How do people change

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How do people change?
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Motivational Enhancement The Process of
ChangeM. Lynn Smith, MA, LCADC
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How do People Change? They change voluntarily
only when

• They become interested in or
• concerned about the need for change
• They become convinced that the change is in their
  best interests or will benefit them more than
  cost them
• They organize a plan of action that they are
  committed to implementing
• They take the actions that are necessary to make
  the change and sustain the change
• Carlo C.
  DiClemente

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Critical Dimensions

• Clarity about what behavior or constellation of
  behaviors is the focus of readiness
• Distinguish between readiness to engage and
  readiness to change
• View readiness as a complex phenomenon and not a
  simple mechanism like an on off switch
• Carlo DiClemente
• 
  

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Prochaska DiClementeTranstheorhetical Model of
Change

• Precontemplation
• Contemplation
• Preparation/Determination
• Action
• Maintenance

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Cycle of Change
Prochaska DiClemente
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Precomtemplation

• Task Raise awareness doubt
• Strategies Develop rapport,
• establish attitude of respect,
• validate individuals freedom to
• change or not!, evoke self
• motivational statements and give
• feedback only if person is ready.

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Contemplation

• Task Examine pros cons of change vs. status
  quo tip the balance
• Strategies Decisional balance,
• access good things vs. bad things
• compare, contrast good bad things,
• highlight concerns and discrepancies,
• elicit next step.

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Decisional Balance
Good things about use
Not so good things about use
Not so good things about
change
Good things about change

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Preparation/Determination

• Task Help determine course of action
• Strategies Elicit goals/vision of
• future, examine needs, examine
• option of not changing, elicit
• change options from client,
• reinforce individuals commitment
• to take action.

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Action

• Task Help take steps towards change, following
  through with course of Action
• Strategies Utilize strategies
• developed during determination
• stage. Emphasis is on concrete
• steps.

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Maintenance

• Task Help develop new strategies/new skills to
  prevent relapse.
• Strategies
• Determine vulnerabilities,
• Develop strategies to address
• vulnerabilities, Identify adaptive
• behaviors, Revisit reasons to
• change

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Relapse

• Task Facilitate reentry into process of change
  without becoming stuck or demoralized.
• Strategies Empathy and
• understanding, reframe and
• rename, accept and encourage,
• give realistic feedback about the
• process of recovery. Build on
• lessons learned.

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Principles of Motivational Enhancement Therapy

• Express Empathy
• Develop Discrepancy
• Avoid Argumentation
• Roll with Resistance
• Support Self Efficacy

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Express Empathy

• Skillful reflective listening is fundamental

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Accurate Empathy

• Accurate Empathy is skillful reflective
  listening that clarifies and amplifies the
  persons own experiencing and meaning without
  imposing the counselors own material.
• Carl Rogers

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Reflective Listening

• Hypothesis Testing
• Follow, Dont Lead
• Make a Statement
• Repeat
• Paraphrase
• Reflect on a Feeling Level
• Use Metaphors

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Principles of Motivational Interviewing

• Express Empathy
• Develop Discrepancy
• Avoid Argumentation
• Roll with Resistance
• Support Self Efficacy

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Develop Discrepancy

• Awareness of consequences is important
• Discrepancy between behaviors and goals motivates
  change
• Have the client present reasons for change

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Avoid Argumentation

• Resistance is signal to change strategies
• Labeling is unnecessary
• Arguing is counterproductive
• Client attitudes are shaped by their words not
  yours

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Roll with Resistance

• Use momentum to your advantage
• Shift perceptions
• Invite new perspectives
• Clients are valuable
• resources in finding
• solutions to problems

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Support Self Efficacy

• Belief in possibility of change
• Client is responsible for choosing and carrying
  out change
• There is hope in the range of alternative
  approaches

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Therapist Pitfalls

• Underestimating Ambivalence
• Misjudging Stage of Change
• Prescribing Unacceptable Program of Change
• Not Providing Sufficient Direction

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The Therapeutic Relationship

• Through Support and Empathy, the clinician is
• the caring other that offers support and
• the empathic other who reflects back content,
  affect, themes, and patterns in the clients
  story from the clients perspective.

