>> Motivation refers to a state of readiness to change.
Clients in the engagement and persuasion stages of treatment are not yet ready or motivated
to change their substance abuse or the management of their mental illness.
Motivation counseling includes techniques a clinician can use
to help clients become ready to change.
Characteristics of motivational counseling are that the client's view is important
and that the client and clinician are on equal ground.
Persuasion is an important part of this work, and providing support is essential.
A variety of strategies are helpful,
but focusing on the client's ambivalence about change is crucial.
These are the five principles of motivational counseling.
Let's look at examples of how to put each one into practice.
The first principle of motivational counseling is to express empathy
by using skillful reflective listening.
Expressing empathy is important because acceptance facilitates change.
Part of this process is to understand the client's ambivalence.
Ambivalence is normal.
People want to change while, at the same time, they want to stay the same.
For example, many of us have experienced wanting to lose weight so we can look slim,
but we don't want to give up eating our special dessert.
Just can't get ourselves to exercise.
Ambivalence is necessary in the process of change.
To express empathy, the clinician listens actively
without judging, criticizing, or giving advice.
Making good eye contact, asking for more details,
repeating or summarizing client's perceptions help express empathy.
The goal here is to understand your client's world and his goals.
Clients have valuable personal goals, but substance use or mental illness symptoms may get
in the way of reaching their goals.
Awareness of consequences of their use or symptoms is important
and may reveal a discrepancy between their present behavior
and steps towards important goals.
This discrepancy will motivate change.
When discrepancies are highlighted,
the client will usually present their own argument for change.
To develop discrepancy, help your client identify his goals
for himself then identify small steps towards meeting the goal.
Focus on those that are feasible and healthy.
When substance use comes up, explore the impact of substance use on reaching the goals.
To look at the impact, it can be helpful to make a list of the pros and cons of using substances.
This is called a decision balance.
Again, allow your client to make his own argument for change.
The next important concept in motivational counseling is to avoid arguing with clients.
In general, arguments are counterproductive because, when a client has to argue,
he becomes defensive and doesn't want to change.
When you sense a reluctance to change or resistance, it's time to change strategies,
switch topics, and go back to the client's goals.
Additionally, labeling is unnecessary because it can make people feel defensive.
It's helpful to identify behavior rather than label or diagnose people.
Examples include talking about drinking rather than alcoholism; talking about isolating,
not paranoia; and talking about voices rather than schizophrenia.
To avoid arguing with your clients, monitor the conversation.
If you sense an argument coming on, change strategies or the focus of the discussion.
Focus on your client's perceptions of the pros and cons
or ambivalence regarding change, not your own.
As we discussed earlier, the term resistance refers to when a client is reluctant to change.
This reluctance is a part of ambivalence in the persuasion stage, and it is normal.
We all feel a little resistant when we are contemplating change.
Resistance or reluctance is usually observable during interactions with clients,
and it signals that the clinician needs to slow down.
It may mean that you are trying to be in the action stage of treatment rather
than in the persuasion stage with the client.
There are many effective strategies for rolling with resistance.
First is reflective listening where you restate the client's position.
Next is shifting the focus back to the client's concerns or goals.
Third is to emphasize personal control.
Another effective technique is to side with the negative
where the clinician states the reasons not to change.
The final principle of motivational counseling is to support self-efficacy or the belief
that the client can make the change and that the client is responsible
for making any change happen.
Belief in change is an important motivator.
When clients learn that there are many approaches to change, they feel more hopeful.
To support self-efficacy, you can help your client achieve success
on small goals or remind him of past successes.
You can try to rekindle optimism and hope for change by letting him know
that there is no one way to change.
>> Throughout this video, you'll notice great examples
of clinicians using motivational counseling styles.
Look in your toolkit for references as to
where to find great motivational interviewing resources.