1. Carl Åke farbring 2009 Affirmations in MI MINT FORUM, Sitges, June 2009 Carl Åke Farbring

2. Carl Åke farbring 2009 … It happens, but rarely It happens, but rarely that one of us really sees the other person one moment a person is seen as on a photo but more clearly and in the background something that is bigger than his shadow --- --- TOMAS TRANSTRÖMER (The Gallery: The Truth Barrier, 1978) (The Gallery: The Truth Barrier, 1978)

3. Carl Åke farbring 2009 The Use of Affirmations in MI  Attributing interesting qualities to a person (MINUET, 2002) – making the person feel ”seen” as a person (not just as a client).  Bill Miller (2007): ” (ref. Linehan, 2002)  Bill Miller (2007): ” ”It seems clear that we have not enough understood or emphasized the importance of affirmations in MI.” (ref. Linehan, 2002)  Self Affirmation Theory (Steele, 1988)  Extends and elaborates on the present definition and practice of affirmation in MI  Sherman & Cohen (2006) – The Psychology of Self- Defense Advances in Experimental Social Psychology, 38, 183-242.

4. Carl Åke farbring 2009 Favourite teacher… From Carolina Yahne What was your favourite teacher like when you went to school? What were your grades like in that subject? Opinion about the teacher + - -+ grades Is there a correlation? What made you perform so well? What was the characteristic that made the teacher important to you...? What do you think the counselor means as a person in motivational work?

5. Carl Åke farbring 2009 Affirmation ”intuitively”: the importance of being seen as a person HYPOTHESIS: TO IMPART TO A PERSON THAT HE/SHE IS A SIGNIFICANT PERSON MAKES CHANGE MORE LIKELY

6. Carl Åke farbring 2009 Basic tenets in Self Affirmation Theory (Steele, 1988)  People are strongly motivated to uphold self integrity and self respect and a positive image of themselves on domains that are important!  This motivation often results in defensive responses, more rationalizing than rational.  The self system is flexible. You compensate failures in one domain by increasing the importance in another one. (Your are fighting very hard to uphold the image of yourself as a positive person and upholding self worth.)

7. Carl Åke farbring 2009 Defensive attitudes  Defensive attitudes are adaptive and natural. They reduce threat against positive self image and self worth.  People downplay threatening information  They are maladaptive when change is necessary (e.g. to survive).  ”It doesn´t concern me. They have only proved that rats shouldn´t smoke” … ”I just drink like everybody else…”

8. Carl Åke farbring 2009 Defensive bias as self protection  People want to feel valuable and important (in their own eyes at least)  To protect and uphold self integrity is a strong motivational process (thoughts…)  Can you help people to accept ”threatening” information and consequently to be more open to change?

9. Carl Åke farbring 2009 AFFIRMATIONS (Steele, 1988)  Problem: People often do not accept and reject information and resist treatment (to protect their own positive image of themselves)  Affirmations reduce defensive attitudes and increase willingness from clients to accept ”problem” and treatment  Affirmations strengthen the psychological immune system (Sherman & Cohen, 2006)

10. Carl Åke farbring 2009 AFFIRM in MI  Alluding and referring to what has been said or done earlier: - I understand that it is hard for you to talk about this. - I understand that it is hard for you to talk about this. - You have lots of resources that will help you to deal with this problem - You have lots of resources that will help you to deal with this problem - It must have been difficult for you… and you made it! - It must have been difficult for you… and you made it! - I appreciate that you could come here today - I appreciate that you could come here today - I think that it is very good that you want to deal with this problem - I think that it is very good that you want to deal with this problem - You showed that you really could! - You showed that you really could!

11. Carl Åke farbring 2009 AFFIRM (cont.)  Attributing interesting qualities to a person; making him/her seen as a (-n) (interesting) person: - You are a bit of a philosopher really. You are saying some really interesting things here. - You are a bit of a philosopher really. You are saying some really interesting things here. - You have qualities of a leader. People look up to you. - You have qualities of a leader. People look up to you. - You look a little bit lika a professional athlete! - You look a little bit lika a professional athlete! - You are the kind of person who cares a lot for others. - You are the kind of person who cares a lot for others. - You are a person with very high integrity! - You are a person with very high integrity! (Farbring, 2002)

12. Carl Åke farbring 2009 Effect of affirmations  When global measures of self integrity are strengthened the need to uphold defense against threatening information is reduced, since it can be seen, understood and dealt with in a bigger context.  Self integrity can be actively upheld, by engaging in activities that strengthen your conception of ”who you are” and what you are worth.

