FALL 2013
MOTIVATING FOR CHANGE
MOTIVATING FOR CHANGE
• Ray Caesar LPC, LADC-MH• Director of Addiction Specialty Programs• Oklahoma Department of Mental Health &
Substance Abuse Services• (405)522-3870• [email protected]
OUTLINE
• Achievement Motivation Theory
• Self-Determination Theory
• Operant Conditioning
• Motivational Interviewing
MOTIVATING INDIVIDUALS
ROMAN LEGION
DECIMATION
AMERICAN MILITARY
FRENCH REVOLUTION
MOTIVATION
DEFINITION
• Motivation• The process of arousing and sustaining goal-
directed behaviors.
NEEDS DRIVES
DRIVES INCENTIVES
MOTIVATION
WHAT IS MOTIVATION?
External motivation
Internal motivation
WHY WE WORK
• Support ourselves and our families.• Pay bills.• Most people enjoy work.• Sense of purpose.• Social aspect of being with other people.
MOTIVATION
MOTIVATION IS NOT
Directly observableSynonymous with satisfaction
Always consciousDirectly controllable
ACHIEVMENT MOTIVATION THEORY
ACHIEVEMENT MOTIVATION THEORY
LOW ACHIEVEMENT MOTIVATION
HIGH ACHIEVEMENT MOTIVATION
ACHIEVEMENT MOTIVATION THEORY
LOW ACHIEVEMENT MOTIVATION
• Prefer very easy tasks• Failure is unlikely
• or very difficult tasks• Failure not embarrassing
ACHIEVEMENT MOTIVATION THEORY
HIGH ACHIEVEMENT MOTIVATION
• Prefer moderately difficult tasks• Success is attainable• Success is attributable to skill and effort
EXTRINSIC AND INTRINSIC MOTIVATION
MOTIVATION
EXTRENSIC AND INTRINIC MOVIVATION
Extrinsic motivationA desire to perform based on external
reward or threat of punishment
Intrinsic motivationA desire to perform a behavior based on internal (personal) reward or
punishment
MOTIVATION
EXTERNAL VERSUS INTERNAL
Better to have intrinsic motivation.
Behave not because you fear punishment or expect reward (external),
but because you want to behave in a certain way(intrinsic).
Motivation from within
COMPONENTS OF INTRINSIC MOTIVATION
Autonomy: self-governing
Competence: self-efficacy
Relatedness: support and affirmation from peers.
INTERNAL MOTIVATION
EXTRINSIC MOTIVATION
~ Needed when there are no intrinsic motivators. An example is paying taxes
~ Hopefully the behavior will alter to intrinsic motivation over time. An example is seat belt use.• At first extrinsic: avoid tickets, alarms, nagging
children• Over time this behavior becomes internalized
EXTRINSIC MOTIVATION
Environment controls behavior
External rewards and punishments
Praise increases the likelihood of participation
Criticism decreases the likelihood of participation
Principles of operant conditioning are at work*
MOTIVATION
• Exposure to commercial media prompt a focus on materialism which provides fleeting satisfactions.
• Individuals may seek extrinsic rewards in order to compensate for deficits in fulfilling basic psychological needs.
• Extrinsic rewards are insufficient and poor compensation.
• Ryan & Deci
MOTIVATION
MOVING FROM EXTERNAL TO INTERNAL MOTIVATION
WHY WE WORK
• Support ourselves and our families.• Pay bills.• Most people enjoy work.• Sense of purpose.• Social aspect of being with other people.
SAFER TO WEAR SEATBELTS.
• It is well-known that seatbelts save lives.• Compliance varies greatly.• 91% in California• 78% in Connecticut• 51% in Mass before law, now 76%.• Requirement and enforcement make a difference
PUNISHMENT AND REINFORCEMENT.
• “Click it or ticket”• Threat of punishment.• Random checks.• Cars come with warning buzzers that stop if you buckle up.
• Reinforces compliance
EVENTUALLY INTERNALIZED
• Starts extrinsic.• Not wearing seatbelt might lead to punishment.• Wearing reinforced by others and by vehicle.• Seat belt usage becomes a matter of habit.• Becomes intrinsic.
SELF DETERMINATION
THEORY
Ryan and Deci
SELF-DETERMINATION THEORY
A meta-theory of motivation incorporating multiple “mini-theories” into a unified whole.
