Motivational Interviewing & Behaviour Change

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					 Assessing Motivation
       Decisional Balance




Benefits               Concerns
                   Using scales

Readiness
0   10   20   30   40   50     60   70   80   90   100




Importance
0   10   20   30   40   50     60   70   80   90   100




How much better life will be
0   10   20   30   40   50     60   70   80   90   100




Confidence
0   10   20   30   40   50     60   70   80   90   100
 The Flow of Change Talk



Motivational
               Change Talk   Commitment   Change
Interviewing
 Resistance / sustain talk

Take three minutes to write down
resistant statements that you come across
in your practice
    Responding to Resistance

   How have you felt in the
    past when working with
    resistant clients?

   What responses have not
    worked well?

   What responses have
    worked well?
     DEALING with RESISTANCE
                         THERAPISTS ROLE

   Not to assume it is wholly a client characteristic

   Greater resistance = less chance of change

   Lower levels of resistance is a good sign (change talk)

   Resistance should be a therapist concern

   Same therapist switching styles can affect outcome
    (Patterson & Forgatch, 1985)
Cont…
                  RECOGNISING RESISTANCE


   Anything inconsistent with change

   Suggests the client and therapist are not at the same
    point.

   Change talk is the opposite to resistance

   Resistance may be normal initially. Therapist task is not
    to elicit more but to manage effectively
      STRATEGIES for DEALING
         WITH RESISTANCE
   Simple reflection
   Amplified reflection
   Double sided reflection

   Shifting focus
   Agreement with a twist
   Emphasising personal choice / control
   Reframe
   Paradox
Therapist Style and Client Response
Miller, Benefield & Tonigan (1993) JCCP 61: 455-461
Avoid eliciting resistance
Cont…
   Confrontation is likely to elicit resistance

   At 24 month follow up lower levels of
    alcohol consumption were noted in the
    group that had least in-session conflict

    Miller, W.R., Benefield, R.G. and Tonigan, J.S. (1993) ‘Enhancing motivation for
    change in problem drinking: a controlled comparison of the two therapist styles’
    Journal of Counselling and Clinical Psychology, 61: 455-461
       Research & Resistance
   Level of client resistance during counseling
    predicted absence of change in drinking (Miller,
    Benefield & Tonigan, 1993)

   Verbal commitment to drug use during MI
    predicted continued drug use (Amrhein et al.,
    2003)

   Resistance / poor outcome relationship
    replicated in several other studies
       Practice Responding to
             Resistance
   Resistant client
   Use some of the resistant statements you
    have already written down and in pairs
    practice responses
             Further Reading

   motivationalinterview.org
   Motivational Dialogue Raistrick & Tober (2007)
   Motivational Interviewing Miller & Rollnick(2002)

   Email contact:
    jon.mcgowan@leedspft.nhs.uk

				
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