Understanding Human Motivation: Self-Determination Theory & Motivational Interviewing, Exams of Sociological Theories

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NBHWC Exam - Real Balance Complementary Theories Guide self-determination theory (SDT) - represents a broad framework for the study of human motivation and personality. self-determination theory (SDT) - articulates a meta theory for framing motivational studies, a formal theory that defines intrinsic and varied extrinsic sources of motivation, and a description of the respective roles of intrinsic and types extrinsic motivation in cognitive and social development and individual differences. self-determination theory (SDT) - how social and cultural factors facilitate or undermine people's sense of volition and initiative, in addition to their well being and the quality of the their performance. self-determination theory - theory of human motivation in which the social context of an action has an effect on the type of motivation existing for the action self-determination theory - Deci and Ryan's theory asserting that all humans have three basic, innate organismic needs: competence, relatedness, and autonomy. self-determination theory types of motivation - controlled motivation autonomous motivation there is a motivational spectrum from amotivation to intrinsic motivation, extrinsic motivation is between theses two. self-determination theory assumes... - an inherent human need for fulfillment and self actualization through personal growth AND "CAR" Competence Autonomy Relatedness self determination theory's controlled motivation - "carrot and stick" doing something in order to get a reward or to avoid punishment. seduced or coerced. sense of pressure, obligation, or force. (this approach can have negative consequences and short cuts) Self Determination Theory's autonomous motivation - two aspects interest and enjoyment and deeply held values and beliefs SDT's Motivational Spectrum - Amotivation Extrinsic Motivation Intrinsic Motivation need satisfaction becomes nutriment to promote, develop and nourish intrinsic motivation SDT's autonomy - engaging in behavior that is self endorsed, that one agrees with and finds congruent within oneself. Its self initiating and entails having and making choices. "integration of freedom" SDT's competence - feeling confident and effective in your environment and having a sense of mastery over the things that are important to you. autonomy and competence combine to move one along the extrinsic motivational spectrum towards intrinsic motivation. SDT's relatedness - feeling cared for by others, caring for others and feeling a sense of belonging in various groups that are important to the individual. Feeling connected and valued. 5 strategies to facilitate and support autonomous motivation. 1. - begin with the individual's perspective. explore the client's internal frame of reference. 5 strategies to facilitate and support autonomous motivation. 2. - provide people with choice. engage the client to be in the decision making process. facilitate identification of options and support the client in making their own choice. 5 strategies to facilitate and support autonomous motivation. 3. - promote and support exploration and the experience of trying out different or new ways. 5 strategies to facilitate and support autonomous motivation. 4. - encourage the individual to self initiate and to be a self starter 5 strategies to facilitate and support autonomous motivation. 5. - facilitate exploration and identification of meaningful rationale for their choice. The rationale may already exist within their value system and belief structures or it may emerge through self exploration, learning and growth. SDT's 6 mini theories 1. - Cognitive Evaluation Theory concerns intrinsic motivation, which is based on the satisfactions of behaving "for its own sake" SDT's 6 mini theories 2. - Organismic integration Theory addresses the topic of extrinsic motivation across the spectrum SDT's 6 mini theories 3. - Causality Orientations Theory describes individual differences in self regulation and adapting to different environments. SDT's 6 mini theories 4. - Basic Psychological Needs Theory explores the concept of psychological needs and their relations to psychological health and well being. SDT's 6 mini theories 5. - Goal Contents Theory explores the distinctions between intrinsic and extrinsic goals and tier impact on motivation and wellness. SDT's 6 mini theories 6. - Relationships Motivation Theory is concerned with relationships and social interaction as both desirable and essential for adjustment and well being. positive psychology - the scientific study of optimal human functioning; aims to discover and promote strengths and virtues that enable individuals and communities to thrive positive psychology - the scientific study of human flourishing, with the goals of discovering and promoting strengths and virtues that help individuals and communities to thrive positive psychology - the scientific study of what makes life worth living. Seligman's study of well being and human flourishing. PP's assumes - that the absence of mental illness is not equivalent to mental health or well being. PP includes areas of study in... - positive emotions resilience thriving teams and organizations grit creativity courage character strengths mindset well being of self/collective compassion mindfullne ss engageme nt flow meaning in life positive relationships achievement etc. How does PP help coaches? - by providing empirical validation to effective approaches that are supported by research ie. goal setting inquiry emotion mindset resilience etc PP's 5 building blocks - PERMA positive emotion engagement relationships meaning achievement PERMA's requirements - each element of well being must itself have three properties 1. it contributes to well being 2.many people pursue it for its own sake, not merely to get any of the other elements. 