MOTIVATIONAL INTERVIEWING Motivation can be defined as a

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MOTIVATIONAL INTERVIEWING

• Motivation can be defined as a
• concept
• used to describe the factors within an individual
  which
• arouse,
• maintain,
• and
• direct behaviour towards
• a pre-defined goal.

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MOTIVATIONAL INTERVIEWING

• TO ASSIST PEOPLE IN ACCEPTING REPONSIBILITY FOR
  THEIR CONDITION WE MUST FIRST ACKNOWLEDGE
• THEIR INERTIA, MANIFEST IN
• THE PASSIVITIES.
• I.E. THE WAY MOST PEOPLE SOLVE THEIR PROBLEMS.

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PASSIVITIES

• DO NOTHING, WAIT AND SEE WHAT HAPPENS.
• WAIT AND SEE WHAT OTHERS DO BEFORE DOING
  ANYTHING.
• THEN DO NOTHING.
• NOTHING CAN CHANGE THE OUTCOME SO WHY BOTHER
  DOING ANYTHING?

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PASSIVITIES

• KEEP DOING WHAT DOESNT WORK,
• BUT EXPECT THINGS TO IMPROVE.
• DO EVERYTHING BUT WHAT IS RECOMMENDED BY YOUR
  TREATING HEALTH CARE PROFESSIONAL.
• SOMEONE ELSE WILL SOLVE MY PROBLEM.
• SHELL BE RIGHT MATE.

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QUESTION?

• HOW DO YOU DEFINE MOTIVATION?
• HOW DO YOU RECOGNISE IT IN AN INDIVIDUAL?
• HOW WOULD YOU KNOW IF A PERSON IS MOTIVATED?

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MOTIVATIONAL INTERVIEWING

• If we see
• MOTIVATION
• As a
• CHARACTERISTIC OR PERSONALITY TRAIT
• It establishes a
• SELF FULLFILLING PROPHECY
• which is ultimately a
• DISEMPOWERING BELIEF for the treating
  professional and client alike.

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MOTIVATION

• THE LEVEL OF MOTIVATION WITHIN A PERSON
• IS OPEN TO INFLUENCE.
• MOOD STATES ALONE WILL DO THAT.
• IT IS CERTAINLY OPEN
• TO THE INFLUENCE OF
• THE TREATING PROFESSIONAL.

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MOTIVATIONAL INTERVIEWING

• Motivation levels fluctuate as a consequence of
• INTRAPERSONAL EVENTS
• (e.g. cognitions, tiredness, depression, illness,
  fear)
• and
• INTERPERSONAL EVENTS
• (e.g. professional contact,
• objective information,
• personal advantage.)

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MOTIVATIONAL INTERVIEWING

• PEOPLE CHANGE BEHAVIOURS
• WHEN THEY
• COGNITIVELY
• RE-EVALUATE
• THE IMPACT ON THEIR LIVES.
• WHEN THE
• ACTUAL CONSEQUENCES OUT WEIGH THE PERCEIVED
  BENEFITS
• BEHAVIOURAL CHANGE IS MUCH MORE LIKELY TO OCCUR.

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The most important behavioural characteristics
that influencethe level of motivation in the
patient are

• THE PERSON CENTERED APPROACH.
• THE SKILL OF REFLECTIVE LISTENING.
• BEING OPTIMISTIC.
• EXPRESSING WARMTH.

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• BEING SUPPORTIVE.
• EXPRESSING EMPATHY.
• BEING SYMPATHETIC.
• BEING ATTENTIVE.
• AN ACTIVE INTEREST IN THE PERSONS WELL BEING.

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Think of motivation as COMPLIANCE,recognisable in

• ORIENTATION TO THE PROBLEM.
• RECOGNISING IT AS A PERSONAL PROBLEM.
• SEARCHING FOR A SOLUTION.
• APPLYING THE SOLUTION.
• MAINTAINING THE GAINS.

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Directing a cognitive re-evaluation of the
problematic behaviour.

• Bring into awareness the DISCREPANCY between
• REAL SELF vs IDEAL SELF.
• VALUES vs BEHAVIOUR.
• HEALTHY vs UNHEALTHY BEHAVIOUR.
• CURRENT STATE OF LIFE vs IDEAL STATE OF LIFE.

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Discrepancy produces psychological tension which
can result in-

• RISK REDUCTION
• a move to reduce unwanted consequences of the
  problematic behaviour.
• FEAR REDUCTION
• - a move to reduce the unwanted emotional state
  by a cognitive reversal, i.e. a return to
  precontemplation.

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RISK REDUCTION occurs when five factors are
present.

