Motivational Interviewing: Preparing For Change

Motivational Interviewing: Preparing People for Change

Changing Behavior Is The Client’s Choice, How Can You Help The
Client Come To A Place Where He/She Sees Change And Sees The
Process Of Changing As Worthwhile.

Phase 1. As A therapist I would want to:
1. Avoiding premature focus trap. Start broad.
2. Confrontation/denial trap. Client ends up arguing against change.
3. Labeling Trap
4. Blaming Trap. Maybe active discussion of problem makes the
client feel blamed. Client feels blamed whatever the cause
5. Question/Answer Trap. Creates a passive client and controlling
counseling. Never ask 3 questions in a row, especially if you
open your session with questions
6. Expert Trap. Also involves asking too many questions. Activity,
energy and commitment needed for client in outside world; why
not let the client be more of an active participant in counseling?
Information gathering by doctor should reinforce energy and
activity, involving behavior, rather than passivity when you
expect them to actively take their medication, etc.
OPENING STRATEGIES: I might engage the client by:

1. Ask open-ended questions-can’t answer yes or no. Closed
questions can establish a passive client and are typical of intake
and many first sessions of counseling. Rethink what you need to
2. Listen reflectively (empathically); follow client’s path, not
yours .. Reflect back what client tells you. More efficient. It’s the
client who needs to move. Listen to himlher. Like Roger’s idea of
being a mirror for the client. Good for gaining time when you
don’t know where you want to go or to cross cultural boundaries.
Concentrate on client’s interpretation of problem, not problem
itself. No on judgment; yes on reflection whether you agree with
client or not. Validate. Allows client to make “change talk” and
locate his/her fear and anxiety about change. Don’t react to
hearing negative information. Listen to their body language or
when client stops talking. This technique provides a safety net.

3. Summarize. Giving back to the person in a contained form. Here
is where you can be a bit directive. Person hears themselves in my reflecting
back of what they have said and then they hear your
summary, which contains your emphases to reinforce certain
aspects of what they said and not other aspects. Don’t use
needless words. “Offering a bouquet to the client.” Can serve as
an interim summary and then ask, “What else?”

4. Affirm. With “problem talk” and “problem focus,” easy to forget
positive things. Convey respect for client’s achievement,
struggles, and feelings. Reframing weaknesses into strength.
Must not be phony or contrived on counselor’s part. Must
monitor yourself to see where you see possible affirmation.

5. Eliciting self-motivating statements. The client makes the
argument for change. This is usually done by counselor, so you
change that relationship.

a. Problem recognition. The client’s realizing that there is a
need for a change and he/she articulates the costs and
benefits of change.

b. Expressed concern. Both the cognitive and emotional
aspects of their condition. Follow this by reflective

c. Intention to change. Arises more in later stages of change 1
but also can occur in crisis (like aftereffects of substance
abuse). The client needs to “own’ the change.

d. Optimism for change. Ability to change-goes beyond
intention. “I could change in chose to.” The client
articulates the ability to behave differently.

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