• Self-Determination Theory addresses both intrinsic and extrinsic sources of motivation.
• Self-Determination Theory focuses on • Autonomy• Competence • Relatedness
COMPONENTS OF INTRINSIC MOTIVATION
Autonomy: self-governing
Competence: self-efficacy
Relatedness: support and affirmation from peers.
SELF-DETERMINATION THEORY
Self-Determination Theory proposes that the degree to which autonomy, competence or relatedness are supported and enhanced will have a significant positive effect on the individual within the specific context.
SELF-DETERMINATION THEORY
Self-Determination Theory proposes that the degree to which autonomy, competence or relatedness are unsupported or hindered will have a significant negative effect on the individual within the specific context.
SELF-DETERMINATION THEORY
Autonomy, competence and relatedness are recognized as basic psychological needs.
PSYCHOLOGICAL NEEDS
Not necessary for survival like biological needs.
People engage in all kinds of activities unrelated to basic needs.
Make life worth living.
MASLOW
SELF-DETERMINATION THEORY
THE FIVE MINI-THEORIES OF
SELF-DETERMINIATION THEORY
SELF-DETERMINATION THEORY
COGNITIVE EVALUATION THEORY
ORGANISMIC INTEGRATION THEORY
CAUSALITY ORIENTATIONS THEORY
BASIC PSYCHOLOGICAL NEEDS THEORY
GOAL CONTENTS THEORY
SELF-DETERMINATION THEORY
Cognitive Evaluation Theory
SELF-DETERMINATION THEORY
Cognitive Evaluation Theory
Intrinsic motivation
What are the effects of social contexts on intrinsic motivation?
Highlights competence and autonomy.
Explores reward, ego-involvement, controls
SELF-DETERMINATION THEORY
Organismic Integration Theory
SELF-DETERMINATION THEORY
Organismic Integration Theory
Extrinsic motivation
Explores the determinants, properties and consequences of extrinsic motivation
Identifies a continuum from external to
internal
Degree autonomy will be enhanced or hindered
SELF-DETERMINATION THEORY
Causality Orientations Theory
SELF-DETERMINATION THEORY
Causality Orientations Theory
Intrinsic/extrinsic motivation
Identifies how individual differences alter how the environment is perceived.
Identifies three orientations – autonomy, control (rewards) and impersonal (amotivational).
SELF-DETERMINATION THEORY
Basic Psychological Needs Theory
SELF-DETERMINATION THEORY
Basic Psychological Needs Theory
Intrinsic/extrinsic
Optimal well being is predicated on autonomy, competence and relatedness. All three are required.
Contexts that support or thwart these needs must be considered.
SELF-DETERMINATION THEORY
Goal Contents Theory
SELF-DETERMINATION THEORY
Goal Contents Theory
Intrinsic/extrinsic
Compares and contrasts the effects of internal and external motivators.
Goals have varying effects on need satisfaction.
SELF-DETERMINATION THEORY
LEVELS OFSELF-DETERMINATION
SELF-DETERMINATION THEORY
AMOTIVATION
The individual does not pursue a behavior as success is seen as unlikely or impossible – there is no point in trying
SELF-DETERMINATION THEORY
EXTERNAL REGULATION
The individual pursues a behavior for a reward (pay) or due to coercion.
SELF-DETERMINATION THEORY
INTROJECTED REGULATION
The individual pursues a behavior because of an internalized guilt or shame related sense of “ought to” or “should”.
SELF-DETERMINATION THEORY
IDENTIFIED REGULATION
The individual pursues a behavior because the outcomes are important to the individuals goals
SELF-DETERMINATION THEORY
INTEGRATED REGULATION
The individual pursues behaviors because they symbolize what is important to the person’s sense of worth.
SELF-DETERMINATION THEORY
TRUE INTRINSIC MOTIVATION
The individual pursues behaviors for the pleasure of accomplishing, knowing, or for the stimulation.
SELF-DETERMINATION THEORY
I TRUE INTRINSIC MOTIVATIONII INTEGRATED MOTIVATIONIII IDENTIFIED MOTIVATIONIV INTROJECTED MOTIVATIONV EXTERNAL REGULATIONVI AMOTIVATION
REGULATORY STYLES
AMOTIVATION
• Non-regulation• Don’t care about rewards and punishments.• Lack of control.• “They pretend to pay us and we pretend to
work.”
