Introduction to Motivational Approach

Social Services Forum for First Nations of Quebec

January 30, 2014By Barbara Bouchard & Sophie Pelletier

Presentation outline

• Workshop objectives and targeted participants• Background and philosophy of the approach• Motivation to change• The stages of change• Relevance of the approach for the

intervention• Intervener's tasks

Workshop objectives

1- Learn about the motivational approach and its relevance for the intervention

2- Identify the various stages of change

3- Decide if you whish to learn more about the motivational approach

Targeted participants

Interveners in health and social services:• Psychosocial services• Addictions • Mental health • Childhood/ youth/ family • Mother and child health • Etc.

BACKGROUND AND PHILOSOPHY OF THE APPROACH

Background and philosophy

• Developed by Miller & Rollnick, 1991 (Helping relation & process of change )

• Gives interveners the tools needed to create a positive environment for change and to increase motivation for people who are ambivalent or who show little interest in change

Background and philosophy (cont’d)

• Moving away from the confrontation models prevalent in the 80’s

• Identifying the crucial elements of a brief intervention in order to increase motivation to change: six crucial elements

Background and philosophy (cont’d)

Six crucial elements • FEEDBACK• FREE WILL• OPINIONS• OPTIONS MENU• EMPATHY• SENSE OF SELF-EFFICACY

Background and philosophy (cont’d)

“FEEDBACK”

• The person is given objective information on the current state of his personal life situation.

EXAMPLE: • Intervener: This week you didn’t drink any alcohol four

days out of seven and you did activities with your loved ones on the days you didn’t drink alcohol.

Background and philosophy (cont’d)

“FREE WILL”

• It is important to remind people that they have freedom of choice and action. No one can decide or change for them.

EXAMPLE:

A person does not want to go to a treatment centre but is willing to talk about his difficulties with an intervener at the health centre.

Background and philosophy (cont’d)

“OPINIONS”

• Opinions shall be delivered in a professional and objective manner to help a client change his behaviour (at his request).

EXAMPLE: • Client: What should I do to sleep better? • Intervener: Have you thought of reading before going to

bed to help you relax?

Background and philosophy (cont’d)

“OPTIONS MENU”

• An options menu allow people to choose the therapeutic means that best suit their needs.

• People are more likely to engage in a treatment plan in which they participated.

EXAMPLE: • Therapeutic methods: diary, AA meetings, traditional methods, etc.

Background and philosophy (cont’d)

“EMPATHY”

• Empathetic therapists get better results with their clients

• Confrontation as an intervention strategy brings about resistance in the client

EXAMPLE: • Intervener: “I understand your fear that your child might fail

his school year” versus “you do not seem to help your child deal with his problems at school”

Background and philosophy (cont’d)

“SELF-EFFICACY”

• This technique is about a person’s beliefs regarding his power to change and the impact of his actions (power over his life)

EXAMPLE:• Client: The possibility to use my money to take care of

myself gives me the feeling of being engaged in a journey for my well-being

THE MOTIVATION TO CHANGE Reflection and exchange

QUESTIONS?

1- Can everyone change / modify their behaviour?

2- Do you think most individuals need professional help to change / modify their behaviour?

3- Can a client with little interest in changing his behaviour become motivated to change?

Motivation to change

The motivation to change is all the forces which determine:• The decision to change one’s behaviour

• The implementation of change strategies

• Maintaining the new behaviour

Motivation to change (cont’d)

• Motivation evolves (not stable, not a characteristic of the individual)

• Motivation is specific to a particular behaviour

• Motivation is influenced by the interveners and the environment with which the person interacts (interveners can influence and create an environment favourable to change)

Motivation’s three components

1- The importance of change from the person’s perspective (wanting to change)

2 - Confidence in the change (feeling able to change)

3 - Readiness to change (being ready to change)

THE PROCESS OF CHANGE Stages of change

Stages of change

• Inspired from the model “stages of change” from Prochaska and DiClemente (1984) and adapted by Miller and Rollnick (1991)

• Change is a step by step dynamic process. Events happen before, during and after the change.

Stages of change

-Pre-contemplation-At this stage, the person:• Doesn’t think he has a problem• Doesn’t want to change his behaviour• Alludes to an external motivation: justice system,

family, etc.• Doesn’t see the negative impacts on his life even

though his entourage sees and feels them

Stages of change (cont’d)

-Contemplation-• Is characterized by a state of ambivalence (e.g.

yes I consume everyday but ...)

• Gradually recognizes the difficulties experienced but isn’t ready to commit to a concrete process of change (e.g. I may consume too much but I'm not sure I want to change my consumption)

Stages of change (cont’d)

-Decision / Preparation-At this stage, the person: • Admits his problem • Decides to change his behaviour • Thinks of ways to change and plans how he will

implement the change • Is ready to develop an action plan

Stages of change (cont’d)

-Action-At this point, the person:

• Is engaged in action, tries different strategies to change

• Makes the right choices for the desired change to happen

• Increases his confidence in his ability to change

Stages of change (cont’d)

-Maintain-At this point, the person:

Has made the changes he wanted and works towards consolidating them Remains vigilant about potential situations that could get him back to his old habits Has planned strategies to cope with any risky situations Is motivated to maintain his gains

MOTIVATIONAL APPROACHRelevance for interveners and

application

Motivational approach

Relevance for interveners:

To intervene right from the client’s motivational stage using tools and intervention strategies

To reduce interveners’ fatigue and powerlessness (we don’t argue with clients but we don’t give up on them either)

To foster a client’s perseverance, his commitment and open mind towards specialized services, if needed

Motivational approach (cont’d)

Relevance for interveners:

Clients with little or no interest in changing their behaviour (e.g. reference by the court, the Youth Protection, etc.)

Clients who are ambivalent about changing their behaviour (I want to change but ..)

Clients surprised about professionals’ recommendations (e.g. a client consults for his physical pain but not for his daily alcohol consumption)

INTERVENER’S TASKSand stages of change

Intervener’s tasks and stages of change

STAGES OF CHANGE INTERVENER’S TASKS

Pre-contemplation - Make the client aware of the risks and difficulties that his behavior brings about

- Seeding doubt

Contemplation - Discuss the pros and cons of change as well as pros and cons of status quo

- Influence the decision

Decision/Preparation - Help the person to identify the steps and actions he wants to take

Action - Help the client make the first step- Develop the change plan with the client

Maintain - Help the client to identify and put in place prevention strategies of relapse and recognize risky situations

THANKS!ANY QUESTIONS???

Barbara Bouchard: bbouchard@cssspnql.comSophie Pelletier: spelletier@cssspnql.com