If only I were human

I am retyping these notes we got from class as a way to relearn and absorb the material.  And I’m a nut.

A Guide to Motivational Interviewing
From: Motivational Interviewing by Miller and Rollnick (2002)

“The proper question is not, “Why isn’t this person motivated?”
but rather “For what is this person motivated?”

Definition of Motivational Interviewing:  A client-centered, [consciously] directive method [of communication] for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller & Rollnick, pag 25).

Phase 1: Building Motivation for Change
Five Early Methods in Motivational Interviewing
These methods are important to start using from the beginning:
1) Ask Open Questions: Client should be doing most of the talking.
2) Listen Reflectively: respond with a statement that is a guess about what the speaker means.  Inflection of statement should be turned down at the end of the statement, not up like a question.
3) Affirm: Respond with statements of appreciation and understanding.
4) Summarize:  Link together and reinforce material that has been discussed.
a.  Collecting summary: summarizing change talk themes, can end in “what else?” be careful not to interrupt client’s flow.
b. Linking summary: tie together what the person has just been saying with something offered earlier.
c.  Transitional summary: marks and announces a shift from one focus to another.
5) Eliciting Change Talk: see above; Directly Respond to Change talk with selectively elaborating, reflecting, summarizing, and affirming change talk.
a. Non-directive approaches look like client-centered counseling: clarifying ambivalence, clarifying values.

Phase 2: Strengthening Commitment to Change
Recognizing Readiness for Change
1) Decreased resistance.
2) Decreased discussion about the problem.
3) Resolve: feeling at peace.
4) Increase in change talk.
5)  Questions about change.
6) Envisioning a new life.
7)   Experimenting with change.

Hazards
1) Underestimating Ambivalence:  Ambivalence doesn’t disappear just because change began so continue to engage.
2)  Overprescription:  be aware of prescribing a plan that is unacceptable to the client.
3)  Insufficient Direction:  on the other hand, make sure you give a little help.

Initiating Phase 2
1) Recapitulation: summarize the current situation.
2) Key questions: continue to ask open ended questions.
3)  Giving information and advice: two circumstances when advice is good:  when the client asks for it, or with the person’s permission.

Negotiating a Change Plan:  not unlike a treatment plan – but client led!
1) Setting goals: have  a clear goal to move towards.
2) Considering Change options:  what are possible methods for achieving the chosen goals>
3) Arriving at a Plan:  have the client arrive at the plan; having them voice it increases its strength.
4)  Eliciting Commitment:  “Is this what you want to do?”

Facilitating Change
Beware the Righting Reflex:  the inclination to set things right.  The response from an ambivalent client may be to increase resistance or offer alternate solutions.

Develop Discrepancy:
a)  The client should be voicing the argument for change (pg 22)
b) The larger the discrepancy between what is and what is not desired, the greater the importance to change.
c)  For some then, the goal is to first become ambivalent (undecided) due to the increase in this discrepancy.

Four principles of MI
1.  Express Empathy
a. Acceptance facilitates change.
b. Skillful reflective listening is fundamental.
c. Ambivalence is normal.
2.  Develop discrepancy
a.  The client rather than the counselor should present the arguments for change.
b.  Change is motivated by a perceived discrepancy between present behavior and important personal goals or values.
i. Be careful not to focus on behavioral gaps that are too big; this may diminish confidence in ability to change.
3. Roll with resistance
a.  Avoid arguing for change.
b.  Remember to try not to directly oppose resistance.
c.  New perspectives are invited but not imposed.
d.  The client is a primary resource in finding answers and solutions.
e.  Resistance is a signal to shift approach with the client.
4.  Support self-efficacy
a.  A person’s belief in the possibility of change is an important motivator.
b.  The client, not the counselor, is responsible for choosing and carrying out change.
c. The counselor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy.
d. “I will change you” is not the message but rather “If you wish, I can help you change.”

Understanding Client Behavior:  Change and Resistance
Two most important client behaviors to be aware of:  Change talk and resistance
GOAL:  Respond in a way that reinforces Change Talk and diminishes Resistance.  (The way you respond to these two behaviors predicts whether or not it will increase or decrease.)

Change talk:  Communicating in a way that draws out the clients own reason for and advantages to change.  Change talk allows the clinician to intensify and resolve ambivalence (pg 24).
FOUR CATEGORIES of Change Talk:
1) Disadvantage of the status quo: reasons for concern or discontent (not necessarily admission of a problem.)
2) Advantages of change: things that are gained from change.
3) Optimism for change:  I could or I can statements.
4) Intention to change: willingness or commitment to change: weak or strong.
Resistance:  the opposite of “change talk.” Signal of conflict in the counseling relationship.

(MORE TO COME… about two more pages.)