INTERNAL REGULATION
• Synthesis with self-congruence.• Agreement conforms to beliefs
• Goal is to get people to accept goals as their own.• Move from compliance to self-regulation.
FACILITATING INTERNALIZATION
• Relatedness• Desire to belong and feel connected.• Group projects, share tasks
• Self-efficacy• Improves chances of success• Work to avoid early failures
PSYCHOLOGICAL NEEDS
• Self-determination theory relates to psychological needs.• Extrinsic motivation is not strongly related
to well-being• Wealth, fame and image.
• Well-being not enhanced by achievement of extrinsic goals.
MASLOW
SELF ACTUALIZING
• Promotes autonomy and competence.
• Encourages natural potential for growth.
• Facilitates human achievement and well-being
• Provides the social environment to support growth.
OPERANT CONDITIONING
MOTIVATION
OPERANT CONDITIONINGAlso referred to as Instrumental Conditioning
EXTRINSIC MOTIVATION
Environment controls behaviorExternal rewards and punishmentsPraise increases the likelihood of
participationCriticism decreases the likelihood of
participationPrinciples of operant conditioning are at
work
EFFECTS ON BEHAVIOR
Reinforcement• Leads to an increase in behavior.Punishment• Leads to a decrease in behavior.
TYPES OF REINFORCEMENT
Positive reinforcement (reward): behavior leads to reward.
Negative reinforcement (reward): behavior removes pain or anxiety
The goal is to increase a wanted behavior
TYPES OF PUNISHMENT
Behavior leads to unpleasant outcome or takes away something pleasant.
The goal of punishment is a decrease in unwanted behavior.
MOTIVATION
REWARDS AND PUNISHMENTS
Add to Take away from
Pleasant
Unpleasant
REWARDS AND PUNISHMENTS
Add to Take away from
Pleasant Positive reinforcement
Negative punishment
Unpleasant Positive punishment
Negative reinforcement
PROBLEMS WITH PUNISHMENT
I Negative feelings towards person giving punishment.
II Physical or psychological pain.
III Escalate in severity.
INTRINSIC MOTIVATION
MOTIVATIONAL INTERVIEWING
Hope ExpectancyThe belief that one can change and will be successful at making changes.
15%
Therapeutic RelationshipThe degree to which counseling conveys a nonjudgmental, empathic, accepting, warm environment.
30%
Client TraitsStrengths, temperament, resources, and skills.
40%
Technique/Orientation The skills and counseling orientation.
15%
EVALUATING MI
Set goals Report &discuss Create planfindings
Evaluate ImplementChanges
Measure satisfaction Identify issues && assess Adjust componentsimplementation
MOTIVATIONAL INTERVIEWING
• Encourages a respectful counselor-client relationship.• Aids in resolving discrepancies in client
values & behaviors promoting homeostasis.• Emphasizes consultation not confrontation.• Honors the clients ability to use personal
strengths in recovery.• Engages client in the recovery process.
STAGES OF CHANGE
“I don’t have a problem.”
STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
“I need to do something different.”
STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
“I need to do something different.”
“I am taking action.”
STAGES OF CHANGE
“I don’t have a problem.”
“I may have a problem.”
“I need to do something different.”
“I am taking action.”
“I’m living differently.”
MOTIVATIONAL INTERVIEWING
Directive
MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
Elicits positive behavior change
MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
Elicits positive behavior change
Addresses client ambivalence
MOTIVATIONAL INTERVIEWING
Directive
Client-Centered
Elicits positive behavior change
Addresses client ambivalence
Respects Autonomy
MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
Roll with resistance
MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
Roll with resistance
Support Self-efficacy
ASSESSING READINESS
MOTIVATIONAL INTERVIEWING
PHASE 1:
Building Motivation
PHASE 2:
Strengthening Commitment to Change
PHASE ONE
MI SKILLS AND STRATEGIES
PHASE I
• Open-Ended Questions
• Affirmations
• Reflective Listening
• Summarizing
• Eliciting Change Talk
MI SKILLS AND STRATEGIES
PHASE II
• Recognizing Readiness
• Transitional Summary
• Key Question(s)
• Information and Advice
• Negotiating Plans for Change
MI PHASE ONE STRATEGIES
OARS
Open-Ended Questions
Affirmation
Reflective Listening
Summary
MOTIVATIONAL INTERVIEWING
CLOSED vs OPEN QUESTIONS• Open• Requires more than a yes or no response• Eliciting—more person-centered• Aids individual cognitions
• Closed• Quick, easy, & efficient• Less client-centered• Less engaging
AFFIRMATIONS
• Compliments.