• I WANT TO DO IT.
• I CAN DO IT.
• IT WILL BE AN ADVANTAGE TO ME OR I CAN AVOID A
  DISADVANTAGE.
• I WILL WORK AT IT.
• I WILL BE DETERMINED AND PERSIST AT IT.

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5IVE

• Let us understand the five factors.

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WANT TO?

• What are the reasons for the person to do what is
  required to improve their lives?
• BECAUSE,
• BECAUSE,
• BECAUSE!
• Use the freakin word!

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• BECAUSE
• PROVIDES
• REASON,
• AND
• REASON
• MOTIVATES.

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SEASON OF REASON

• People are much more likely to be motivated to be
  compliant when they REASONS
• to do so.

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• Never forget, the human brain tries to
• MAKE SENSE OF,
• to UNDERSTAND,
• to FIND MEANING.
• TO MOTIVATE PEOPLE OFTEN ALL WE HAVE TO DO IS
  PROVIDE MEANING.

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GOOD REASON

• YOU ARE SUBTLY FORCING THEM TO THINK ABOUT IT BY
  GIVING THEM REASONS TO DO SO,
• AND IS ESPECIALLY POWERFUL WHEN WE PROVIDE THEM
  WITH A GOOD REASON.

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• IT IS AT ITS MOST POWERFUL WHEN THE PERSON IS
  MOTIVATED BY
• THEIR
• GOOD REASON.

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HIERARCHY.

• PERSONS GOOD REASON
• TO BE MOTIVATED.
•  
• YOUR GOOD REASON.
• (STRIVE FOR MAXIMAL CONGRUENCE,
• I.E. SAME REASONS)
•  
• YOUR REASONABLE REQUEST AS TO HOW IT WILL BE
  DONE.

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CAN DO IT.

• IF A PERSON DOES NOT BELIEVE THAT THEY CAN CARRY
  OUT THE STEPS AND INFLUENCE THE OUTCOME,
• THEY WONT EVEN TRY.
• OR, AS SOON AS THEY HIT AN OBSTACLE,
• THEY GIVE UP.
• S.F.P.

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ADVANTAGES / CATASTROPHE.

• HELP THE PERSON IDENTIFY
• THE ADVANTAGES
• OF BEING COMPLIANT AND
• THE CATASTROPHES
• IN NOT BEING COMPLIANT.

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MOTIVATIONAL INTERVIEWING

• Avoid the creation of
• RESISTANCE
• RELUCTANCE
• REACTANCE
• to the natural change process by arguing that
  there is a problem.

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KEY PRINCIPLES IN MOTIVATIONAL INTERVIEWING.

• ROLE WITH THE RESISTANCE.
• FACILITATE THE PERSON CONVINCING THEM SELF.
• THIS THEY WILL DO IN RESPONSE TO THE FOCUSSED
  QUESTIONS
• YOU ASK.

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KEY PRINCIPLES IN MOTIVATIONAL INTERVIEWING.

• PEOPLE LEARN
• WHAT THEY BELIEVE
• AS THEY HEAR THEMSELVES SAY IT
• BECAUSE
• I BELIEVE
• WHAT I TELL MYSELF
• IS TRUE.

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1. GAIN PERMISSION.

• DONT ASSUME THAT THE PERSON IS READY TO DISCUSS
  THE ISSUE OR HEAR YOUR CONCERNS. ASK.
• YOU WOULDNT MIND IF WE DISCUSS (ISSUE) NOW?
• I AM SURE THAT YOU WOULD LIKE TO HELP ME
  IDENTIFY AND REDUCE YOUR HEALTH RISKS

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WHAT PURPOSE DOES THE ACTIVITY SERVE IN THEIR
LIVES?

• HUMAN BEHAVIOUR IS MOTIVATED.
• WHAT IS THE MOTIVATION BEHIND THE ACTIVITY TO BE
  ESTABLISHED
• OR
• REMOVED?

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2. UNDERSTAND POSITIVE EXPECTANCIES

• TELL ME WHAT IT IS YOU ENJOY ABOUT.
• (E.G. SMOKING)
• WHAT DO YOU GET OUT OF?
• HOW DOES.FIT INTO YOUR LIFESTYLE?
• ACKNOWLEDGE,
• BUT DONT REINFORCE REASONS FOR ACTIVITY.

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3. FOCUS THE NEGATIVES.

• (I.E. THE UNWANTED CONSEQUENCES OF THE BEHAVIOUR)
• YOU HAVE GIVEN ME THE UPSIDE, WHAT ABOUT THE
  OTHER SIDE OF IT, TELL ME A BIT ABOUT THAT.
• WHAT ARE YOUR CONCERNS ABOUT. (E.G. SMOKING)?
• GOOD THINGS vs
• LESS GOOD THINGS

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THE SUM OF ALL FEARS.

