5 Elements of Motivational Interventions & 5 Principles of Motivational Interviewing

414 -5 Elements of Motivational Interventions & 5 Principles of Motivational Interviewing
Instructor: Dr. Dawn-Elise Snipes, PhD
Executive Director: AllCEUs.com, Counselor Education and Training
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery
Objectives
– Learn how motivation is dynamic
– Explore reasons and methods for enhancing motivation
– Identify 3 critical elements of motivation
– Delineate the 5 elements of motivational approaches
– Review the FRAMES model
– Identify ways to deal with resistance
– Review how to use decisional balance exercises

Why Enhance Motivation-
– Inspiring change
– Preparing clients to enter treatment
– Engaging and retaining clients in treatment
– Increasing participation and involvement
– Improving treatment outcomes
– Encouraging a rapid return to treatment if symptoms recur
– Creates a therapeutic partnership
6 Characteristics of Motivation
– Motivation is positive and a key to change
– Motivation “harnesses” energy to use to accomplish a task
– What happens when you are not motivated– To clean, exercise, work
6 Characteristics of Motivation
– Motivation is multidimensional
• Emotional
• Mental
• Physical
• Social Support and Pressures
• Legal
• Financial
– Cube activity
– #1
– On a large box identify all the reasons to NOT change on each face
– Can include drawbacks to change and benefits to staying the same
– Discuss ways to eliminate those drawbacks
– #2
– Get small-ish square boxes for clients to decorate
– On each face of the cube, have them identify motivations for change
6 Characteristics of Motivation
– Motivation is multidimensional
– Scale Activity
– Get at least 10-20 regular marbles and 10 shooter marbles (bigger)
– Get (or fashion a scale) One side is labeled “change” the other side is labeled “same”
– Write on the white board 2 columns
– Benefits to Staying the Same (and drawbacks to change)
– Benefits to Change (and drawbacks to staying the same)
– Have clients complete each list
– Then talk about how some “reasons” carry more weight.
– Bring out the scale and stones.
– Have clients assign a “weight” to each reason and deposit it in the appropriate side
– Goal is to see that it is about the total weight that tips the balance

6 Characteristics
– Motivation is dynamic and fluctuating
– Is a dynamic state that can fluctuate over time and in relation to different situations rather than a static personal attribute
– Can vacillate between conflicting objectives
– Differs between objectives
– Varies in intensity, faltering in response to doubts and increasing as doubts are resolved and goals are envisioned more clearly.
– Example: Getting Healthy
– Nutrition
– Exercise
– Sleep
– What conditions would make you motivated and what conditions would undermine your motivation-
6 Characteristics
– Motivation is dynamic and fluctuating
– SMART Goals increase efficacy
– Specific
– Measurable
– Achievable
– Relevant
– Time Limited

– Examples
– Get healthy to reduce my risk of cancer
– Lose weight to get my partner to pay attention to me
Goal Setting Activities
– Out of the Hat
– Write goals on strips of paper and put them in a hat or box
– Have clients draw a strip and restate the goal in specific, measurable, Achievable, Relevant and Time limited terms
– The strip might say: Lose Weight
– The client might say: Lose 10 pounds in 2 months so I am more comfortable in my clothes
– The strip might say: Not be depressed
– The client might say: Increase my overall happiness to a rating of 4 out of 5 at least 5 days per week in the next 8 weeks.
– The strip might say: Improve my relationship
– The client might say: Reduce arguments with my partner to less than 2 per week and spend at least 1 day per week together doing something enjoyable.

6 Characteristics
– Motivation can be modified/changed
– Social Influences (Media, friends, who you are doing it for)
– Emotional
– Mental
– Physical
– Legal
– Financial
– Environmental Pressures (nonsmoking buildings, custody)
– Distress Levels (Raising the bottom)
– Critical Life Events (loved one dying of cancer)
– Activity
– Use the same goals as in the Goal Setting Exercise to identify ways to increase motivation (Weight loss, depression…)
6 Characteristics
– Motivation is influenced by clinician’s (and client’s) style
– Nonpossessive warmth & friendliness
– Genuineness
– Respect
– Validation
– Empathy
– Talk about the successes as well as the challenges
– Motivation is purposeful and intentional
Help Increase Motivation
– Counselor Techniques OARS
– Open ended questions
– Respect the client's autonomy
– Affirm their ability to succeed
– Recognize co-occurring disorders, acknowledge difficulties
– Employ client centered treatment
– Reflective listening
– Using empathy more than authority. Validate client experience
– Summarize
– Focus on client strengths, successes and personal power

CRAVE Check In
– Compassion—I am human. I am here.
– Report how the week went
– Acknowledge difficulties
– Validate
– Explain how they used their strengths and personal power to create successes (even if it is just to try again the next day)

Critical Elements of Motivation (WAR)
– Willingness involves the importance a person places on changing—how much a change is wanted or desired.
– Activity: Yes, but….
– Write a goal on the board and have clients think of as many yes, buts for getting started on that goal as possible. When you are finished, discuss ways to deal with those objections.
– Ability refers to the extent to which the person has the necessary skills, resources, and confidence to carry out a change.
– Activity: Review the SMART goals the group created (or start with new ones). Discuss what skills and resources a person needs to accomplish the goal and how to acquire those.
– Readiness represents a final step in which the person decides to change a particular behavior.

