1. Kelly Hill

2.  What are they?
 How can they be measured?
 Your client.
 Make a list…….

3. INDIVIDUAL ‘PROFESSIONAL’
 Isolated
 Ambivalent
 Willingness to change
 Your professionalism
 Wanting to help
 Knowing ‘what is best’

4.  ‘Movere’ Latin for ‘to move’
 Energy and direction.
 Goals.
 Sources of motivation?
 Think of a behaviour of yours that you have
thought about changing;
Eg: drinking/smoking/studying/untidiness
 Where has the motivation to change
originated from? External or internal?

5.  Easy to assume.
 Sometimes people are unaware.
 How?
 Why?
 Pleasure vs pain.

6.  Informed by 7 distinct theories:
1) Conflict and ambivalence (Orford, 1985)
2) *Decisional balance (Janis and Mann, 1977)
3) Health beliefs (Rogers, 1975)
4) Reactance (Brehm and Brehm, 1981)
5) Self-perception (Bem, 1967)
6) Self-regulation theory (Kanfer, 1987)
7) Rokeach’s value theory (Rokeach, 1973)

7. (Prochaska and DiClemente, 1984)

8.  Pre-contemplation
Happy to maintain status-quo
 Contemplation
Question the present situation

9.  Decision/determinism
Change talk/plan/strategy
 Active changes
Strategy implemented, steps taken

10.  Maintenance
Changed behaviour adopted and maintained
 Relapse
Learning from ‘failure’
One step forward, two steps back…..
Most people need more than one attempt.

11.  Rooted in work of Carl Rogers.
 ‘A collaborative, person-centred form of
guiding to elicit and strengthen motivation
for change’
(Miller and Rollnick, 2009)

12.  More than a set of techniques.
 Based on 3 key elements: ACE
 Autonomy (vs Authority)
 Collaboration (vs Confrontation)
 Evocation (vs Imposition)

13.  Express Empathy (vs sympathy)
Empathy because you have ‘been there’ vs
sympathy when you have not.
 Support Self-Efficacy
Supporting the belief that change is possible.
Focus on previous successes.

14.  Develop Discrepancy
Mismatch between ‘where they are’ and ‘where
they want to be’. Conflict between current
behaviour and future goal. ‘Throw away’
comments.
 Roll with Resistance
Comes from conflict between view of ‘problem’
and ‘solution’. Non-confrontation using de-
escalation techniques. ‘Yes, but….’ MI focus on
client define problem results in more ‘dancing and
less wrestling’.

15.  Hesitance
 Uncertainty
 Indecision
 Irresolution
 Doubt
 Fickleness
 Being in two minds…

16.  Exploration and resolution of ambivalence.
 Ambivalence is preferred to resistance in
order to explore the dynamic
interrelationship (Arkowitz et al, 2008)
 Approach-Avoidance-moving betwixt and
between e.g. just one more drink, play on
the gaming machine, slab of chocolate……..

17.  http://www.youtube.com/watch?v=kN7T-
cmb_l0

18.  What mistakes do you think were made in this
clip?

19.  Open ended questions:
 Affirmations-support self-efficacy. Must be
congruent and genuine.
 Reflections. Has 2 purposes; help to express
empathy and resolution of ambivalence by
focusing on negatives of maintenance and
positives of change.
http://www.youtube.com/watch?v=xrbXMaiR_
Ww example of reflective listening

20.  Repeating
 Re-phrasing
 Paraphrasing
 Reflection of feeling

21.  Summaries-communicate interest and
understanding. Shift attention/direction-
‘move on.’ Highlight both sides (but focus
more on positives) of ambivalence therefore
promote discrepancy.

22.  Seek to guide client to expressions of change
talk.
 Correlation between statements of change
and change behaviour.
 DARN CAT-types of change talk.

23.  Desire (I want to change)
 Ability (I can change)
 Reason (Its important to change)
 Need (I should change)
Examples……..?

24.  Commitment (I will change)
 Activation (I am ready, prepared and willing
to change)
 Taking steps (I am taking specific action to
change)

25.  Ask evocative questions
 Explore decisional balance (pros/cons-more
pros)
 Good/not so good about behaviour
 Ask for examples
 Look back
 Look forward
 Query extremes
 Use change rulers
 Explore goals/values

26.  Decreasing resistance/ambivalence.
 Less emphasis on the problem.
 Change talk; person gives off increasing
resolve.
 S/he is posing her own questions about her
own change process.
 Envisioning-how the future might look, could
look.

27.  Labelling.
 Blaming/judging.
 Resisting the ‘righting reflex’.
 Forgetting the answers lie within the
individual.
 Any more?

28.  http://www.youtube.com/watch?v=URiKA7CK
tfc&feature=related

29.  MI not based on the TTM. What is the
difference?
 MI not a way of tricking people into change
behaviour. ALWAYS in the persons best
interests. You do not ‘MI’ someone. You
cannot do MI ‘on’ or ‘to’ someone.
 MI is not a technique. Not simple with steps
to follow. More complex.
 MI is not a decisional balance. Exploring pros
AND cons can sometimes avoid influencing
direction of choice.

30.  MI is not CBT. MI is a brief intervention-new
skills are not learned. NOT ‘I have what you
need’ rather ‘you have it already.’
 MI is not just client centred counselling. Goal
focused.
 MI is not what you were already doing.
Communication style rather then problem
solving.
 MI is not a panacea. Not suitable for all health
related problems. Short term sessions
required.

31.  Bem, D. (1967) Self-Perception. An Alternative
Interpretation of Cognitive Dissonance Phenomena.
Psychological Review 74 (3), p.183-200.
 Brehm, S. S. and Brehm, J. W. (1981) Psychological
Reactance: A Theory of Feedom and Control. New
York: Academic Press.
 Janis, I. L. and Mann, L. (1977) Decision- Making. A
Psychological Analysis of Conflict, Choice and
Commitment. New York: Free Press.
 Kanfer, F. H. (1987) Self Regulation and Behaviour.
Jenseits des Rubikon. Heidelberg: Springer-Verlag.
 Miller, W. R. and Rollnick, S. (2009) Ten Things that
MI is Not. Behavioural and Cognitive Psychotherapy
37, p.129-140.

32.  Orford, J. (1985) Excessive Appetites. A
Psychological View of Addictions. New York: Wiley.
 Prochaska, J. O. and DiClemente, C. C. (1984) The
Transtheoretical Approach. Crossing Traditional
Boundaries of Therapy. Homewood, Illinois:
Dow/Jones
 Rokeach, M. (1973) The Nature of Human Values.
New York: Free Press.
 Rogers, R. W. (1975) A Protection Motivation
Theory of Fear Appeals and Attitude Change.
Journal of Psychology 91 (1), p.93-114.