3. it is defined and measured independently of the other elements. Seligman's PERMA and five building blocks that enable flourishing P - Positive emotion is largely assessed subjectively Seligman's PERMA and five building blocks that enable flourishing E - Engagement- also measured subjectively ie. flow state an experience in which someone fully develops the skills, strengths, and attention for a challenging task. Seligman's PERMA and five building blocks that enable flourishing R - Relationships- The Simultaneity Principle - (change begins in the inquiry-including the conversations, questions and reflections) The moment we ask a question, we begin to create change. "unconditional positive questions" The Poetic Principle - (positive attention and focus in the now) Foundation to AI. the only thing we have is the right now. this inspires change, conjures up imagination, creative, rhythmical and inspiring. focusing on what is wanted. mindful attention to the present. The Anticipatory Principle - (humans move in the direction of their image of the future) the more positive and hopeful the image of the future, the more positive the present day action. positive future images inspire action towards that image. The Positive Principle - (positive energy and emotion) Momentum for change requires large amounts of positive affect and social bonding. the momentum is best generated through positive questions that amplify the positive core. motivational interviewing - Miller and Rollnick describe MI as a collaborative conversation style for strengthening a person's own motivation and commitment to change. and a form of counseling to effect lifestyle behavior change. motivational interviewing - a collaborative, person-centered form of guiding to elicit and strengthen motivation for change motivational interviewing - client-centered communication style for eliciting behavior change by helping clients and groups explore and resolve ambivalence to change Motivational Interviewing (MI) - a directive, client-centered style for eliciting behavior change by helping clients explore and resolve ambivalence Motivational Interviewing (MI) - A humanistic, client-centered, psychosocial, directive counseling approach that was developed by William R. Miller and Stephen Rollnick in the early 1980s. MI emphasizes... - the critical importance of recognizing ambivalence as a normal human experience, engaging in deep appreciation and respect for everyone, embracing "radical" acceptance, working with ambivalence rather than against it and not trying to rush the process. "Stuck in Ambivalence" - - ambivalence is common - getting stuck there is common - assisting in resolving the ambivalence may assist in the process of change - forcing the change may result in a paradoxical response "Stuck in Ambivalence" - using ineffective strategies in coaching: client- a reinforced sense of being stuck or even strengthening the negative side of the ambivalence because the feel demeaned, judged or criticized. coach- exasperation that leads to blaming the client, labeling them as resistant or oppositional and walking away. Identifying the Language of Ambivalence - change talk vs sustain talk MI teaches to meet the client where they are with sustain talk, and begin to facilitate movement towards talk to forward movement and freedom from ambivalence "change talk" 2 Stages of Change Talk - 1st aligns with Prochaska's stages of comtemplation into preparation 2nd aligns with preparation into action. Here there is a facilitation of shift in perspective, exploring the client's willingness and readiness to take action and actually begin the action journey. Working with Sustain Talk DARN - What is keeping the client where they are. Desire - "I don't want to change" Ability - "I've tried, and I don't think I can" (efficacy) Reasons - "I don't have time" (lack of perceived benefit) Need - "I have to smoke, I can't go without it" (clients perception) Working with Change Talk OARS - O - open ended questions, elaborations and examples A - affirmation, recognize/acknowledge client, support and encourage (don't praise) R - reflection, "the mainstay and skill of MI", know the different types of reflection S - summarize, 3 types here: collecting, linking, transitional 4 Guiding Principles of Motivational Interviewing - Express Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy MI's Express Empathy - full listening and acceptance. not confusing empathy with pity or sympathy use AI's 4 D's (discover, dream, design, destiny) MI's Discrepancy - based on the concept that change is motivated by "a perceived discrepancy between present behaviors and desired goals and honoring and respecting the individuals freedom and right to choose and "the revocable right and capacity of self direction" The Spirit of MI characteristics - Affirmation: seek and acknowledge the individual strengths and efforts The Spirit of MI characteristics - Evocation: "you have what you need, and together we will find it" The Four Processes of MI - Engaging Focusing Evoking Planning MI's Engaging - both parties establish a helpful connection and working relationship. this is a prerequisite for everything that follows. MI's Focusing - the process by which the coach develops and maintains a specific direction in the conversation