• SUMMARISE THE NEGATIVES ADDITIVELY.
• (A AB ABC ABCD).
• THIS IS LIKELY THE FIRST TIME THAT THEY HAVE
  ASSEMBLED AND HEARD ALL THEIR CONCERNS.

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4. CREATE THE DISCREPANCY.

• YOU OBVIOUSLY HAVE CONCERNS ABOUT THE WAY. IS
  AFFECTING YOUR HEALTH, RELATIONSHIP, CAREER,
  LIFESTYLE, ETC.
• PERHAPS THE SITUATION IS NO LONGER ACCEPTABLE TO
  YOU?
• WHAT DO YOU WANT TO DO ABOUT YOUR IT IS
  SOMETHING YOU DO, NOT WHO YOU ARE.

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5. ESTABLISH PRIORITIES.

• WHEN YOU THINK ABOUT (ISSUE) AND YOUR HEALTH,
  WHICH ONE IS MOST IMPORTANT TO YOU?
• IF YOU HAD TO MAKE A CHOICE BETWEEN A AND B
  WHICH ONE WOULD IT BE?
• I DONT MIND WHICH ONE YOU CHOOSE, BUT I NEED TO
  KNOW IN ORDER TO BEST ASSIST YOU.

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6. CLARIFY OBSTACLES TO CHANGE.

• HAVE YOU EVER TRIED TO DO SOMETHING ABOUT THIS
  BEFORE?
• WHAT HAPPENED?
• WHEN YOU THINK ABOUT STOPPING (CHANGING) WHAT
  COULD PREVENT YOU FROM ACHIEVING IT?
• WHAT DID YOU LEARN FROM PREVIOUS ATTEMPTS TO
  CHANGE?

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7. NEGOTIATE SOLUTIONS.

• WHAT DO YOU WANT TO DO ABOUT THIS?
• WHAT WOULD YOU LIKE TO TRY FIRST, NICOTINE GUM,
  NICOTINE PATCHES, OR XYBAN TO HELP YOU QUIT?
• WHERE POSSIBLE GIVE THREE CHOICES.

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8. GET COMMITMENT.

• NEGOTIATE THE GOALS OF TREATMENT, BE SPECIFIC,
  AND USE CONTRACTS.
• REMIND THAT SUCCESS IS PREDICATED UPON
  PERSISTENCE
• AND
• DETERMINATION.
• FOLLOW UP
• AND SUPPORT!

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RULE OF THUMB.

• To progress a person from
• Precontemplation
• to
• Contemplation
•  
• INCREASE THE REASONS
• FOR THEM TO DO SO.

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RULE OF THUMB.

• To progress a person from
• Contemplation to Action
•  
• DECREASE THE COSTS.

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RULE OF THUMB.

• To support a person in
• Action
•  
• INCREASE
• THE REASONS TO DO SO,
• DECREASE THE COSTS.
•  
•  

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RULE OF THUMB.

• TWICE AS MUCH EFFORT SHOULD BE PUT INTO
  ESTABLISHING THE REASONS TO CHANGE
• AS IN REDUCING THE COSTS.

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OTHER COUNSELLING STRATEGIES USED WITHIN THE M.I.
FRAMEWORK.

• RETROSPECTION.
• What was life like before the emergence of the
  problematic behaviour?
• What does the person remember, what plans, dreams
  did they have?
• The goal is to assist the person to see how
  things have deteriorated over time because of the
  problematic behaviour.

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FUTURESPECTION

• The person in treatment has to envision two
  futures
• 5 10 years hence.
• The first will be the future in which they
  continue with the problematic behaviour.
• The second will be the possible future should
  they decide to change.
• Dont argue for one or the other,
• Ask the client to comment.

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IMPORTANCE AND CONFIDENCE.

• Whilst people may indicate a preference for the
  best of all possible futures, how important is it
  to them and how confident are they that they can
  achieve it?
• Explore what makes the change important, how it
  would fit in to other aspects of their life,
• what could occur to make it more important?

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FRAMES.

• Feedback.
• Responsibility.
• Advice.
• Menu of options (3).
• Empathy.
• Self efficacy.

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BATTLE PLAN.

• As people are being supported in making changes
  it is essential to identify obstacles. Their
  diary becomes their best friend with agreed
  strategies in place.
• Assist them in planning the next sixty days, what
  it is that they want to achieve and how they are
  going to achieve it,
• the big plan.

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THE BIG PLAN.

• They need to implement a system that will keep
  bringing them back on track.
• One that will keep
• re-orienting them towards their goals again and
  again.
• If there is no reminder system,
• then old habits will always triumph over new
  intentions and motivation.