Transcript Motivational Interviewing & Behaviour Change

Assessing Motivation
Decisional Balance
Benefits
Concerns
Using scales
Readiness
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Importance
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How much better life will be
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Confidence
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The Flow of Change Talk
Motivational
Interviewing
Change Talk
Commitment
Change
Resistance / sustain talk
Take three minutes to write down
resistant statements that you come across
in your practice
Responding to Resistance
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How have you felt in the
past when working with
resistant clients?
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What responses have not
worked well?
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What responses have
worked well?
DEALING with RESISTANCE
THERAPISTS ROLE
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Not to assume it is wholly a client characteristic
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Greater resistance = less chance of change
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Lower levels of resistance is a good sign (change talk)
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Resistance should be a therapist concern
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Same therapist switching styles can affect outcome
(Patterson & Forgatch, 1985)
Cont…
RECOGNISING RESISTANCE
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Anything inconsistent with change
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Suggests the client and therapist are not at the same
point.
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Change talk is the opposite to resistance
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Resistance may be normal initially. Therapist task is not
to elicit more but to manage effectively
STRATEGIES for DEALING
WITH RESISTANCE
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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…
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Confrontation is likely to elicit resistance
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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
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Level of client resistance during counseling
predicted absence of change in drinking (Miller,
Benefield & Tonigan, 1993)
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Verbal commitment to drug use during MI
predicted continued drug use (Amrhein et al.,
2003)
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Resistance / poor outcome relationship
replicated in several other studies
Practice Responding to
Resistance
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Resistant client
Use some of the resistant statements you
have already written down and in pairs
practice responses
Further Reading
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motivationalinterview.org
Motivational Dialogue Raistrick & Tober (2007)
Motivational Interviewing Miller & Rollnick(2002)
Email contact:
[email protected]