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.

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.

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?

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.

QUESTION?

HOW DO YOU DEFINE “MOTIVATION”?

HOW DO YOU RECOGNISE IT IN AN

INDIVIDUAL?

HOW WOULD YOU KNOW IF A PERSON IS

MOTIVATED?

MOTIVATIONAL INTERVIEWING

If we see

MOTIVATION

As a

CHARACTERISTIC OR PERSONALITY TRAIT

It establishes a

SELF FULLFILLING PROPHECY

which is ultimately a

DISEMPOWERING BELIEF for the treating

professional and client alike.

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.

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.)

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.

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.

BEING SUPPORTIVE.

EXPRESSING EMPATHY.

BEING SYMPATHETIC.

BEING ATTENTIVE.

AN ACTIVE INTEREST IN THE PERSON’S WELL BEING.

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.

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.

Discrepancy produces psychological tension

which 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.

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.

5IVE

Let us understand the five factors.

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!

BECAUSE

PROVIDES

REASON,

AND

REASON

MOTIVATES.

SEASON OF REASON

People are much more likely to be motivated to be compliant when they

REASONS

to do so.

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.

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.

IT IS AT ITS MOST POWERFUL WHEN THE PERSON IS MOTIVATED

BY

THEIR

GOOD REASON.

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.

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.

ADVANTAGES / CATASTROPHE.

HELP THE PERSON IDENTIFY

THE ADVANTAGES

OF BEING COMPLIANT AND

THE CATASTROPHES

IN NOT BEING COMPLIANT.

MOTIVATIONAL INTERVIEWING

Avoid the creation of

RESISTANCERELUCTANCEREACTANCE

to the natural change process by arguing

that there is a problem.

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.

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.

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”

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?

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.

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

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.

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.”

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.”

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?”

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.

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!

RULE OF THUMB.

To progress a person from

Precontemplation

to

Contemplation 

INCREASE THE REASONS

FOR THEM TO DO SO.

RULE OF THUMB.

To progress a person from

Contemplation to Action

 

DECREASE THE COSTS.

RULE OF THUMB.

To support a person in

Action

 

INCREASE

THE REASONS TO DO SO,

DECREASE THE COSTS.  

RULE OF THUMB.

TWICE AS MUCH EFFORT SHOULD BE

PUT INTO ESTABLISHING THE

REASONS TO CHANGE

AS IN REDUCING THE COSTS.

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.

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.

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?

FRAMES.

Feedback.

Responsibility.

Advice.

Menu of options (3).

Empathy.

Self efficacy.

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”.

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.