Motivational Interviewing

This is linked in to the SDT post a few days ago. Motivational Interviewing (MI) was developed for alcohol problems as a result of dissatisfaction with previous treatment approaches (e.g. alcoholics failing to respond to treatment are in denial so you confront them… which will not have positive results and persuading someone to change can be seen as a threat to their autonomy).

MI emphasizes your autonomy and personal responsibility, and negotiates in developing goals and the strategies to achieve them.

Four General Principles:

  1. Express empathy – reflective listening ensures you show understanding of their perspective
  2. Develop a discrepancy – make sure client can see that where they are is not where they want to be (however, this can result in the pressure to make yourself change, not intrinsic)
  3. Roll with resistance – gently persuade not full on confrontation
  4. Support self-efficacy – if the client does not believe they can implement solutions to problems they will not try (do or do not , there is no try).

Next time you give people advice or encourage them to do something, think of that darn cat.

DARN –sdt4 preparatory change talk.
Desire – I want to change
Ability – I can change
Reason – It’s important to change
Need – I should change

Great, they know they need to change… it doesn’t mean somebody will. I want to eat less chocolate because I know I can cut down and it’s important that I do not eat as much sugar, and I really should stop before I get diabetes – but will I? Debatable.

CAT – Implementation change talk
Commitment – I will change
Activation – I’m ready to change
Taking steps – I am changing

Core Skills
At the heart of MI are many of the core skills seen in other talking therapies. Another acronym coming…

OARS

  • Open Questions – ask for specific examples and seek elaboration
  • Affirm – conveys respect for the client, reframe apparent weaknesses as strength but must be genuine
  • Reflect – Reflective listening demonstrates understanding, empathy, and allows therapist to step into client shoes
  • Summarise- chance to be directive, changes direction, good strategy when stuck, seek elaboration; can be simple, amplified, double-sided, shift the focus, or reframe

Other techniques:
MI uses many, many techniques to evoke change in the client. Below are just a few:
– Problem recognition
– Concern for present condition
– Intention to change
– Optimism to change
– Imagining extremes
– Looking backwards/forwards
– Exploring pros/cons short/long term
– Rating importance and confidence (0-10)

When giving advice follow the elicit-provide-elicit rule… Elicit their permission “what do you know about/can I tell you about”; provide the advice; elicit a response “how does that fit/what do you think?”

Self-Determination Theory

Is this all there is? A question that has plagued humankind for a long time. Our pursuit of knowledge and growth has ensured that each generation extend themselves further than the previous due to our innate need to grow. The Self-Determination Theory (SDT) holds that we seek to resolve psychological inconsistencies and satisfy needs, therefore interventions focus on facilitation, support, and nurture.

There are three fundamental needs and a good way to really understand them is thinking about the PK//Weber trade:sdt1

  • Autonomy – volition and agency is your actions aka when PK was traded to Nashville, it was not an autonomous decision from him.
  • Competence – the need to feel effective within your environment and experience the optimal exercise of your capabilities e.g. PK is more than a competent player – he’s incredible but I’m biased – however Therrien didn’t feel he had competence in Montreal so bye bye Pernell
  • Relatedness – the need to experience mutually satisfying social relationships… Therrien banned the triple low five between Carey Price and PK Subban because they had an overwhelmingly satisfying social relationship, and it is one he cannot relate to

So there we have our basic needs. But not everybody will seek to have meaningful relationships, be autonomous, or be competent at what they do; and for some it will not be of their own free choice. We all know that going running is great for the body and the mind, but let’s be honest – it is awful. So why do people run? It’s all down to different motivations.

sdt2

On this spectrum amotivation is a complete lack of intention to engage in a behaviour (definitely me on the running front). External regulation is running because others have pressure me to go and if I don’t go running then I have to cook dinner/I get to run and come home and eat dinner. Introjected regulation is accompanied by a negative emotional tone and an inner conflict because you don’t value the activity but you have a high demand to do it. I must go running or else I will feel guilty about not going. A little further along the scale there is identified regulation whereby you engage in a behaviour because it has personally valued outcomes. I run because it has health benefits and is good for my asthma therefore it’s important that I do (no matter how much I cry). Integrated regulation means the activity fits with your own sense of self, I run because I am a runner. Now this is different to intrinsic motivation where you run just because you love running and love a challenge (very strange). The goal is to shift motivations closer to intrinsic.

You can have all these needs and the desire to achieve them but you need an environment where you can thrive. Think of PK in Montreal. Quality player, good relationships, he was the only player who had his sh*t together last season, the city of Montreal really loved him – they still love him – he gave a lot to charity and got involved with the community. So naturally, you trade this player from his facilitating environment………… Likewise, Shea Weber was very loved in Nashville and served as their captain. Changing environments can be a strange experience, so another part of SDT is to maintain a facilitating environment to nurture the three needs. Conversely, one that is controlling, over-challenging or rejects an individual’s needs will result in defensive behaviours and psychological withdrawal. Take Tyler Seguin who started out alright in Boston, but he was a young guy with the world at his feet on a team where the majority were married and settled down and the management began to restrict him. Send him to Dallas, with an environment that better fits him and what a turn-around in his stats. How do you provide a supportive environment?

  • sdt3Autonomy Support – provision of options, minimise pressure, encourage them to initiate their own actions
  • Structure – Positive feedback, clear and realistic expectations, behaviour-outcome relations are understood by both
  • Involvement  – emotional support, genuine interest, empathy

 

(If you really want to thwart someone’s needs then be controlling, give unstructured or negative feedback, and alienate them!).