Today's Goal. Motivational interviewing. Motivational interviewing is: Methods that don't help

Transcription

1 Today's Goal Motivational interviewing To get an understanding of MI as a way of relating to the client To be able to judge different motivational stages To be able to use some of MI s techniques Motivational interviewing is: Therapist directed Goal oriented Client centred A consultation style with the goal of helping the client investigate and resolve ambivalence to change. Methods that don't help Talking more than the client Lying ahead of the client in the process Closed questions Threats and warnings 1

2 Traditional consultation techniques Do not lead to change Make the helpers feel helpless People / clients do not like to be told what to do and how to act Factors that influence motivation in a positive direction Experiences of having succeeded in one or more areas earlier in life A positive view of oneself Insight in the present situation Knowledge of available treatment Positive experiences of helper relationships and treatment Experiencing being treated positively in the actual situation. Motivation cycle Sören Kierkegaard Relapse Retaining change Precontem plation Contemplation If I am to succeed in directing an individual toward a given goal, I must first find her where she is and start from there. He who cannot do that, deceives himself when he thinks he can help others. Action Pre pari ng (free translation) 2

3 Ambi = dubble Valence = validity Ambivalence Di (two) lemma (theme/argument) Ambivalence Help the client tip the balance A start for change! A difficult choice situation, usually because of conflicting issues that have to be met Guiding principles Show empathy Develop discrepancy Avoid argumentation Roll with the resistance Support feelings of competence Showing empathy Listen attentively Mediate understanding The understanding is investigated through reflective listening This can be practiced! 3

4 Communication What I say What I mean What you hear What you think I mean I know that you believe that I understand what you thought I said but I'm not sure that you realise that what you heard is not what I meant. Develop discrepancy Avoid argumentation The difference between how the client has it and how he/she wants it to be. Arguments for a change should be expressed by the client. To argue for change encourages objections. Argumentation hinders the client from developing his/her own arguments for a change. 4

5 Roll with the resistance A positive view on resistance Energy that can be used constructively Emphasize the positive points Assume that the client is ambivalent (at all stages of change) Support feelings of competence Belief in ones own capacity - self-efficacy Strengthen the clients real resources Mobilize the clients own resources Experiment instead of failure Success breeds success Basic tools Confirmation Open ended questions Reflective listening Summaries Confirmation That was a good idea! Thank you for coming I appreciate you telling me this 5

6 Open ended questions Get the client to tell, describe or explain something with his/her own words Cannot be answered with one or two words Starts often with the words how, what, and how did that come about Reflective listening Repeat - same word, same sentence Reformulate - another word, same sentence Reformulate - another word, another sentence Reflection of feelings Reflective listening Acknowledgement that one's message has gotten through/ that one is understood Acknowledgement stimulates an investigation of the the subject The carer/therapist conveys respect Maintaining the client's own responsibility A gentle but powerful way of steering the discussion toward change Start for reflection You feel.. As you see it You mean Your concern is You are angry/sad/happy etc 6

7 Summaries At the start of a talk in a series of talks During a talk if the other jumps from one subject to another If the conversation comes to a stop When the other has exhausted a subject Summaries - how You have told me quite a lot. Let us see if I ve understood how it all makes sense? You seem to have taken this very hard. Let s see if I ve understood the most important things of what you ve said? Use a ruler Enticing self motivating statements Open ended questions about the self assessment The ruler How important is it for you to..? 0 10 Totally Very Unimportant important 7

8 The ruler How sure are you that you would be able to..if you descided to? 0 10 Absolutely Absolutely sure I would sure I would NOT be able to be able to The ruler How is it that you chose a six and not a lower number? What would be needed to make it more important for you to change, so that you would choose a seven or an eight? 8