Contemplators
Structure of the
chapter
The Action stage
Precontemplators
Overview:
Motivational Interviewing
The stages of change
Preparation
(previously referred to as
Determination)
691 Ch 7 Motivational Interviewing
Change is the central feature of any therapeutic interaction.
Counselors work with clients to change feelings, attitudes,
behaviors, perceptions, knowledge, skills, and behaviors.
MI is client centered - a transtheoretical approach to the
change process that encompasses both an attitude and set of
techniques
the client and counselor together work to resolve the client’s
ambivalence
Change model, tools and techniques, managing resistance
a client may begin the change process at any stage in the
cycle and may either progress to the next stage or cycle back to
prior stages
represented by this wheel are precontemplation,
contemplation, preparation, action, maintenance, and relapse
It is important to realize that the stages of change are not time
limited. That is, some stages may last only hours while others last
for years. Sometimes a stage may be skipped altogether.
clients have not considered changing their behavior or they do
not see why change is necessary.
individuals may deny having a problem; even recognize they
have a problem, but may not believe they have the fortitude or
willpower to change
open to the idea that perhaps their behavior is problematic
are typically thinking about change but do not act on those
thoughts
weighing the pros and cons of change, but are not yet ready
to engage
client realizes that the behavior is having enough of a negative
impact to warrant at least a slight change. The client is now ready
to begin taking steps
develops a specific plan and oftentimes selects a start date
develop a change plan only after carefully examining their
strengths, resources, and activities to determine what will help,
and what may hinder, the change process
change talk is any statement made by the client that appears
to promote positive change and momentum
is when the change plan is implemented. The counselor’s role
Change
Resistance
Change talk
Helping Clients
Achieve Change
The first pillar is
expressing empathy.
Reverting to earlier
stages
during this stage is to help the client remember why he or she
decided that change was necessary
Self-efficacy is a person’s belief about his or her ability to
accomplish a task, a concept that emerged from Bandura’s (2001)
work on self-efficacy theory.
self-efficacy influences whether a person is likely to take on a
task which they perceive as challenging
Clients in these latter stages of change typically report
stronger therapeutic alliances than clients at earlier stages and
this factor appears to be quite crucial in helping a client maintain
motivation to change
Ex: they will discuss the potential impact of continuing to drink
even half a glass a day.
Maintenance stage of change. This stage is aptly named in
that its sole focus is on maintaining the new, positive behaviors.
Counselors will view this reversion as resistance and will
continue to engage the client in MI. Relapses into former
behaviors are viewed as a normal part of the change process,
and their importance ought to be minimized.
an addicted person’s mind and body typically creates a
physical, psychological, and neurological resistance to the
removal of the coveted substance
a client appears to be working against change while a
counselor may seem to be arguing for change.
Counselors are encouraged to view resistance as a welcome
signal that the therapeutic relationship is at a turning point. In
other words, the client is signaling the counselor that it is time to
do something differently.
ambivalence waxes and wanes, and motivation is a fluid
rather than a constant state
Medical professionals utilize MI to help patients commit to
health-improvement behaviors such as weight loss, healthy
eating, heart-healthy activities, blood sugar monitoring, HIV
prevention, medication compliance, and sexual and reproductive
health
Counselors use OARS to elicit change talk from clients: Open-
Ended Questions, Affirmations, Reflective Listening, and
Summaries. Counselors are intentional about what they choose to
summarize and reflect upon and are careful to ensure the change
talk stemmed from the client.
Empathy, or the communication of an understanding of the
client
normalizes ambivalence and demonstrates that the counselor
unconditionally accepts the client
Transitional
Linking summaries
blocking behaviors.
The second pillar is
developing discrepancy
The third pillar is
rolling with resistance
The fourth and final
principle of MI is to
support self-efficacy.
Five Techniques to
Use Early and Often
When a client is able to experience an internal discrepancy
between his or her current behaviors and his or her values,
beliefs, and goals, the change process can begin. This is due in
large part to the underlying principle of cognitive dissonance
the individual will seek to reduce that inconsistency (Festinger,
1957). When a client reveals incongruence between beliefs (or
attitudes) and behaviors, the counselor can help amplify the
incongruency, thus highlighting ambivalence. Ambivalence is
considered to be the catalyst to change, with the assumption that
the client will seek to reduce the stress caused by cognitive
dissonance.
the counselor will view resistance as a signal that the session
should go in a different direction
believe they have personal choice and control in changing
their behavior.
believes in his or her ability to change
asking open-ended questions, listening reflectively, directly
affirming the client’s personhood and efforts, and summarizing the
client’s verbal expressions and exploration. The final method,
eliciting change talk, is especially enhanced with counselors using
MI.
“Tell me about the times you use alcohol to relax” as opposed
to asking, “Do you ever use alcohol to relax?”
cautioned against engaging in a back-and-forth question-and-
answer session that may inhibit client exploration of ambivalence
and intention
“What are some additional reasons besides the expense of
smoking that make you want to be a nonsmoker?”
Some of these blocks include shaming, labeling, commanding,
directing, threatening, warning, persuading with logic, lecturing,
disagreeing, judging, criticizing, analyzing, consoling,
sympathizing, questioning (probing), withdrawing, or changing the
subject
use statements or ideas that the client came up with in the
past (such as in prior therapeutic encounters) and relates those
ideas to current information. These statements specifically
address recurrent themes as presented in a series of sessions
and are designed to highlight ambivalence. For example, a
counselor might say, “You mentioned in our first session that you
hate to be considered an addict, yet right now you would just
prefer to stop caring about what people think of you rather than
change the addiction. You don’t want to be an addict yet you want
to keep the addiction.”
are statements used to shift from one aspect of the
summaries
Looking Back or
Looking Forward
Importance Ruler,
Decisional Balance
Querying Extremes i
therapeutic encounter to another. The counselor may use a
transitional summary as a session wrap-up, or in shifting from one
topic of focus to another, to be certain the prior topic is fully
discussed before moving on. Transitional summaries highlight the
therapeutic alliance and make certain to reflect an understanding
of the client’s exploration and wishes.
on which clients rate their ability to change their behavior on a
scale from 1 to 10. Counselors then ask why the client chose that
number rather than another one.
Decisional Balance process, the counselor assists the client in
fully exploring the pros and cons of change. A 2 × 2 table is often
drawn, with four components: (1) the benefits of the status quo,
(2) the costs of the status quo, (3) potential benefits of change,
and (4) potential costs of change (Miller & Rollnick, 2009). The
counselor should help the client fully explore all components here
and elaborate on their answers. This can be done by simply
asking the client to “tell me more about that” or “describe that in
more detail, please.”
involves asking questions that allow clients to look at the
consequences of not changing, or imagining what life may look
like if they did decide to change. When trying to assist in
facilitating “change talk,” it could be useful to have them look back
at life before their problem behavior began or look forward to what
they want their life to look like.
Lare techniques that can lead to clients developing their own
discrepancies between the past, present, and future. For
example, imagine if Marilyn’s counselor asks her to remember a
time when she was able to get through the day without wine.
“Marilyn, how would you think and feel about yourself if you
had nonalcohol ways of relaxing and coping with life?” or “How do
you imagine your daughter would feel about you once you’ve had
10 years sober?”
