E1142Mental Health7 Recovery and self advocacy7.1 Approaches to practice7.1.1 Motivational interviewingMotivational Interviewing (MI) has been discussed in earlier modules. In this topic we recap thekey concepts.MI was developed by William Miller and Stephen Rollnick as a method to work with peopletowards making positive changes in their lives. The essence of MI is understanding thecomplexity of the human change process; it aims to increase people’s motivation to achieve theirgoals.MI is firmly rooted within the person-centred approach: it puts the consumer at the heart of theprocess. This includes working with everything the consumer brings to the process, including theirambivalence and resistance, as this is seen as a normal part of the change process. This alsomeans that MI approaches consumers in non-judgemental, non-confrontational and nonadversarial ways, putting it in stark contrast to the therapeutic approaches to behaviour change.Instead of confronting consumers, MI works in the spirit of collaboration, compassion, acceptanceMI is a collaborative, goal-oriented style of communication with particular attention paid to‘the language of change’. It is designed to strengthen personal motivation for andcommitment to a specific goal by eliciting and exploring the person’s own reasons forchange within an atmosphere of acceptance and compassion Miller and Rollnick ,1991.“and evocation (Miller et al., 1992).MI SpiritCore Motivational Interviewing Skills: OARS. Retrieved from:aipc.net.auMI was developed in the 1980s and 1990s. Around this time the AOD sector thought bestpractice was to confront consumers with their “wrong-doings” and the negative outcomes of theiraddictions. This approach was known as ‘confrontation therapy’ and it was later criticized asstigmatizing and highly ineffective, as it shames people living with AOD and has a negative effecton their self-esteem.| Topic – 2 / 12© Open Colleges Pty Ltd, 2020.MI offers an entirely different way of working with consumers in a respectful and positive manner.Rather than confronting resistance with the aim of breaking through defences, MI sees conflictand arguments as counterproductive – they just create more defensiveness. MI practitioners cansuggest and invite new perspectives on behaviours and change, however, these views shouldnever be imposed on the person (Wagner et al., 2013).Practitioners who wish to work with MI need to work with the key principles of MI in order to beeffective. These key principles are easy to remember using the acronym DEARS:developing discrepancyexpressing empathyavoiding argument/ amplify ambivalencerolling with resistancesupporting self-efficacy (Miller & Rollnick, 1991).MI practitioners are also required to work with four basic skills which are often expressed in theacronym OARS:open-ended questionsaffirmations (recognising both difficulties and strengths)reflective listening (repeating back content and feelings to consumers)summary statements (pulling things together to move on to the next topic)Activity 44552MI used with SMART recoveryThisguide[https://smartrecovery.org/wp-content/uploads/2017/03/UsingMIinSR.pdf]outlines the key principles of MI and the application to the SMART recovery work which supportspeople with addressing their AOD use.MI can be used for all types of behavior change, not just AOD use.| Topic – 3 / 12© Open Colleges Pty Ltd, 2020.ACTIVITY 44552 TYPE ResourceSCENARIO MI used with SMART recovery Watch this video to see how one of the pioneers of MI explains the concept of working towardschange. There is a longer version of this interview available on YouTube if you are interested.[https://youtube.com/watch?v=cj1BDPBE6Wk]MI has the aim of amplifying ambivalence in consumers which can then increase the motivation tochange. This means that MI can be used in conjunction with the Stages of Change method toachieve outcomes for consumers. The Transtheoretical Model was developed by JamesProchaska and Carlo di Clemente in the late 1970s; this popular model of behaviour change isalso known by the much simpler title of Stages of Change.This model separates the movement towards behaviour change into five, or sometimes six,distinct stages which require practitioners to use different strategies and interventions,depending of what stage the person is in at the present time.The stages of change are:| Topic – 4 / 12© Open Colleges Pty Ltd, 2020.Pre-contemplation No intention of changing behaviourContemplation / Ambivalence Aware a problem exists, no commitment to actionPreparation Intent upon taking actionAction Active modification of behaviourMaintenance Sustained change – new behaviour replaces oldRelapse Fall back into old patterns of behaviour.Relapse is only mentioned as a separate stage some of the time, as it is an exit point from themodel, and people can exit and enter the model at any stage.1 2 3 4 5 6| Topic – 5 / 12© Open Colleges Pty Ltd, 2020.Adapted from:www.problemgambling.net.auMost people will not move through the stages and achieve sustained change immediately so it isvalid to consider the movement through the stages as part of the overall change, even if relapseprevents sustained change from happening. Each relapse offers learning, insight and thedevelopment of further skills which can then lead to the desired outcome and for the person toleave the stages of change altogether as the behaviour change cannot be maintained.The Stages of Change combined with the techniques of MI can be very effective when workingwith consumers towards change. However, it is important for workers to understand that thestages of change are not necessarily linear so it is important to undertake ongoing assessment| Topic – 6 / 12© Open Colleges Pty Ltd, 2020.to find out where the person is with regards to their motivation to achieve change. This meanslistening out for statements made by the person to understand what stage they are in and tailorinterventions accordingly.Hall et al. (2012) suggest the following tasks for practitioners working with MI techniques in theStages of Change:Pre-contemplation:raise doubt and increase the person’s perception of the risks and problems with theircurrent behaviourprovide harm reduction strategies.Contemplation:Evaluate the pros and cons of change with the person and work on helping them tip the balanceby:exploring ambivalence and alternativesidentifying reasons for change/risks of not changingincreasing the person’s confidence in their ability to change.Preparation – action:clear goal setting – help the person to develop a realistic plan for making a change and to takesteps toward change.Maintenance:help the person to identify and use strategies to prevent relapse.Relapse:| Topic – 7 / 12© Open Colleges Pty Ltd, 2020.help the person renew the processes of contemplation and action without becoming stuck ordemoralised (Hall et al., 2012).Activity 44553Practitioner tasks in the Stages of ChangeThis flowchart demonstrates practitioner tasks at different stages of change.