
How might resistance show itself? • By only being prepared to consider 'safe' or low priority areas for discussion. • By not turning up for appointments • By being overly co-operative with professionals. • By being verbally/and or physically aggressive. • By minimising the issues. (Egan, 1994)
What might we be doing to make it worse? • Becoming impatient and hostile • Doing nothing, hoping the resistance will go away • Lowering expectations • Blaming the family member • Absorbing the family member's anger • Allowing the family member to control the assessment inappropriately
What might we be doing to make it worse? • Becoming unrealistic • Believing that family members must like and trust us before assessment can proceed. • Ignoring the enforcing role of some aspects of child protection work and hence refusing to place any demands on family members. (Egan, 1994)
What It Is Not • Skills training • Confrontive denial breaker • Simply sitting there listening and reflecting • The solution to all client issues and clinician headaches
The Problem With Them Is…. • They don’t see (insight, denial) • They don’t know • They don’t know how • They don’t care
So The Answer is….. • Give them Insight……if they just seethey will change. • Give them Knowledge….. if they just knowthey will change. • Give them Skills….. if you can just teach them howto change, then they will change. • Give them Hell….. if you can make them feel bad or afraid enough they will change.
And Yet….. Sometimes Insight, Knowledge, Skills, And Feeling Bad Or Fearful Is Still Not Enough
What Is Happening? • Ambivalence • Motivation • Readiness • Confidence Issues of……
Key Assumptions • Motivation is interpersonal • Resistance is interpersonal • Clinician approach and behaviors matter • Persuasion is usually not an effective method to increase motivation and change
MI: How it Works Clinician manages important in-session behaviors of client using MI spirit, principles and skills Interaction of clinician and client Increase Change talk and Decrease Resistance Leads to
Change Talk Desire Ability Reasons Need Taking Steps Commitment Strength Behavior Change
Resistance • Arguing • Interrupting • Denying • Ignoring
Basic MI Principles • D= Develop Discrepancy • R = Roll with Resistance • E= Express Empathy • S= Support Self-efficacy
Develop Discrepancy • Change is motivated by a perceived discrepancy between present behavior and important personal goals or values • The person rather than the counselor should present the arguments for change
Roll with Resistance • Avoid arguing for change • Resistance is not directly opposed • Resistance is a signal to respond differently • The person is a primary resource in finding answers and solutions
Express Empathy • Acceptance facilitates change • Skillful reflective listening is fundamental • Ambivalence is normal
Support Self-Efficacy • A person’s belief in the possibility of change is an important motivator • The person, not the counselor, is responsible for choosing and carrying out change • The counselor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy (HARP)
Strategies • Open Questions • Affirming • Listen Reflectively • Summarizing Dunn/MINT OARS
Change Talk Original idea from Bem’s theory “I learn what I believe from what I hear myself say.”
Assessing Importance • How important on a scale of 1-10? 1---x--------------y-------------10 • Why X and not 1? • What would have to happen for you to go from X to Y?
Confrontation In child welfare services, the Children’s Service Worker must be a skilled confronter. Confrontation is, basically, facing the client with the facts in the situation and with the probable consequences of behaviours (Texas Department of Human Resources)
Confrontation Client: The doctor is telling lies about me. I didn't hurt Angie, she fell downstairs. She is always having accidents. Worker: I understand that children have accidents. Angie's injuries could not have been the result of a fall down stairs. There are two partially healed fractures in addition to the new head injury. Angie's buttocks and back are marked with bruises in the shape of a hand. (Texas Department of Human Resources)
Confrontation • Client: I know we haven't been to counselling in three weeks. Get off my back! My husband and I have other things to do. • Worker: Going to counselling regularly is a part of your agreement with us to regain custody of your children. If the agreement is not followed, we can't recommend that the children come home. (Texas Department of Human Resources)
Effective work involves • Logical discussion • Focusing • Prioritising • Summarising • Setting realistic limits
Effective work involves • Universalising • Confronting • Educating • Modelling behaviour
Effective work involves • Recognising difference • Accepting • Allowing ventilation • Relating to feelings • Direct intervention in the environment
A scale for assessing motivation • Shows concern and has realistic confidence. • Shows concern, but lacks confidence. • Seems concerned, but impulsive or careless • Indifferent or apathetic about problems • Rejection of parental role.
Shows concern and has realistic confidence. • Parent is concerned about children’s welfare; wants to meet their physical, social, and emotional needs to the extent he/she understands them. • Parent is determined to act in best interests of children • Has realistic confidence that he/she can overcome problems and is willing to ask for help when needed • Is prepared to make sacrifices for children.
Shows concern, but lacks confidence • Parent is concerned about children’s welfare and wants to meet their needs, but lacks confidence that problems can be overcome • May be unwilling for some reason to ask for help when needed. Feels unsure of own abilities or is embarrassed • But uses good judgement whenever he/she takes some action to solve problems.
Seems concerned, but impulsive or careless • Parent seems concerned about children’s welfare and claims he/she wants to meet their needs, but has problems with carelessness, mistakes and accidents. Professed concern is often not translated into effective action. • May be disorganised, not take enough time, or pays insufficient attention; may misread ‘signals’ from children; may exercise poor judgement. • Does not seem to intentionally violate proper parental role; shows remorse.
