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Motivating People to change

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Presentation on theme: "Motivating People to change"— Presentation transcript:

1 Motivating People to change
Sustainable, meaningful change for children and their families

2 Seminar outline Introduction and housekeeping Stories of motivation
What we know about motivation – incentives and sanctions– what really works? Coffee break John’s talk Exercise Summing up

3 Think about it artificial change environments embedded change
how humans respond to change – what motivates them to do something different from what they have always done.

4 Recycling

5 Bill Strickland

6 Elements that enabled change
A person who was interested in him A vision that the future could be different A belief that he could make a choice A belief that he could learn to do something he valued.

7 What makes therapy successful?
Meta Analyses of Research on Family Support THERAPY NEUTRAL e.g. psychodynamic bed-wetting CLIENT HOPEFULNESS - statements about the future CLIENT CHARACTERISTICS - GIVEN SOCIAL SUPPORT – FGCs, harnessing strengths, SEE PLAN = family doing the work! RELATIONSHIPS - positive work / questionnaires (200) / professional clear boundaries / … The model works with a range of therapeutic techniques – I also manage a Voluntary Sector Family Centre, which has a long-standing commitment to psychodynamic social work. The model still works for them – if the family centre things that e.g. Johnny’s bed-wetting is down to his childhood sexual abuse and a therapeutic treatment will help him recover – then a reduction in his bed-wetting may provide evidence of the treatment’s effectiveness. Client Hopefulness – our outcomes are statements about the future and we use scaling (as I will come on to) to measure progress – gaining hope with intractable problems is a frequent report coming back from families that I have been doing research with. Client Characteristics and Social Support – We can’t do much about client characteristics, but we can mobilise family support, and our services are premised on doing this. As I said, we use family group and community conferencing to support people with change. Relationship – The key question here is how working towards outcomes effects the relationship between staff and service users. The evidence (of around two hundred questionnaires we’ve had back on this subject) demonstrates that the model helps staff and families to be clear about their roles and to be clear about how they can work together to produce change. Whether they like each other or not is irrelevant – it’s a professional – change-making relationship. Kieran McKeowan A guide to what works in family support services for vulnerable families (Dublin, 2000)

8 Seven steps to determination
I accept there is a problem I have some responsibility for the problem I have some discomfort about the problem and my part in it I believe that things must change I can make a choice I can see that I can be part of the solution I can see the first steps towards the change

9 Problem tree

10 Maslow hierarchy of needs

11 Cycle of change

12 The typical social work response to creating change

13 Artificial change

14 Embedded change

15 What journey’s are you helping people take?

16 Motivating people to change
Workshop materials

17 Motivational Interviewing
A person-centered, goal-oriented method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

18 De-motivating

19 How might resistance show itself?
By only being prepared to consider 'safe' or low priority areas for discussion. By not turning up for appointments By being overly co-operative with professionals. By being verbally/and or physically aggressive. By minimising the issues. (Egan, 1994)

20 What might we be doing to make it worse?
Becoming impatient and hostile Doing nothing, hoping the resistance will go away Lowering expectations Blaming the family member Absorbing the family member's anger Allowing the family member to control the assessment inappropriately

21 What might we be doing to make it worse?
Becoming unrealistic Believing that family members must like and trust us before assessment can proceed. Ignoring the enforcing role of some aspects of child protection work and hence refusing to place any demands on family members. (Egan, 1994)

22 What It Is Not Skills training Confrontive denial breaker
Simply sitting there listening and reflecting The solution to all client issues and clinician headaches

23 The Problem With Them Is….
They don’t see (insight, denial) They don’t know They don’t know how They don’t care

24 So The Answer is….. Give them Insight……if they just see they will change. Give them Knowledge….. if they just know they will change. Give them Skills….. if you can just teach them how to change, then they will change. Give them Hell….. if you can make them feel bad or afraid enough they will change.

