Introduction to Motivational Interviewing and Stages of

Change

…What the Non-Specialist Needs to Know

By Elizabeth Kotkin, MA, LMFTProgram Director

YES Adolescent Skills Center-Manhattan

What Do You Do to Relax?

What If Someone Said NO Took away all the ways

you relax. Told you that you have to

do something else. Told you that you have to

stop doing what you like to do to relax, but everyone you know can continue.

Motivational Interviewing“Motivation can be understood not as something one

has but rather as something one does. It involves recognizing a problem, searching for a way to change and then beginning and sticking with that change strategy” Miller (1995)

· Motivational Interviewing is a way to minimize resistance, resolve ambivalence and induce change.

· Readiness levels are accepted starting points for treatment rather than reasons for elimination from treatment services.

Motivation: The Old Way

· Motivation is key to change and it is constantly in flux· Motivation is influenced by social interaction, namely

the counselor’s style· At all stages of change, ambivalence is seen as normal

and not pathological

CONCEPTUALIZING MOTIVATIONAL INTERVIEWING

Client Resistance

Involves feelings-actions-behaviors of an interpersonal nature where there is a lack of

collaboration

Stages Of Change

Precontemplation stage Contemplation stage Preparation stage Action stage Maintenance Relapse

For any behavioral problem at a given time, there are (in the population at large)

• 40% in Pre-Contemplation• 40% in Contemplation• 20% on Preparation or Action

• * Prochaska and DiClemente, 1998

“There is a myth…that more is always better. More education, more intense treatment, more confrontation will necessarily produce more change. Nowhere is this less true than with precontemplators. More intensity will often produce fewer results with this group. So it is particularly important to use careful motivational strategies, rather than mount high-intensity programs…We cannot make precontemplators change, but we can help motivate them to move to contemplation.” DiClemente, (1991)

Stage 1: Precontemplation

The client does not consider change. Seeks treatment due to outside pressures such as family, job, etc., or due to legal and/or medical concerns

Motivational Interviewing Tasks: Building Readiness

A) Raise doubt about client’s belief that the behavior is harmless

B) Increase the client’s perception of risks and problems with current behaviors

Clinical Interventions

A) Establish rapport and offer factual information B) Explore the meaning of events that brought the

person in and the results of previous efforts

“Contemplation is often a very paradoxical stage of change…Ambivalence is the archenemy of commitment and a prime reason for chronic contemplation. Helping the client to work through the ambivalence, to anticipate barriers, to decrease the desirability of the problem behavior and to gain some increased sense of self-efficacy to cope with this specific problem are all stage-appropriate strategies.” DiClemente, (1991)

Stage 2: Contemplation

The client is highly ambivalent about change. The client both considers change and rejects it. The client will seesaw between reasons for concern and

justifications for continuing the behavior.

Ambivalence

A state of mind in which a person has coexisting but conflicting feelings, thoughts, and actions about something. In this stage, the client sees the possibility of change but is ambivalent

and uncertain about beginning the process Primary task : resolve the ambivalence and helping the client choose

to make the change

Motivational Interviewing Tasks: Increasing Commitment A) Tip the decisional balance and strengthen self-efficacy B) Evoke from the client reasons to change and risks of not

changing

Clinical Interventions

A) Show interest in how the behavior affects all areas of the client’s life

B) Talk about the person’s sense of self-efficacy and expectations of what the change will entail

C) Summarize self-motivational statements

Stage 3: Preparation-Determination

The client is committed to and planning to make a change in the near future but is still considering what to do

Goal: Help client to get ready to make a change Primary task: Help client identify appropriate change strategies Elements of Change:…Ready….Willing….Able

Strategies For Preparation Stage

Clarify goals & strategies Menu of options Offer advice Negotiate change plan

Identify and lower barriers to change

Get social support Treatment expectations Publicize change plans

Stage 4: Action

•     Client has decided to make a change, but hasn’t stabilized the process

•       Client has verbalized or demonstrated a firm commitment to change

•    Efforts to modify behavior and/or environment are being taken

•       Client demonstrates motivation and effort to achieve real change

•        Client is involved in, and committed to, the change process

• Client is willing to follow suggested strategies and activities to change

Strategies for Action Stage of Change

• Summarize a realistic view of change through small steps

• Help the person identify high-risk situations and develop appropriate coping strategies

• Assist the person in finding new reinforcers of positive change

• Help access family and social supports

Maintenance and Relapse

Definition: A stage in which the client has achieved the goals and is working to maintain them

Primary task: Client needs to develop new skills for maintaining recovery

Possible Strategies for Maintenance Stage

Help client identify and try alternative behaviors

Maintain supportive contact Encourage person to develop escape plan Work to set new short and long term goals

Maintenance and Relapse

You Can Make A Difference

This is an overview of the Stages of Change model by the psychologists who first wrote about it.

Another useful resource is TIP 35, (Enhancing Motivation for Change in Substance Abuse Treatment) published by the Center for Substance Abuse Treatment (CSAT) and available at SAMHSA for a free download.

Changing For Good,by Proshaska,Norcross and DiClemente