• Statements of appreciation.
•Highlights strengths.
• A form of Reflective Listening.
• Client-focused.
• Accurate.
ROADBLOCKS
• Order and, direct • Warn or threaten• Advise, suggest and
solve• Persuade, argue and
lecture• Moralize, preach -
“shoulds”• Disagree, judge and
blame
ROADBLOCKS
• Agree, approve and praise• Shame, ridicule or label• Interpret and analyze• Reassure, sympathize and
console• Question or probe• Withdraw or distract with
humor or change subject
COMMUNICATION MODEL
The words the The words the speaker listener hears says
What the speaker What the listenerreally means thinks the speaker means
Thomas Gordon
REFLECTIVE LISTENING
• Hearing the meaning behind client words
• Building hypothesis vs. making assumptions
• A non-judgmental, accepting environment
REFLECTIVE LISTENING
SimpleRepeat Rephrase
ComplexParaphraseReflection of FeelingsSummary, Metaphors
REFLECTIVE RESPONSES
•Simple
•Amplified
•Double-Sided
SUMMARIZING
• This is a special form of reflection.
• Counselor chooses what to include and emphasize.
• Include client’s concerns about change, problem recognition, optimism about change and ambivalence toward change.
• Let client know you are listening.
• Invite the client to respond to the summary.
CHANGE TALK
• What are the advantages of change
• What are the disadvantages of the status quo
• Stating optimism for change
• Stating an intention to change
• Stating a commitment
CHANGE TALK STRATEGIES
• Evocative QuestionsDesires, Ability, Reasons, Needs & Commitment for Change (DARN-C)
• Elaboration• Importance• Confidence Rulers
• Decisional Balance
• Looking Forward– Looking Back
• Exploring Goals and Values
MI CHANGE TALK STRATEGY PROCESS
ASK FOR ASSESS HEAR THE SEE THECOMMITMENT CHANGE
Desires Readiness Strong self-talk positive Abilities behaviorsReasonsNeeds
PHASE ONE TRAPS
• Question/Answer Trap
• Taking Sides
• Expert/Labeling
• Premature Focus
• Blaming
OARS AND CHANGE TALK
• Open-ended questions• Affirmation• Reflective
Listening• Summary• Eliciting change
talk
• Evocative question• Elaboration• Important
Confidence rulers• Decisional balance• Looking forward—
looking back• Exploring goals
and values
CLIENT RESISTANCEI N V O LV E S F E E L I N G S , A C T I O N S , A N D B E H AV I O R S O F A N I N T E R P E R S O N A L
N AT U R E W H E R E T H E R E I S A L A C K O F C O L L A B O R AT I O N .
RESISTANT BEHAVIORS
• Arguing
• Denying
• Blaming
• Interrupting
• Taking over
• Not responding
MOTIVATIONAL INTERVIEWING
FUNDAMENTAL PRINCIPALS OF MI
Express empathy
Develop discrepancy
Roll with resistance
Support Self-efficacy
STRATEGIC RESPONSES
• Shifting focus
• Agreement with a twist
• Emphasizing personal choice
• Reframing
• Siding with the negative
• Supporting self-efficacy
REFLECTIVE & STRATEGIC RESPONSES
TO RESISTANCE
• Shifting focus• Agreement with a
twist • Emphasizing personal
choice
• Reframing• Siding with the
negative• Support self-efficacy
Simple Amplified Double-Sided
PHASE TWO
PHASE 2 STRATEGIES
Recognizing Readiness
Transitional Summary
Key Questions
Information and Advice
Negotiating Plans for Change
CHANGE PLAN ELEMENTS
• Negotiating the plan• Identify the barriers to change• Implement the plan• Enlist support• Identify outcome measures• Measure success and revise the plan if
necessary
PHASE TWO HAZARDS
• Underestimating Ambivalence
• Over Prescription
• Insufficient Direction
MOTIVATING FOR CHANGE
• Ray Caesar LPC, LADC-MH• Director of Addiction Specialty Programs• Oklahoma Department of Mental Health &
Substance Abuse Services• (405)522-3870• [email protected]