Strengthening commitment to change
Smrithi M
2nd PhD Scholar CP
Junior Consultant , CAM
Contents
⚫ Introduction
⚫ Understanding client’s readiness to change
⚫ Possible barriers for change
⚫ Techniques to strengthen commitment to change
Introduction
⚫ Second phase of Motivational interviewing
⚫ It starts when client is able and willing to change and
is ready for change
⚫ Clinical skills in therapist – appropriate judgment of
client’s readiness
⚫ Readiness to change signs are a gradual process and
not a “EUREKA” moment
Cues to indicate readiness to
change
⚫ Decreased resistance
⚫ Decreased discussion about the problem
⚫ Resolve
⚫ Client engages in change talk, questions about change
⚫ Envisioning
⚫ Experimenting between sessions
Possible Barriers
Underestimating
Overprescription
Ambivalence
Insufficient
direction
Techniques
Key
Recapit Questions
ulation
Giving Negotiating
Information a change
and Advice plan
Recapitulation
⚫ Summarising client’s current situation based on
reflection from client’s conversation.
⚫ It includes: announcing statement, reasons for
change, client’s reluctance/ ambivalence
Key questions
- open questions about change
- Eg: “ It sounds like things can’t stay way they
are now . What do you think you might do”
- Therapists response with reflective listening
- Personal responsibility, freedom and choice
emphasized
Giving information and advice
- circumstances under which advice is given to
be considered.
-Two ways: therapist initiated or client initiated
• Therapist initiated – after enough ideas about
change has been elicited from client; to
enhance client’s motivation and safety for
change
Cntd…
- direct and indirect ways of asking permission
before giving advice
- Open for client’s acceptance /non-acceptance of
advice
- Direct:
- eg: “I have an idea which may/may not be
relevant . Do you want to hear it?”
Cntd..
- Indirect :
- E.g: “I don’t know whether this would work for you
or not but I can give you an idea of what some other
people have done in your situation”
• Client initiated : avoiding expert trap and
maintaining expert position of client.
- Direct invitation /requests; evoking multiple
invitation/requests
- Providing as menu of alternatives
Negotiating a change plan
⚫ It involves:
- Setting goals –eliciting client goals, broader
view of goals than just being on drugs, assessing
realistic nature of goals, prioritizing the goals,
plans to increase chances of success in goals.
- Considering change options –brainstorm and
evaluate possible change strategies with the
client .
cntd…
-Arriving at a plan – written/oral change plan,
change plan worksheet, summarize plan to client
- Change Plan Worksheet
The most important reasons My main goals for myself in making this change
why I want to make this change are:
are:
I plan to do these things in order to Other people could help me with change in these ways
accomplish my goals (Specific action? (Person ? Possible ways of help):
When?):
These are some possible obstacles to I will know that my plan is working when I see these
change, and how I could handle them results:
(possible obstacles? solution?):
Cntd..
- Eliciting commitment –
• obtain commitment from client to change
Therapist Client 1 Client 2
Response Response
Is it what you want Yes I guess so
to do?
• making commitment public –verbalize decision and
obtain social support
• roleplays on verbalising commitment
Cntd..
⚫ Client 2 Response:
- Time to think , maintain follow up and contact
with client
Follow up
Question
Have You ×
decided yet?
What are √
you thinking
at this point
?
Case vignette
⚫ 38 yr old , B.tech, working in an IT firm, married
having one child
⚫ Alcohol use since 20 yrs. of age, occasional drinking
with friends. Regular use since past 5-6 yrs. Mostly
drinking with peers and for pleasure . Experiencing
memory blackouts , physical health issues.
⚫ Family history of ADS in father
⚫ Has never sought help for alcohol related problems
before . In precontemplation stage of motivation
Cntd..
⚫ Reasons for meeting therapist- physician’s
response and feedback, husband’s concerns
about her drinking.
⚫ Client has been seen by therapist for two
sessions. Phase one on change talk , assessments
and feedback about assessments on MI style has
been given to the client . Motivation-
contemplation stage
Summary
⚫ 2nd Phase of MI
⚫ Initiated only when client is ready for a change
⚫ Therapist clinical judgment and skills
important .
⚫ Recapitulation, key questions, information
giving and advice, negotiation and change plan
important in strengthening commitment
THANK YOU