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Empathy

• Empathy is not SYMPATHY
• Empathy the ability to immerse oneself in
  anothers experience without losing ones own
  sense of self
• Empathy is much more than just putting oneself in
  the other persons shoes.
• Empathy requires a shift of perspective.
• Empathy requires a constant shifting between my
  experiencing as you and what you feel, and my
  being able to think as me about your experience.

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The StrengthBased Approachvs Traditional
Problem-focused Approach

• Problem Focused Approach
• Perceives clients in negative terms
• May lower expectations of positive change
• Clients are seen in terms of diagnostic
  categories or presenting problems these labels
  may create distance between counselor and client
• Labels also create pessimism in both parties
• Negative labels and expectations obscure the
  unique capabilities of clients

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The Strength-Based Approach

• 1. Every individual, group, family, community
  has strengths.
• In the end, clients want to know that you
  actually care about them, that how they fare
  makes a difference to you, that you will listen
  to them, that you will respect them no matter
  what their history and that you believe that the
  can build something of value with the resources
  within and around them.
• But most of all clients want to know that you
  believe they can surmount adversity and begin the
  climb toward transformation and growth.

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The Strength-Based Approach

• 2. Trauma, abuse, illness and struggle may be
  injurious , but they may also be sources of
  challenge and opportunity.
• A strength-based approach recognizes clients
  inherent competencies, resilience, and
  resourcefulness in having survived past
  difficulties as well as their current motivation
  for growth and development.

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The Strength-Based Approach

• 3. Assume that you do not know the upper limits
  of the capacity to grow and change, and take
  individual, group and community aspirations
  seriously.
• Creating hope where there is little to hope for,
  strengthening belief when there is little to
  believe in, and creating aspirations where there
  are none is the essence of therapeutic practice
  from a strengths perspective.
• J. Poulin p. 11 Strength-Based Generalist
  Practice 2005

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The Strength-Based Approach

• 4. We best serve clients by collaborating with
  them.
• You are not the sole expert!!!!

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The Strength-Based Approach

• 5. Every environment is full of resources
• In every environment there are individuals,
  associations, groups, and institutions who have
  something to give, something that others may
  desperately need knowledge, an actual resource
  or talent, or simply time and place. (Saleeby
  2002)

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The Strength-Based Approach

• 6. Caring, caretaking and context are important.
• Caring for others and being cared for is a basic
  human right.

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Strength Perspective Questions of
Counselor/Therapist

• What do clients want? What do they need?
• How do they think they can get it?
• How do they see their situation problems as
  well as opportunities?
• What values do they want to maximize?
• How have they managed to survive thus far?

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Opening Strategies

• Ask Open-Ended Questions
• Practice Reflective Listening
• Affirm
• Summarize
• Elicit Self-Motivational
• Statements

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Putting It All Together
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Note

• The following slides were not used in class, but
  contain useful information

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Twelve RoadblocksThomas Gordon

• Warning or threatening
• Giving Advice
• Persuading, arguing, lecturing
• Moralizing, preaching
• Judging, criticizing
• Ordering, directing or commanding

• Agreeing, praising
• Shaming, name calling
• Interpreting, analyzing
• Reassuring, consoling
• Questioning, probing
• Withdrawing, distracting

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Helpful Responses vs. Roadblocks

• Whats your HRQ?
• 1. No Reflection, at least one Roadblock
• 2. Reflection and a Roadblock
• or neither
• 3. Simple Reflection
• 4. Paraphrase, adding inferred meaning
• 5. Paraphrase, inferred meaning and
  Reflection of Feeling or appropriate metaphor or
  simile

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Recognizing Resistance

• Arguing
• Interrupting
• Negating
• Ignoring

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Handling Resistance

• Simple Reflection
• Amplified Reflection
• Double Sided Reflection
• Change Directions
• Agreement with a Twist
• Coming alongside
• Reframing

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Strengthening Commitment

• Review
• Use Open Ended Key Questions
• Give Advice Carefully
• Negotiate a Plan