Developing and Building Discrepancy
We found we had to make haste slowly. –Bill W.
Given a choice between changing and proving that it is not necessary most people get busy with the proof (Latchford, 2010). Change tends to occur when a person perceives a significant discrepancy between important goals or values and the status quo. In order to be motivating, a discrepancy needs to be large enough to encourage change but not so large as to be demoralizing. A variety of MI strategies can be used to instill (infuse slowly) discrepancy with the bounds of the person’s own values.
As you begin to establish a therapeutic alliance, the client will begin to acknowledge that something is not right in their environment, but may spend more time and energy in session disavowing that they really need to change. Therefore, your role is to encourage client’s to think about change, evoke and strengthenthe client’s existing argument (ambivalence) for change through an honest discussion about the consequences of not changing as well as changing.
But what about clients who do not seem to be ambivalent? In the precontemplation stage, there is no change talk to evoke. Consider these examples of “unmotivated” clients. Provide commentary for each example regarding the process of howto instill discrepancy collaboratively with the client. Be specific with your chosen strategy for developing discrepancy and highlight the what, how and why.
Do not use proposed dialogue for this assignment. Please provide a narrative reflecting your general approach to what, how and why.
1. A patient being treated at a trauma center for injuries sustained in an alcohol-related crash, who blames the other driver and has no apparent personal concerns about drinking.
2. A teenager brought to treatment by concerned parents who discovered marijuana and drug paraphernalia during a room check. The teen is incensed about being check up on and regards cannabis as harmless.
3. A pregnant woman who expresses no intention to quit smoking or using methamphetamine.
ENGAGE
PLAN
EVOKE
FOCUS
If they want to
to, support
them to plan changes
Draw out their own good
reasons to change
Find a useful direction
ENGAGE
Settle into a helpful conversation
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“Settle into a helpful conversation”
ENGAGE
1. Just be nice and friendly?
2. Better & better
3. A service-wide challenge
Rapid engagement & the 20% rule
ENGAGE
DEMONSTRATION
Listen for all I am worth!
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FOCUS
PLAN
EVOKE
FOCUS
If they want to
to, support
them to plan changes
Draw out their own good
reasons to change
Find a useful direction
ENGAGE
Settle into a helpful conversation
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“Find a useful direction”
FOCUS
1. Who’s direction?
2. Multiple options are common
3. Agenda mapping as a skill
Finding a useful direction
FOCUS
1. Its obvious
or
2. Options – agenda mapping
or
3. Unclear – explore
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Agenda mapping
FOCUS
1. Permission
2. Step back – identify topics
3. Invite person to produce new ones
4. Raise your own (including difficult subjects)
5. Agree
g
order
6. Return to this as needed
Thanks to Nina Gobat for suggesting the term “agenda mapping”
Agenda mapping
DEMO
She has diabetes. Very brief routine consultation.
What’s the focus going to be?
diet, exercise, smoking, drinking, medication?
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EVOKE
PLAN
EVOKE
FOCUS
If they want to
to, support
them to plan changes
Draw out their own good
reasons to change
Find a useful direction
ENGAGE
Settle into a helpful conversation
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“Draw out their own good reasons to change”
EVOKE
1. Defining heart of MI
2. Ear for language: change talk
Preparation
(Pre-) Contemplation
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Action
Preparatory change talk (D.A.R.N.)
EVOKE
DESIRE to change (want, like, wish . . )
ABILITY to change (can, could . . )
REASONS to change (if . . then)
NEED to change (need, have to, got to . .)
Mobilizing Change Talk (C.A.T.S.)
Reflects resolution of ambivalence
EVOKE
COMMITMENT (intention, decision, promise)
ACTIVATION (willing, ready, preparing)
TAKING STEPS
41
PLAN
PLAN
EVOKE
FOCUS
If they want to
to, support
them to plan changes
Draw out their own good
reasons to change
Find a useful direction
ENGAGE
Settle into a helpful conversation
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“If they want to, support them to plan
changes”
PLAN
1. Righting reflex & other familiar
challenges
2 Multiple routes are common
2.
3. Path mapping as a skill
The practice of MI
Core skills
Lecture, demo, exercise, video, discussion
Engage, Focus, Evoke & Plan
Lectures demo
Lectures,
demo, video and more
Your state of mind
Exercise, video, our shared observations
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Your state of mind
How easy will
ill iit b
be ffor you to slow
l
the pace down during interviews?
Dr Ng’s story
www.vimeo.com/67088727
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Turnitin Report
Formatting
Title Page
Citation
Outline
