Motivational Interviewing - Personal Competence - Lecture Slides, Slides of Sociology

Download Motivational Interviewing - Personal Competence - Lecture Slides and more Slides Sociology in PDF only on Docsity! Motivational Interviewing Docsity.com TIP 35 by William R. Miller, PhD • Motivational Interviewing:a therapeutic style intended to help clinicians work with clients to address the client’s continuous fluctuation between opposing behaviors and thoughts. Docsity.com Client's Stage of Change Appropriate Motivational Strategies for the Clinician Contemplation The client acknowledges concerns and is considering the possibility of change but is ambivalent and uncertain. Normalize ambivalence. Help the client "tip the decisional balance scales" toward change. Elicit and summarize self- motivational statements of intent and commitment from the client. Elicit ideas regarding the client's perceived self- efficacy and expectations regarding treatment. Docsity.com Client's Stage of Change Appropriate Motivational Strategies for the Clinician Preparation The client is committed to and planning to make a change in the near future but is still considering what to do. Explore treatment expectancies and the client's role. Clarify the client's own goals. Negotiate a change--or treatment--plan and behavior contract. Consider and lower barriers to change. Help the client enlist social support. Docsity.com Client's Stage of Change Appropriate Motivational Strategies for the Clinician Action The client is actively taking steps to change but has not yet reached a stable state. Engage the client in treatment and reinforce the importance of remaining in recovery. Acknowledge difficulties for the client in early stages of change. Help the client identify high-risk situations through a functional analysis and develop appropriate coping strategies to overcome these. Docsity.com Skills • Express EMPATHY through reflective listening. • Develop discrepancy or inconsistencies between client goals and current behavior. • Avoid argument and direct confrontation. • Adjust to client’s resistance rather than opposing it directly. • Support self- efficacy and optimism. Docsity.com Expressing Empathy Acceptance facilitates change Skillful reflective listening is fundamental to expressing empathy Ambivalence is normal. Source: Miller and Rollnick, 1991. Reprinted with permission. Docsity.com Develop Discrepancy • Motivation for change is enhanced when clients perceive discrepancies between their current situation and their hopes for the future. • One useful tactic for helping a client perceive discrepancy is sometimes called the "Columbo approach" (Kanfer and Schefft, 1988). Docsity.com Four Types of Client Resistance Arguing The client contests the accuracy, expertise, or integrity of the clinician. Docsity.com “Resistance Continued” Interrupting The client breaks in and interrupts the clinician in a defensive manner. Docsity.com “Resistance Continued” Denying The client expresses unwillingness to recognize problems, cooperate, accept responsibility, or take advice. Docsity.com Amplified Reflection Another strategy is to reflect the client's statement in an exaggerated form--to state it in a more extreme way but without sarcasm. This can move the client toward positive change rather than resistance. Docsity.com Double-sided Reflection A third strategy entails acknowledging what the client has said but then also stating contrary things she has said in the past. This requires the use of information that the client has offered previously, although perhaps not in the same session. Docsity.com Shifting Focus You can defuse resistance by helping the client shift focus away from obstacles and barriers. This method offers an opportunity to affirm your client's personal choice regarding the conduct of his own life. Docsity.com Rolling With Resistance Momentum can be used to good advantage. Perceptions can be shifted. New perspectives are invited but not imposed. The client is a valuable resource in finding solutions to problems. Source: Miller and Rollnick, 1991. Reprinted with permission. Docsity.com Siding With the Negative One more strategy for adapting to client resistance is to "side with the negative"--to take up the negative voice in the discussion. If your client is ambivalent, your taking the negative side of the argument evokes a "Yes, but..." from the client, who then expresses the other (positive) side. Docsity.com Self-Efficacy Belief in the possibility of change is an important motivator. The client is responsible for choosing and carrying out personal change. There is hope in the range of alternative approaches available. Source: Miller and Rollnick, 1991. Reprinted with permission. Docsity.com Listen Reflectively "Reflective listening is a way of checking rather than assuming that you know what is meant" Docsity.com Summarize "Summaries reinforce what has been said, show that you have been listening carefully, and prepare the client to move on" Docsity.com Affirm When it is done sincerely, affirming your client supports and promotes self-efficacy. Docsity.com