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MOTIVATIONAL INTERVIEWING: Strategies and Techniques

MOTIVATIONAL INTERVIEWING: Strategies and Techniques. COUNSELLING TRAPS. 1. Premature focus trap Start broad, not with the problem. 2. Confrontation-denial trap Creates counterarguments. B: 01.40 – 04.45. COUNSELLING TRAPS. 3. Question-answer trap

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MOTIVATIONAL INTERVIEWING: Strategies and Techniques

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  1. MOTIVATIONALINTERVIEWING:Strategies and Techniques

  2. COUNSELLING TRAPS 1. Premature focus trap Start broad, not with the problem 2. Confrontation-denial trap Creates counterarguments B: 01.40 – 04.45

  3. COUNSELLING TRAPS 3. Question-answer trap Implies the counsellor is in control whilst the client is a passive recipient B: 06.45 – 08.00

  4. COUNSELLING TRAPS 4. The expert trap Implies the counsellor has all the answers Intervention should be viewed as a partnership B: 08.00 – 10.45

  5. OPENING STRATEGIES • Ask open questions • Let the client set the agenda • Build a picture of the client’s context B: 10.50 – 12.20

  6. OPENING STRATEGIES 2. Reflective listening B: 12.20 – 26.00

  7. OPENING STRATEGIES 3. Summarising Begins to be directive The counsellor chooses what to summarise B:26.00 – 30.20

  8. OPENING STRATEGIES 4. Affirming Convey respect for the client Reframe apparent weaknesses as strengths B: 30.20 – 32.30

  9. OPENING STRATEGIES 5. Elicit self-motivating statements Change talk Encourage the client to make the case for change B: 32.30 – 33.10

  10. 1. Recognising there is a problem I hadn’t realised how bad things are 2. Concern for present condition I’m really worried about this SELF-MOTIVATING STATEMENTS B: 33.10 – 36.40

  11. 3. Intention to change I think it’s time I thought about changing 4. Optimism for change I’m sure I can change, if I putmy mind to it SELF-MOTIVATING STATEMENTS B: 36.40 – 39.00

  12. SELF-MOTIVATING STATEMENTS Cognitive, affective and behaviouraldimensions of motivation to change

  13. ASK EVOCATIVE QUESTIONS NotDo youhave concerns about your problem?ButWhatconcerns you about the problem? C: 00.50 – 04.40

  14. ASK EVOCATIVE QUESTIONS 1 Problem recognition Does (your current behaviour)cause you any problems? 2 Concern for present condition In what ways does this worry you?

  15. ASK EVOCATIVE QUESTIONS 3 Intention to change What is going to have to change tomake things different? 4 Optimism for change What do you think would help you tochange?

  16. EXPLORE IMPORTANCE AND CONFIDENCE Importance How important is it to you to change right now? 1 – 10 ConfidenceHow confident are you that you could change? 1 - 10 HBC: S9. 39.40 – 48.46

  17. EXPLORE IMPORTANCE AND CONFIDENCE Why (3) and not zero? What would it take you move youup to (5)? HBC: S9. 39.40 – 48.46

  18. EXPLORING THE PROS AND CONS Discuss the positive and negativeconsequences of changing Develop a discrepancy betweennow and the ideal state C: 04.40 – 12.00

  19. Decisional balance PROS SHORT-TERM CONS SHORT-TERM PROS LONG-TERM CONS LONG-TERM

  20. Decisional balance PROS SHORT-TERM CONS SHORT-TERM Feel better about myselfSleep betterFamily would approve Hard workPainful musclesFeel tiredCosts moneyEat more and put on weightHard to find timeLess time for other things PROS LONG-TERM CONS LONG-TERM Get fitHave better healthLose weightLess likely to get heart diseaseHave more energyFeel I’ve accomplished somethingFeel less stressedFamily would be proud of me Have to fit it in to my daily life

  21. SEEK ELABORATION Reinforces the theme and elicits furtherself-motivational statements Ask for specific examples: When you say you’d feel better about yourself, what exactly do you mean? C: 12.00 – 13.35

  22. Imagining Extremes What is the worst/best that could happen if you did/did not change? Looking Forward What would things be like? How would that be different to now? Looking back What was it like before? J: 21.45 – 49.20 (27) C: 13.35 – 21.45

  23. DEALING WITH RESISTANCE Recognising resistance Argument and disagreement Ignoring/tuning out Passive agreement Denial or minimisation Interrupting D: 00.00 – 07.40

  24. DEALING WITH RESISTANCE Confrontation merely increases resistance Resistance is an interpersonal event A reduction in resistance is a sign thatchange is occurring

  25. ELABORATIONS ON REFLECTION 1 Amplified Increase the intensity 2 Double-sided Reflect ambivalence 3 Shift the focus Avoid going round in circles D: 08.00 (12.55) – 19.45

  26. ELABORATIONS ON REFLECTION 4Reframe See things in a different way 5 Agreement with a twist Reflect then reframe 6 Emphasise personal control and choiceDiffuses resistance D: 19.45 – 27.30

  27. ELABORATIONS ON REFLECTION 6. Side with the negative Places the client in the position that resistance results in self-motivational statements Needs careful handling D: 27.30 – 31.30

  28. Counsellor:Well, we’ve explored a number of options today but it seems that you feel that none of them will work for you. You seem happy to carry on not worrying about the serious consequences you’ll face if you don’t lose some weight. Perhaps we should leave it at that and accept that you’ll never change.

  29. Client:OK. Bye-eee! J: 31.30 – 47.36 P: 47.40 – 59.45

  30. MOVING TO ACTION BRAINSTORMING SOLUTIONS - PRINCIPLES There are usually lots of ways of implementing change As the exercise expert, you can explain what has workedfor others The client is the expert on themselves and can best judgewhat is likely to work for them S14 1:13:10; 09:47

  31. BRAINSTORMING SOLUTIONS Explore a range of options for change Offer suggestions where appropriate Encourage the client to make suggestions Rule nothing out to begin with Let the client decide which option to take Emphasise flexibility – “if this doesn’t workyou can try something else” Set appropriate (SMART) goals

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