[https://res.cloudinary.com/opencolleges/image/upload/v1464587135/zondwbmuz78jynqyf67h.png][https://res.cloudinary.com/opencolleges/image/upload/v1464587148/acjwod6zejads5wnpzmv.png][https://res.cloudinary.com/opencolleges/image/upload/v1464587175/tur4jzozgtcmf3qzbdxg.png]| Topic – 8 / 12© Open Colleges Pty Ltd, 2020.[https://res.cloudinary.com/opencolleges/image/upload/v1464587188/d9w0dqvxvufuhtbvxnts.png][https://res.cloudinary.com/opencolleges/image/upload/v1464587200/csyqte2s89igrw5fq1v9.png]Stages of change and strategies for promoting change. Retrieved from:www.dentalcare.com[http://www.dentalcare.com/media/en-US/education/ce74/flowchart.pdf]HintsRemember that this model is not linear. It is important to assess where the person is at.ACTIVITY 44553 TYPE ConsumeSCENARIO Practitioner tasks in the Stages of Change | Topic – 9 / 12© Open Colleges Pty Ltd, 2020.Activity 44555Guide to using MIThisCCNC Motivational Interviewing (MI) Resource Guide[https://www.communitycarenc.org/media/files/mi-guide.pdf]provides practical strategies to use MI in their work with consumers.Use the check sheet at the end of the resource if you want to self-assess your skills.ACTIVITY 44555 TYPE ResourceSCENARIO Guide to using MI ACTIVITY 44539 TYPE HtmlSCENARIO Meet JacobJacob had lived with his partner for over 10 years and helped her raise her two childrenfrom another relationship. Jacob is very angry about the break-up, especially because hisex-partner is stopping him from seeing her son Larni whom Jacob helped raise almostsince birth.Jacob has spent the past few months in emergency accommodation and he is very clearthat he has hated his time there. Despite multiple challenges, Jacob managed to keep hisjob as a salesman for a large electronics chain.As you build the relationship with Jacob, you find out a bit more about his story. Jacob haslived with anxiety ever since he can remember and he was diagnosed with panic disorder.He says that he has always felt what he calls ‘constant, low-level anxiety’, the conditionbecame much worse about eight years ago. Jacob was working in the public service andJacob became homeless last year when his relationship with his partner broke down. “| Topic – 10 / 12© Open Colleges Pty Ltd, 2020.climbing the career ladder when he had a breakdown that resulted in him being admitted toinpatient services for several weeks.Jacob says that he cannot put his finger on exactly what caused his breakdown, only that hethinks there was a build-up until he simply could not cope anymore. Jacob says that hispartner, Rose, helped him through the tough times. However, he now he believes that sheonly did this thinking he would be back on his feet soon to support the family financially onceagain. He says that he now sees Rose as ‘heartless’ and he’s very worried about his ownanger, insisting that he tries very hard to make it go away but nothing seems to work.Jacob’s anger recently spilled-over at work, he shouted at a customer and was put on awarning for this. Jacob is very worried that he might lose his job and he is not sure how hewould be able to deal with this. He says that he already knows that he is simply ‘a waste ofspace’ and that he would ‘lose any reason to live’ if he loses his job as well as his family.Jacob admits that he’s never been opposed to a drink or two and that since his breakup hehas been drinking a few beers every day after work. He says that he sometimes feels thealcohol is having a negative impact on him, he also says that it is the only thing that seems todeal with his anxiety. Jacob says that his anxiety seems to calm down after he’s had a fewdrinks.Following the incident at work, Jacob’s psychiatrist put him on a new drug regimen to helphim remain calm. Jacob says that the new medication is not good for him, he feels that theymake him depressed and irritable. They also make him feel nauseous every time he has totake them and he’s been having trouble sleeping since starting the new treatment. Heclaims to have spoken with his psychiatrist about his this but he was told to stay on themedication as the psychiatrist was concerned that without the drugs, Jacob could be ‘a riskto himself and others’.Jacob was determined to see another psychiatrist to get a second opinion but when heraised this issue with his case worker in housing, she said that Jacob was at risk of losing histenancy if he did not comply with his current treatment. Jacob is upset about this.Jacob says that he reminds himself of his father. Jacob has four older sisters. He was veryclose to his mother who died when he was 13. Jacob’s father raised the family by himselfwhich was difficult for all involved. Jacob’s father was a veteran of the Vietnam war; he spent| Topic – 11 / 12© Open Colleges Pty Ltd, 2020.2 years as a prisoner of war. Even though Jacob has no clear memories of the time, he saysthat his father seemed like a different man when he returned home. Jacob has clearmemories of his father’s angry outbursts that were often directed toward Jacob’s mother.He also targeted Jacob who he accused of being ‘soft’. Jacob says that he sometimes thinkshis mother just ‘gave up’ when she was diagnosed with cancer because her marriage had‘robbed her of the will to live’.Jacob is also upset that his psychiatrist contacted Jacob’s father when he was unwell. Thepsychiatrist explained to Jacob that he needed to gather information to provide treatment,Jacob continues to feel that this was a breach of his privacy.When you start working with Jacob, he challenges you straight away, asking to be givenexact information about confidentiality in the service.Activity 44557Working with JacobWhat issues might you be able to address with this MI?How might you work with Jacob, following the key principles of MI?HintsIt might be a good idea to work out where Jacob is according to the Stages of Change.ACTIVITY 44557 TYPE ContributeSCENARIO Working with Jacob 1 2| Topic – 12 / 12© Open Colleges Pty Ltd, 2020.
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