25 And Yet….. Sometimes Insight, Knowledge, Skills, And Feeling Bad Or Fearful Is Still Not Enough

26 What Is Happening? Issues of…… Ambivalence Motivation Readiness

27 Key Assumptions Motivation is interpersonal
Resistance is interpersonal Clinician approach and behaviors matter Persuasion is usually not an effective method to increase motivation and change

28 MI: How it Works Clinician manages important in-session behaviors of client using MI spirit, principles and skills Interaction of clinician and client Increase Change talk and Decrease Resistance Leads to

29 Change Talk Desire Ability Reasons Need Taking Steps Commitment
Strength Behavior Change

30 Resistance Arguing Interrupting Denying Ignoring

31 Basic MI Principles D = Develop Discrepancy R = Roll with Resistance
E = Express Empathy S = Support Self-efficacy

32 Develop Discrepancy Change is motivated by a perceived discrepancy between present behavior and important personal goals or values The person rather than the counselor should present the arguments for change

33 Roll with Resistance Avoid arguing for change
Resistance is not directly opposed Resistance is a signal to respond differently The person is a primary resource in finding answers and solutions

34 Express Empathy Acceptance facilitates change
Skillful reflective listening is fundamental Ambivalence is normal

35 Support Self-Efficacy
A person’s belief in the possibility of change is an important motivator The person, not the counselor, is responsible for choosing and carrying out change The counselor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy (HARP)

36 Strategies OARS Open Questions Affirming Listen Reflectively
Summarizing Dunn/MINT

37 Original idea from Bem’s theory
Change Talk Original idea from Bem’s theory “I learn what I believe from what I hear myself say.”

38 Eliciting Change Talk: A Technique For The Road

39 Assessing Importance How important on a scale of 1-10?
1---x y Why X and not 1? What would have to happen for you to go from X to Y?

40 Confronting the difficulties

41 Confrontation In child welfare services, the Children’s Service Worker must be a skilled confronter. Confrontation is, basically, facing the client with the facts in the situation and with the probable consequences of behaviours (Texas Department of Human Resources)

42 Confrontation Client: The doctor is telling lies about me. I didn't hurt Angie, she fell downstairs. She is always having accidents. Worker: I understand that children have accidents. Angie's injuries could not have been the result of a fall down stairs. There are two partially healed fractures in addition to the new head injury. Angie's buttocks and back are marked with bruises in the shape of a hand. (Texas Department of Human Resources)

43 Confrontation Client: I know we haven't been to counselling in three weeks. Get off my back! My husband and I have other things to do. Worker: Going to counselling regularly is a part of your agreement with us to regain custody of your children. If the agreement is not followed, we can't recommend that the children come home. (Texas Department of Human Resources)

44 Effective work involves
Logical discussion Focusing Prioritising Summarising Setting realistic limits

45 Effective work involves
Universalising Confronting Educating Modelling behaviour

46 Effective work involves
Recognising difference Accepting Allowing ventilation Relating to feelings Direct intervention in the environment

47 A scale for assessing motivation
Shows concern and has realistic confidence. Shows concern, but lacks confidence. Seems concerned, but impulsive or careless Indifferent or apathetic about problems Rejection of parental role.

48 Shows concern and has realistic confidence.
Parent is concerned about children’s welfare; wants to meet their physical, social, and emotional needs to the extent he/she understands them. Parent is determined to act in best interests of children Has realistic confidence that he/she can overcome problems and is willing to ask for help when needed Is prepared to make sacrifices for children.

49 Shows concern, but lacks confidence
Parent is concerned about children’s welfare and wants to meet their needs, but lacks confidence that problems can be overcome May be unwilling for some reason to ask for help when needed. Feels unsure of own abilities or is embarrassed But uses good judgement whenever he/she takes some action to solve problems.

50 Seems concerned, but impulsive or careless
Parent seems concerned about children’s welfare and claims he/she wants to meet their needs, but has problems with carelessness, mistakes and accidents. Professed concern is often not translated into effective action. May be disorganised, not take enough time, or pays insufficient attention; may misread ‘signals’ from children; may exercise poor judgement. Does not seem to intentionally violate proper parental role; shows remorse.

51 Indifferent or apathetic about problems
Parent is not concerned enough about children’s needs to resist ‘temptations’, eg competing demands on time and money. This leads to one or more of the children’s needs not being met. Parent does not have the right ‘priorities’ when it comes to child care; may take a ‘cavalier’ or indifferent attitude. There may be a lack of interest in the children and in their welfare and development. Parent does not actively reject the parental role.

52 Rejection of parental role
Parent actively rejects parental role, taking a hostile attitude toward child care responsibilities. Believes that child care is an ‘imposition’, and may ask to be relieved of that responsibility. May take the attitude that it isn’t his or her ‘job’. May seek to give up the responsibility for children (Magura et al,1987)

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