5 Principles of Motivational Interviewing
– Express empathy through reflective listening.
– Develop discrepancy between clients' goals or values and their current behavior.
– Avoid argument and direct confrontation.
– Adjust to client resistance rather than opposing it directly.
– Support self-efficacy and optimism.

Elements Of Current Motivational
Approaches
– The FRAMES approach
– Decisional balance exercises
– Discrepancies between personal goals and current behavior
– Flexible pacing
– Personal contact with clients in treatment
Help Increase Motivation
– Help clients
– Develop discrepancy between their goals and actions
– Address the drawbacks to change
– Address the benefits to staying the same
– Feel competent to change
– Developing a plan for change
– Begin to take action
– Continue to use strategies that discourage a return to the old behavior

A Note About Resistance
– Resistance and yes, buts are signs that what you are asking is
– Too threatening
– Not sufficiently rewarding
– Already known to fail

– Activity: Have clients identify activities that they resist doing.
– Dieting, ending a relationship, medication, entering treatment
FRAMES
– Feedback regarding personal risk or impairment
– Responsibility for change is placed squarely and explicitly on the client
– Advice is clearly given to the client by the clinician in a nonjudgmental manner.
– Menus of self-directed change options and treatment alternatives are offered to the client.
– Empathic counseling
– Self-efficacy is engendered in the client to encourage change.
Feedback
– Feedback should help a client
– Understand the information
– Interpret the meaning
– Gain a new perspective about the personal impact of the behavior
– Consider changing.
– Recognize a discrepancy or gap between future goals and current behavior.
Responsibility
– Give individuals the responsibility and opportunity to decide when and whether they will change their behavior
– Encourage clients to choose their treatment and be responsible for changing
– Do not impose views or goals on clients.
– When clients are free to choose whether to change, they
– Feel less need to resist or dismiss the clinician’s ideas
– Feel empowered and more invested in treatment
– May be more willing to negotiate common treatment goals with the clinician.
Advice
– The most appropriate time to give advice is when a client requests it.
– As with feedback, the manner in which the clinician advises clients determines how the advice will be used.
– Suggesting yields better results than telling clients what they should do.
– If a client requests direction, the clinician can—
– First clarify what the client wants
– Give simple advice that is matched to the client’s level of understanding and readiness, the urgency of the situation, and the client’s culture.
Menu of Options
– When clients make independent decisions, they are likely to commit to them.
– Offering a menu of options decreases dropout rates and resistance to treatment and increases overall treatment effectiveness.
– Provide accurate information about each option and a best guess about the implications of choosing one particular path
– Elicit from clients what clients think would be effective or what has worked for them in the past
– Reinforce clients’ ability to make informed choices.
Empathy
– Empathic counseling can be particularly effective with clients who are angry, resistant, or defensive.
– Explore the reasons why the client might be angry, afraid or resistant
– Allow the client to do most of the talking in a safe environment
– Allow the client’s change process to unfold, rather than directing or interrupting it
– Communicates respect for and acceptance of clients and their feelings
– Encourages a nonjudgmental, collaborative relationship
Self-Efficacy
– Clients must—
– Believe they are capable of undertaking specific tasks
– Have the skills and confidence needed to change.
– Clinicians help clients develop self-efficacy by—
– Reinforcing clients’ beliefs in their capacities and capabilities
– Believing in clients’ ability to change
– Helping clients identify how they have coped successfully with problems in the past and build on those successes
– Reinforcing small steps and positive changes
– Foster hope and optimism in clients
– Reframing past “failures” as partial successes
– Using questions beginning with “What else”
Failure Activity
– Failure is virtually inevitable sometimes.
– Look up quotes about failure.
– Create a Failure Flag
– On each stripe write a sentence that gives meaning to failure…
– Failure means…
– Discuss how this applies to
prior failures
Flexible Pacing and Personal Contact
– Pacing
– Meet clients at their levels
– Use as much time as necessary with the essential tasks of each stage of change.
– Personal Contact: letters or telephone calls
– Effective for encouraging clients to—
– Return for another clinical consultation
– Return to treatment following a missed appointment
– Stay involved in treatment
– Adhere to a plan for change.
Personal Contact Activity
– Write letters to themselves
– To remind them to reflect on how far they have come
– To reflect on what they have learned (from themselves of each other)
– To encourage them to keep going
– To remind them of all the reasons they wanted to make the change
– To congratulate them on progress

– This can also be done as a group activity in which group members write letters to each other

– Old fashioned mail is often better for this because it is more personal and the letters can be decorated.
Summary
– Motivation is dynamic, influenced by multiple types of motivation including emotional, cognitive, social, environmental
– Motivational Interviewing increases client’s hope and enhances treatment participation
– 3 critical elements of motivation: Ability, willingness and readiness
– 5 elements of motivational approaches
– The FRAMES approach
– Decisional balance exercises
– Discrepancies between personal goals and current behavior
– Flexible pacing
– Personal contact with clients in treatment