Leader’ ’s Guide s Guide Leader Motivating Clients for Treatment and Motivating Clients for Treatment and Addressing Resistance Addressing Resistance Treatnet Training Volume B, Module 2: Updated 15 February 2008
Module 2 training goals: Module 2 training goals: 1. Increase Increase knowledge knowledge of motivational of motivational 1. interviewing strategies and interviewing strategies and resources for substance abuse resources for substance abuse treatment treatment 2. Increase Increase skills skills in using motivating in using motivating 2. strategies and resources strategies and resources 3. Increase Increase application application of motivational of motivational 3. strategies strategies 2
Module 2: Workshops Module 2: Workshops Workshop 1: Principles of Motivational Principles of Motivational Workshop 1: Interviewing Interviewing Workshop 2: How To Use Motivational Skills How To Use Motivational Skills Workshop 2: in Clinical Settings in Clinical Settings Workshop 3: Strategies to Avoid Strategies to Avoid Workshop 3: 3
Workshop 1: Workshop 1: Principles of Motivational Principles of Motivational Interviewing Interviewing
Pre- -assessment assessment Pre 10 Min. Please respond to the pre- -assessment assessment Please respond to the pre questions in your workbook. questions in your workbook. (Your responses are strictly confidential.) (Your responses are strictly confidential.) 5
What are we talking about? What are we talking about? What does “ “increasing increasing What does motivation” ” mean to you? mean to you? motivation 6
Workshop 1: Training objectives Workshop 1: Training objectives At the end of this workshop, you will be able to: At the end of this workshop, you will be able to: 1. Understand the nature of motivation as it influences 1. Understand the nature of motivation as it influences behavioural change behavioural change 2. Understand the role of the clinician and client when 2. Understand the role of the clinician and client when using motivational strategies for behavioural change using motivational strategies for behavioural change 3. Understand the Stages of Change Model and be able 3. Understand the Stages of Change Model and be able to identify a minimum of 3 components to identify a minimum of 3 components 4. Identify a minimum of 3 principles of motivational 4. Identify a minimum of 3 principles of motivational interviewing interviewing 7
An Introduction to An Introduction to Motivational Motivational Interviewing Interviewing Preparing people for change Preparing people for change
Motivating clients: Definition Motivating clients: Definition Motivational interviewing is a directive, Motivational interviewing is a directive, client- -centred centred style of interaction style of interaction aimed aimed client at helping people explore and resolve at helping people explore and resolve their ambivalence about their their ambivalence about their substance use and begin to make substance use and begin to make positive changes. positive changes. 9
In other words… … In other words Many people who engage in harmful Many people who engage in harmful substance use do not fully recognise recognise substance use do not fully that they they have a problem or that their have a problem or that their that other life problems are related to their other life problems are related to their use of drugs and/or alcohol. use of drugs and/or alcohol. 10
It seems surprising… … It seems surprising That people don’ ’t simply stop using t simply stop using That people don drugs, considering that drug addiction drugs, considering that drug addiction creates so many problems for them and creates so many problems for them and their families. their families. 11
However… … However People who engage in harmful drug or People who engage in harmful drug or alcohol use often say they want to stop alcohol use often say they want to stop using, but they simply don’ ’t know how, t know how, using, but they simply don are unable to, or are not fully ready to are unable to, or are not fully ready to stop. stop. 12
Understanding How Understanding How People Change: People Change: Models Models � Traditional approach Traditional approach � � Motivating for change Motivating for change �
Traditional approach (1) Traditional approach (1) The Stick � Change is motivated by discomfort. Change is motivated by discomfort. � � If you can make people feel bad enough, If you can make people feel bad enough, � they will change. they will change. � People have to People have to “ “hit bottom hit bottom” ” to be ready for to be ready for � change change � Corollary: People don Corollary: People don’ ’t change if they t change if they � haven’ ’t suffered enough t suffered enough haven 14
Traditional approach (2) Traditional approach (2) You better! Or else! If the stick is big enough, there is no need for a carrot. 15
Traditional approach (3) Traditional approach (3) Someone who continues to use is Someone who continues to use is “in denial. in denial.” ” “ The best way to “ “break through break through” ” the the The best way to denial is direct confrontation. denial is direct confrontation. 16
Another approach: Motivating (1) Another approach: Motivating (1) � People are ambivalent about change People are ambivalent about change � � People continue their drug use because of People continue their drug use because of � their ambivalence their ambivalence The carrot 17
Ambivalence Ambivalence Ambivalence: Feeling two ways about Ambivalence: Feeling two ways about something. something. � All change contains an element of All change contains an element of � ambivalence. ambivalence. � Resolving ambivalence in the direction Resolving ambivalence in the direction � of change is a key element of of change is a key element of motivational interviewing motivational interviewing 18
Another approach: Motivating (2) Another approach: Motivating (2) � Motivation for change can be fostered by an Motivation for change can be fostered by an � accepting, empowering, and safe accepting, empowering, and safe atmosphere atmosphere The carrot 19
The Process of Change The Process of Change Why don don’ ’t t people change? people change? Why 20
You would think . . . You would think . . . that when a man has a heart attack, that when a man has a heart attack, it would be enough to persuade it would be enough to persuade him to quit smoking, change his him to quit smoking, change his diet, exercise more, and take his diet, exercise more, and take his medication. medication. 21
You would think . . . . You would think . . that hangovers, damaged that hangovers, damaged relationships, an auto crash, relationships, an auto crash, memory blackouts ─ ─ or even or even memory blackouts being pregnant ─ ─ would be would be being pregnant enough to convince a woman enough to convince a woman to stop drinking. to stop drinking. 22
You would think… … You would think that experiencing the that experiencing the dehumanizing privations of dehumanizing privations of prison would dissuade people prison would dissuade people from re- -offending. offending. from re 23
And yet… … And yet Harmful drug and alcohol use Harmful drug and alcohol use persist despite overwhelming overwhelming persist despite evidence of their destructiveness. evidence of their destructiveness. 24
Why don t people change? people change? Why don’ ’t
What is is the problem? the problem? What It is NOT that… … It is NOT that they don’ ’t want to see (denial) t want to see (denial) � they don � they don’ ’t care (no motivation) t care (no motivation) � they don � They are just in the early stages of They are just in the early stages of change. change. 26
How How do do people change? people change?
Natural Change Natural Change � In many problem areas, positive In many problem areas, positive � change often occurs without formal change often occurs without formal treatment treatment � Stages and processes by which Stages and processes by which � people change seem to be the same people change seem to be the same with or without treatment with or without treatment � Treatment can be thought of as Treatment can be thought of as � facilitating a natural process of facilitating a natural process of change change 28
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