around change MI's Evoking - the coach elicits the client's own motivation for change. This is the heart of MI. The coach harnesses the client's own ideas and feelings about how and why they might change. The client voices their own arguments for change. MI's Planning - this happens when motivation reaches a threshold of readiness, the balance tips and the client begins thinking and talking more about when and how to change and less about "whether" and "why". this is the point where individuals may seek out information, education and advice. it encompasses developing a commitment to change and formulating a plan. this is an ongoing process. MI's Importance Ruler - this promotes conscious awareness of the pros and benefits. client identifies how important it is for you to ? Followed by "why are you at that number and not a lower one? straight question backward question forward question MI's Decisional Balance - promotes and supports a neutral stance looking equally at the pros and cons. what are the benefits of staying the same? what is the downside of staying the same? what is the downside of changing? what are the benefits of changing? (not the same as TTMs readiness for change model, decisional balance) MI's Active Listening Skills Simple Reflection - a paraphrase or restatement of what the client said. coach - "I hear you are feeling frustrated" MI's Active Listening Skills Complex Reflection - a stronger emphasis on what the person has said or making a guess about the spoken content. client - "I'm feeling depressed today" coach - "somethings happened since last we spoke. Your mood has been up and down recently, and you look like you don't have much energy." MI's Active Listening Skills Amplified Reflection - maximizes or minimizes what the client says by increasing or decreasing both the affect and the outcome. client: "I don't have time to buy or fix fresh vegetables. My family and friends don't either." coach: "I hear you saying that you don't know anyone who has time to buy or fix fresh vegetables and that it's impossible for you to fit eating fresh vegetables into you schedule." MI's Active Listening Skills Double Sided Reflection - two or more perspectives while encouraging clients to look at different angles. client: "I don't have time to buy or fix fresh vegetables. My family and fiends don't either." coach: "I hear you say they you don't have time to buy fresh vegetables. And you have also said that you feel better and have more energy when you do include them in your meals". MI's Active Listening Skills Shifted Focus Reflection - shifting from a resistance provoking topic to another one where there is less or no resistance. client: "I don't have time to buy or fix fresh vegetables. My family and fiends don't either." coach: "because you don't have time to eat healthy right now, let's talk about the walking routine you did start." Miller and Rollnick's Three Definitions of Motivational Interviewing (2013) of decision making and continuing to elicit and strengthen change talk as a plan emerges. The Spirit of Motivational Interviewing (Miller & Rollnick, 2013) - Collaboration Evocation Autonomy Compassion Collaboration (vs. Confrontation) - Collaboration is a partnership between the helper and the clients, grounded in the point of view and experiences of the clients. This contrasts with some other approaches which are based on the helpers assuming an "expert" role, at times confronting the clients and imposing their perspective on the clients' problem behaviors and the appropriate course of treatment and outcome. Collaboration builds rapport and facilitates trust in the helping relationship, which can be challenging in a more hierarchical relationship. This does not mean that the helpers automatically agree with the clients about the nature of the problem or the changes that may be most appropriate. Although they may see things differently, the therapeutic process is focused on mutual understanding, not the helper being right. Evocation (Drawing Out, Rather Than Imposing Ideas) - The MI approach is one of the helpers' drawing out the individuals' own thoughts and ideas, rather than imposing their opinions as motivation and commitment to change is most powerful and durable when it comes from the clients. No matter what reasons the helpers might offer to convince the clients of the need to change their behavior or how much they might want them to do so, lasting change is more likely to occur when the clients discover their own reasons and determination to change. The helpers' job is to "draw out" the persons' own motivations and skills for change, not to tell them what to do or why they should do it. Autonomy (vs. Authority) - Unlike some other treatment models that emphasize the clinicians/helpers as authority figures, Motivational Interviewing recognizes that the true power for change rests within the clients. Ultimately, it is up to the individuals to follow through with making changes happen. This is empowering to the individuals, but also gives them responsibility for their actions. Helpers reinforce that there is no single "right way" to change and that there are multiple ways that change can occur. In addition to deciding whether they will make a change, clients are encouraged to take the lead in developing a "menu of options' as to how to achieve the desired change. Compassion - The interviewers act benevolently to promote the clients' welfare, giving priority to the clients' needs. Interviewers are for their clients benefit and not primarily for their own. Compassion is a deliberate commitment to pursue the welfare and best interests of others. It is this promotion of others' welfare which motivates people to be drawn to the helping professions. To work with a spirit of compassion is interviewers' having their hearts in the right place so that the trust they engender will be deserved The Principles of Motivational Interviewing (Miller & Rollnick, 2013) - Building on and bringing to life the elements of the MI "style", there are four distinct principles that guide the practice of MI. The helpers employing MI will hold true to these principles throughout treatment. 