Professional Documents
Culture Documents
CHANGE
4.1
Stages of Change
Pre-
contemplation
Recurrence
Maintenance Contemplation
Action Preparation
4.2
Ambivalence
4.3
Motivational Conflict: Precontemplation
4.4
Motivational Support: Precontemplation
4.5
Motivational Conflict: Contemplation
4.6
Motivational Support Needed: Contemplation
4.7
Motivational Conflict: Preparation
4.8
Motivational Support Needed: Preparation
4.9
Motivational Conflict: Action
A client
may be doing all the right things but still
sometimes feel a strong desire to use
substances
Example: “Staying off cocaine for the past 3 weeks
really makes me feel good, but part of me wants to
celebrate by getting high.”
Motivation will naturally wax and wane over time
For example: “Is all this really worth it?”
Client is actively taking steps to change
4.10
Motivational Support Needed: Action
4.11
Motivational Conflict: Maintenance
Clients
in maintenance need to make a lot of
hard decisions about lifestyle
Example: “I know I can’t play football with my old
using buddies anymore, but I really miss it.”
Example: “I just can’t be around my brother when
he’s high, but it’s really hard to say ‘no’ to him.”
4.12
Motivational Support Needed: Maintenance
4.13
Motivational Conflict: Relapse
4.14
Motivational Support Needed: Relapse
4.15
Evoking Change Talk
Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. (2003). Client commitment language during
motivational interviewing predicts drug use outcomes. Journal of Consulting & Clinical Psychology . 71(5), 862–878. 4.16
Types of Change Talk
DARN-C
Desire
Ability
Reasons
Need
Commitment
Source: Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. (2003). Client commitment language
during motivational interviewing predicts drug use outcomes. Journal of Consulting & Clinical Psychology. 71 (5),
862–878. 4.17
DARN-C: Desire
4.18
DARN-C: Ability
4.19
DARN-C: Reasons
4.20
DARN-C: Need
4.21
DARN-C: Commitment
4.22
DARN-C: Commitment (continued)
4.23
DARN-C: Commitment (continued)
4.24
Ways of Evoking Change Talk
Source: Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive
behavior. New York: Guilford Press. 4.25
Ways of Evoking Change Talk (continued)
4.26
Ways of Evoking Change Talk (continued)
Explore
Affirm
Reflect
Summarize
4.28
Responding to Change Talk: Explore
4.29
Responding to Change Talk: Affirm
Expressagreement, appreciation, or
encouragement and reinforce change talk in
any way:
I think it’s great that…
Wow—you’ve come a long way
I think you could really make that work
That’s a very insightful statement
4.30
Responding to Change Talk: Reflect
4.31
Responding to Change Talk: Summarize
4.32
Readiness Ruler
Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change
addictive behavior. New York: Guilford Press. 4.33
Readiness
4.34
Using the Ruler: Be Specific!
NOT
4.35
Using the Ruler: Ask for Elaboration
4.36
Using the Ruler: Look Toward the Future
4.37
Using the Ruler: Tailor Intervention
4.38
Using the Ruler: Track Readiness Over Time
4.39
Using the Ruler: Tracking Importance or
Confidence
4.40
Using the Ruler To Assess Importance or
Confidence
Be specific:
“How important to you is your relationship with your
husband?” NOT “…how important to you are
relationships?”
“How confident do you feel about saying ‘no’ to
offers of cocaine?” NOT “How confident are you that
you can maintain abstinence over the long term?”
4.41
Using the Ruler To Assess Importance or
Confidence (continued)
4.42
Using the Ruler To Assess Importance or
Confidence (continued)
4.43
Using the Ruler To Assess Importance or
Confidence (continued)
4.44
Partner Exercise: Readiness Ruler
4.45
Decisional Balancing
4.46
Goals of Decisional Balancing
4.47
Decisional Balancing: Process
Source: Baumeister, R. F. (1994). The crystallization of discontent in the process of major life change. In: T.
F. Heatherton & J. L. Weinberger (Eds.). Can personality change? (pp. 281–294). Washington, DC: American
Psychological Association. 4.48
Decisional Balancing: Process (continued)
Source: Baumeister, R. F. (1994). The crystallization of discontent in the process of major life change. In: T.
F. Heatherton & J. L. Weinberger (Eds.). Can personality change? (pp. 281–294). Washington, DC: American
Psychological Association. 4.49
Decisional Balancing: Objectives
Source: Sobell, L. C., Cunningham, J. A., Sobell, M. B., Agrawal, S., Gavin, D. R., Leo, G. I., et al. (1996).
Fostering self-change among problem drinkers: A proactive community intervention. Addictive Behaviors, 21 (6),
817–833. 4.50
Listing Pros and Cons of Behavior Change
4.51
Listing Pros and Cons of Behavior Change
(continued)
Costs Costs
-Increased stress/anxiety -Disapproval from friends and family
-Feeling more depressed -Money problems
-Increased boredom -Could lose my job
-Sleeping problems -Damage to close relationships
-Increased health risks
4.52
Decisional Balancing: Lists
4.53
It’s Not Just About the Numbers
4.54
Importance to Client
4.55
Decisional Balancing and Values
4.56
Decisional Balancing: Process Summary
Decide on a format
Introduce the exercise and ask permission to
continue
Explain the format
Use open-ended questions and active listening
4.57
Decisional Balancing: Process Summary
(continued)
Source: Saunders, B., Wilkinson, C., & Allsop, S. (1991). Motivational intervention with heroin users attending a
methadone clinic. In: W. R. Miller & S. Rollnick (Eds.). Motivational interviewing: Preparing people to change
addictive behavior (pp. 279–292). New York: Guilford Press. 4.58
Decisional Balancing
4.59