3. MI IN PROFILE CONTEXT
INDIVIDUAL
• Isolated
• Ambivalent
• Willingness to change
‘PROFESSIONAL’
• Your professionalism
• Wanting to help
• Knowing ‘what is best’
4. INTRINSIC vs EXTRINSIC MOTIVATION
• ‘Movere’ Latin for ‘to move’
• Energy and direction.
• Goals.
• Sources of motivation?
• Think of a behaviour of yours that you have
thought about changing;
– Eg: drinking/smoking/studying/untidiness
• Where has the motivation to change originated
from? External or internal?
5. ASSUMPTIONS ABOUT CHANGE
• Easy to assume.
• Sometimes people are unaware.
• How?
• Why?
• Pleasure vs pain.
6. TRANSTHEORETICAL MODEL
• Informed by 7 distinct theories:
1) Conflict and ambivalence (Orford, 1985)
2) *Decisional balance (Janis and Mann, 1977)
3) Health beliefs (Rogers, 1975)
4) Reactance (Brehm and Brehm, 1981)
5) Self-perception (Bem, 1967)
6) Self-regulation theory (Kanfer, 1987)
7) Rokeach’s value theory (Rokeach, 1973)
8. STAGES OF CHANGE
• Pre-contemplation
Happy to maintain status-quo
• Contemplation
Question the present situation
9. STAGES OF CHANGE (cont)
• Decision/determinism
Change talk/plan/strategy
• Active changes
Strategy implemented, steps taken
10. STAGES OF CHANGE (cont)
• Maintenance
Changed behaviour adopted and maintained
• Relapse
Learning from ‘failure’
One step forward, two steps back…..
Most people need more than one attempt.
11.
12. MI
• Rooted in work of Carl Rogers.
• ‘A collaborative, person-centred form of
guiding to elicit and strengthen motivation for
change’
(Miller and Rollnick, 2009)
13. ‘SPIRIT’ OF MI
• More than a set of techniques.
• Based on 3 key elements: ACE
• Autonomy (vs Authority)
• Collaboration (vs Confrontation)
• Evocation (vs Imposition)
14. 4 PRINCIPLES OF MI
• Express Empathy (vs sympathy)
Empathy because you have ‘been there’ vs
sympathy when you have not.
• Support Self-Efficacy
Supporting the belief that change is possible.
Focus on previous successes.
15. 4 PRINCIPLES OF MI (cont)
• Develop Discrepancy
Mismatch between ‘where they are’ and ‘where they
want to be’. Conflict between current behaviour and
future goal. ‘Throw away’ comments.
• Roll with Resistance
Comes from conflict between view of ‘problem’ and
‘solution’. Non-confrontation using de-escalation
techniques. ‘Yes, but….’ MI focus on client define
problem results in more ‘dancing and less wrestling’.
17. RESISTANCE vs AMBIVALENCE
• Exploration and resolution of ambivalence.
• Ambivalence is preferred to resistance in order to
explore the dynamic interrelationship (Arkowitz et al,
2008)
• Approach-Avoidance-moving betwixt and between
e.g. just one more drink, play on the gaming
machine, slab of chocolate……..
18. HOW NOT TO ‘DO’ MI
http://www.youtube.com/watch?v=kN7T-cmb_l0
20. MI SKILLS IN PRACTICE (OARS)
• Open ended questions:
• Affirmations-support self-efficacy.
– Must be congruent and genuine.
• Reflections. Has 2 purposes; help to express
empathy and resolution of ambivalence by
focusing on negatives of maintenance and
positives of change.
• https://youtu.be/1uRwwz-b6Zk
• https://youtu.be/oG_UlQrFmAY
25. CHANGE TALK
• Seek to guide client to expressions of change
talk.
• Correlation between statements of change
and change behaviour.
• DARN CAT-types of change talk.
26. PREPARATORY CHANGE TALK
• Desire (I want to change)
• Ability (I can change)
• Reason (Its important to change)
• Need (I should change)
Examples……..?
27. IMPLEMENTING CHANGE TALK
• Commitment (I will change)
• Activation (I am ready, prepared and willing to
change)
• Taking steps (I am taking specific action to
change)
28. STRATEGIES FOR EVOKING CHANGE
TALK
• Ask evocative questions
• Explore decisional balance (pros/cons-more pros)
• Good/not so good about behaviour
• Ask for examples
• Look back
• Look forward
• Query extremes
• Use change rulers
• Explore goals/values
29. READINESS TO CHANGE
• Decreasing resistance/ambivalence.
• Less emphasis on the problem.
• Change talk; person gives off increasing resolve.
• S/he is posing her own questions about her own
change process.
• Envisioning-how the future might look, could look.
30. MI ‘TRAPS’
• Labelling.
• Blaming/judging.
• Resisting the ‘righting reflex’.
• Forgetting the answers lie within the
individual.
• Any more?
32. 8 THINGS THAT MI IS NOT
• MI not based on the TTM. What is the difference?
• MI not a way of tricking people into change
behaviour. ALWAYS in the persons best interests.
You do not ‘MI’ someone. You cannot do MI ‘on’
or ‘to’ someone.
• MI is not a technique. Not simple with steps to
follow. More complex.
• MI is not a decisional balance. Exploring pros
AND cons can sometimes avoid influencing
direction of choice.
33. 8 THINGS THAT MI IS NOT (Cont)
• MI is not CBT. MI is a brief intervention-new skills
are not learned. NOT ‘I have what you need’
rather ‘you have it already.’
• MI is not just client centred counselling. Goal
focused.
• MI is not what you were already doing.
Communication style rather then problem
solving.
• MI is not a panacea. Not suitable for all health
related problems. Short term sessions required.
34. REFERENCES
• Bem, D. (1967) Self-Perception. An Alternative
Interpretation of Cognitive Dissonance Phenomena.
Psychological Review 74 (3), p.183-200.
• Brehm, S. S. and Brehm, J. W. (1981) Psychological
Reactance: A Theory of Feedom and Control. New York:
Academic Press.
• Janis, I. L. and Mann, L. (1977) Decision- Making. A
Psychological Analysis of Conflict, Choice and Commitment.
New York: Free Press.
• Kanfer, F. H. (1987) Self Regulation and Behaviour. Jenseits
des Rubikon. Heidelberg: Springer-Verlag.
• Miller, W. R. and Rollnick, S. (2009) Ten Things that MI is
Not. Behavioural and Cognitive Psychotherapy 37, p.129-
140.
35. REFERENCES (cont)
• Orford, J. (1985) Excessive Appetites. A Psychological View of
Addictions. New York: Wiley.
• Prochaska, J. O. and DiClemente, C. C. (1984) The
Transtheoretical Approach. Crossing Traditional Boundaries of
Therapy. Homewood, Illinois: Dow/Jones
• Rokeach, M. (1973) The Nature of Human Values. New York:
Free Press.
• Rogers, R. W. (1975) A Protection Motivation Theory of Fear
Appeals and Attitude Change. Journal of Psychology 91 (1),
p.93-114.
Notas do Editor
Easy to make assumption that people want to change
Where does MI ‘fit’ into this diagram?
Pre-contemplation-seeds of change Contemplation-possibility of change
People who are ready for change do not need MI. It is designed for the resolution of ambivalence with a tip in one direction