1. Express Empathy 2.Develop Discrepancy 3.Roll with Resistance 4.Support Self-efficacy Principle 1: Express Empathy - Expressing empathy towards the clients shows acceptance and increases the chance of developing a rapport. Acceptance enhances self-esteem and facilitates change. Skillful reflective listening is fundamental. Clients' ambivalence is normal. Principle 2: Develop Discrepancy - Developing discrepancy enables the clients to see that their present situation does not necessarily fit into their values and what they would like in the future. The clients rather than the helpers should present the arguments for change. Change is motivated by a perceived discrepancy between present behavior and important personal goals and values. Principle 3: Roll with Resistance - Rolling with resistance prevents a breakdown in communication between clients and helpers and allows the clients to explore their views. Avoid arguing for change. Do not directly oppose resistance. New perspectives are offered but not imposed. The clients are a primary resource in finding answers and solutions. Resistance is a signal for the helpers to respond differently. Principle 4: Support Self-efficacy - Self-efficacy is a crucial component to facilitating change. If the clients believe that they have the ability to change, the likelihood of change occurring is greatly increased. Clients' beliefs in the possibility of change is an important motivator. The clients, not the helpers, are responsible for choosing and carrying out change. The helpers' believe in the clients' ability to change becomes a self-fulfilling prophecy. Motivational Interviewing Skills and Strategies (Miller & Rollnick, 2013) - The practice of Motivational Interviewing involves the skillful use of certain techniques for bringing to life the "MI spirit", demonstrating the MI principles, and guiding the process toward eliciting clients' change talk and commitment for change. Change talk involves statements or non-verbal communications indicating the clients may be considering the possibility of change. talk as the pathway to change. Research indicates a clear correlation between clients' statements about change and outcomes-client-reported levels of success in changing a behavior. The more clients talk about change, the more likely they are to change. Different types of change talk can be described using the mnemonic DARN- CAT. Preparatory Change Talk - D - Desire (I want to change) A - Ability (I can change) R - Reason (It's important to change) N - Need (I should change) Implementing Change Talk - C - Commitment (I will make changes) A - Activation (I am ready, prepared, willing to change) T - Taking Steps (I am taking specific actions to change) Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 1. - 1. Ask Evocative Questions: Ask an open question, the answer to which is likely to be change talk. Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 2. - 2. Explore Decisional Balance: Ask first for the good things about status quo, then ask for the not-so-good things Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 3. - 3. Ask for Elaboration: When a change talk theme emerges, ask for more details. In what ways? Tell me more...? What does that look like? Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 4. - 4. Ask for Examples: When a change talk theme emerges, ask for specific examples. When was the last time that happened? Give me an example. What else? Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 5. - 5. Look Back: Ask about a time before the target behavior emerged. How were things better, different? Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 6. - 6. Look Forward: Ask what may happen if things continue as they are (status quo). Try the miracle question: If you were 100% successful in making the changes you want, what would be different? How would you like your life to be five years from now? Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 7. - 7. Query Extremes: What are the worst things that might happen if you don't make this change? What are the best things that might happen if you do make this change? Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 8. - 8. Use Change Rulers: Ask: "On a scale from 1 to 10, how important is it to you to change (the specific target behavior) where 1 is not at all important, and a 10 is extremely important? Follow up: "And why are you at and not (a lower number than stated)?" "What might happen that could move you from to (a higher number)?" Alternatively, you could also ask "How confident are that you could make the change if you decided to do it?" Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 9. - 9. Explore Goals and Values: Ask what the clients' guiding values are. What do they want in life? Ask how the continuation of target behavior fits in with the clients' goals or values. Does it help realize an important goal or value, interfere with it, or is it irrelevant? Strategies for Evoking Change Talk (Miller & Rollnick, 2013) 10.- 10. Come Alongside: Explicitly side with the negative (status quo) side of ambivalence. "Perhaps is so important to you that you won't give it up, no matter what the cost." In MI...What is Discord? - It is the interpersonal behavior in the MI process that reflects dissonance in the working relationship between the helpers and clients. Sustain talk in itself does not constitute discord. What follows are the examples of discord: Discord in MI has various elements - Arguing: Clients contest the accuracy, expertise, or integrity of the helpers Discord in MI has various elements - Interrupting: Clients break in and interrupts the helpers in a defensive manner Discord in MI has various elements - Discounting: Clients express unwillingness to recognize problems, cooperate, accept responsibility, or take advice Discord in MI has various elements - Ignoring: Clients show evidence of ignoring or not following the helpers What skills are needed to respond to either Sustain Talk or Discord so as to get back to Change Talk - Simple Reflection: The simplest approach to responding to resistance is with nonresistance, by repeating the clients' statements in a neutral form. This acknowledges and validates what the clients have said and can elicit an opposite response. What skills are needed to respond to either Sustain Talk or Discord so as to get back to Change Talk - Shifting Focus: Helpers can defuse resistance by helping the clients shift moving from precontemplation to contemplation The 1st Principle of Progress: - Increase Your Pros. In order for change to happen the pros for change need to increase two times as much as the cons decrease. In precontemplation the emphasis is on increasing the pros. That is why we want to put twice the emphasis or focus on the pros as we do on the cons. moving from precontemplation to contemplation The 2nd Principle of Progress: - Increase Your Consciousness to Increase Your Behavior Change IQ This is about "consciousness-raising" & "making unconscious processes conscious" We help by offering education, information and providing feedback. It is important to be aware that education leads to contemplation not action moving from precontemplation to contemplation The 3rd Principle of Progress: - Dramatic relief is about moving emotionally from precontemplation. This may often entail moving out of and away from the feeling of demoralization. Various techniques can facilitate expressing, releasing and relieving strong emotion and provide relief from the stress and distress of change (such as journaling) What is the best way to deal with demoralization? - by generating hope. "providing innovative and more effective solutions for all problems is the best way to generate hope." Hope is enhanced when the perception of self- efficacy is increased. How to deal with defending? - Transforming defending into Coping: defense strategies protect us from feeling like were being controlled by others. Examining defensive strategies can facilitate identification and development of more effective coping strategies. The 2 D's of Contemplation - Doubt Delay Doubt - characterized by questioning whether the change is really worth it and "the rule of thumb for contemplators: when in doubt, don't act." Doubt leads to delay Delay - contemplators are willing and able to look at risky behaviors and the related threat to health and happiness; they're more likely to talk about their behaviors, research programs and strategies - but they won't take action towards the change What Keeps Contemplators from Moving Ahead? - Chronic Contemplation Wanting Total Certainty Rushing into Action Moving from Contemplation to Preparation - Decrease Cons In contemplation we want the cons to decrease - but they only need to decease by half as much as the pros need to increase. Move from Contemplation to Preparation - Use Environmental Reevaluation Noticing your effects on others. An emotional and cognitive assessment of how the presence or absence of habits/behavior can affect your social environment. Looking at how your stress and distress can threaten the health and happiness of others as well as yourself. The D of Preparation - "Dread of Failing" Moving from Preparation to Action - Use Self-Reevaluation-emotional and mental reassessment of self from both sides of the unhealthy behavior Move to Action - Self-liberation entails a belief in one's own ability (self- efficacy) to change behavior and commitment and recommitment to act on that belief. It is acceptance about not needing to be absolutely certain about the course of action; and knowing that we can commit and then recommitment to change. It is important to understand that making a commitment is not the same thing as making a decision. It is not all about willpower; however strengthening willpower increases the probability for lasting success Action - Action is defined as making a change during the past six months that, according to public health criteria, removes one or more of the highest risk behaviors Action - The TTM uses six months as a criterion for staying in action based on the amount of time it takes to arrive at decreased difficulty maintaining the behavior change and therefore less risk of relapse. "The relapse curve does not level off until around six months. These findings convince us that those seeking change should be prepared for six months of concerted action. Action - Making change and developing new habits in 21 days is a myth! Action - Adequate preparation is critical to moving into action. That entails assessing whether one is prepared enough to keep from crashing soon after they lost their action plan. "One of the surprising parts of ... TTM ... Is that we may tell people not to take action