13. Carl Åke farbring 2009 The global self integrity (Karin) JOB - 3 PHYSICAL SHAPE + 3 ALCOHOL - 3 GOOD MUM + 3 DANCING + 2 BEING POPULAR +3 ATTRACTIVE + 2

14. Carl Åke farbring 2009 The global self integrity (Rolf) JOB - 5 Parish + 3 Family + 2 The Choir + 3 PIANO + 2 YOUTH TRAINER + 2 ART & LITERATURE + 1

15. Carl Åke farbring 2009 My furious friend Peter, hcp 13 And after returning to the game: - You know I could run all this way without even losing my breath and…: and…: - (to himself) At least I am good at saving money

16. Carl Åke farbring 2009 Self affirmation theory (Steele, 1988)  Where is the evidence?  Sherman, D.K., & Cohen, G. L. 2006. The psychology of Self-Defense: Self AffirmationTheory. Advances in Experimental Social Psychology, Vol 38. 183-242

17. Carl Åke farbring 2009 Accept threatening information  You accept and even look for information according to your beliefs and ideology etc. Defensive bias will be reinforced by interpreting this new information. Many studies are about the view on capital punishment = ”law and order” or ”liberal”. = a way to show and uphold your identity as safe guard against crime or humanist/liberal.  Participants in the study had their personal values explored: Half of them were affirmed on a domain unrelated to death punishment. Both groups were confronted with information that was in conflict with their ideology about capital punichsment.  Result: A-group was more balanced in their judgment of the information than the non-A (they were more critical and thought the whole information was biased.) Within the A-group people were influenced in both directions– i.e. those who supported capital punishment were influenced to find capital punishment inhuman and those who were against capital punishment were influenced and could find some good arguments for capital punishment (Cohen et al., 2000; Jacks & O´ Brien, 2004).  The need to protect an important part of your identity or ”self worth” is an important source for bias and closing the door to information, even when it is supported by facts, logic or convincing evidence. (”I don´t believe in that…”).

18. Carl Åke farbring 2009 Accepting threatening information Capital punishment  Participants in the study had their personal values explored: Half of them were affirmed on a domain unrelated to death punishment. Both groups were confronted with information that was in conflict with their ideology about capital punichsment.  Result: A-group was more balanced in their judgment of the information than the non-A. Within the A-group people were influenced in both directions – (Cohen et al., 2000; Jacks & O´ Brien, 2004).  The need to protect an important part of your identity or ”self worth” is an important source for bias and closing the door to information, even when it is supported by facts, logic or convincing evidence.

19. Carl Åke farbring 2009 Can behavior also be influenced?  Sherman (2000) studied if A could reduce risky and harmful sexual behavior by showing a video that pointed to the hazards of AIDS. Half of the participants were affirmed before the video.  Those who were not affirmed tended to show resistance to the informationen but the A-group showed not only more acceptance of the information but it also influenced their behavior: 50% of the participants in that group bought condomes after the video compared to only 25% in non-A. 78% took a brochure about AIDS compared to 54% in non-A.  Conclusion: Affirmations seem to ”buffer” people from the threating part of the information; affirmations make it possible for people to ”open up” for the possibility that they are themselves at risk and help motivate them for preventive behavior.

20. Carl Åke farbring 2009 Correlation between coffee and fibrocystic disease (often precedes breast cancer)  Sherman, Nelson & Steele (2000) Do messages about health risks threaten the self. Increasing acceptance of threatening health messages via self-affirmation. Personality and Social Psychology Bulletin, 26, 1046-1058 Blue = coffee drinkers Red: not coffee drinkers acceptaceacceptace

21. Carl Åke farbring 2009 Stress cortisol as a function of time and status of affirmation  Cresswell, Welch, Taylor, Sherman, Gruenewald & Mann (2005). Psychological Science, 16, 846-851. (The Tries Social Stress Task for job applicants and an arithmetic task 2083 by 13´s)) Affirmations can buffer self integrity not only on psychological measures but on a psyshiological level as well! Yellow = A Red= non-A

22. Carl Åke farbring 2009 Open mindedness to arguments against US foreign policy as a function of affirmations Cohen & Garcia (2005). ”I am us”. Negative Sterotypes as Collective Threats. Journal of Personality and Social Psychology, 89, 566-582. Black line= A Dotted line= non-A Before: r =.58 After: r=-.05 The collective identity

23. Carl Åke farbring 2009 Steretypical threats and performance Martens, Johns, Greenberg & Schimel (2006). Combating Stereotype threat. The effect of self affirmation on women´s intellectual performanced. Journal of Experimental Social Psychology, 42, 236-243. Stereotype : ”Women do not perform as well as men in mathematics” (triggers stress that will influence performance negatively) A test was presented as a) diagnostic --- b) basis for research Result: Women in the diagnostic condition performed worse than the other women and clearly worse than men. Women in the same category a) that were affirmed did just as well as women in the research group and just as well as men also.

24. Carl Åke farbring 2009 Other aspects of affirmations…  Affirmations on the focussed area may backfire!  Affirmations must be unrelated to the domain – Act counterintuitively!  Affirmation theory offers a framework for understanding and dealing with bias.  Mediating factors are not understood; basis for research

25. Carl Åke farbring 2009 Affirmations and cognitive dissonance  Upholding self integrity rather than balance  Looking actively for information not just to gain balance but to restore self integrity  Purpose: to decrease feelings of unease – that value of the person does not depend on the unfortunate event…

26. Carl Åke farbring 2009 What can we do as clinicans to reduce defensive bias when change is important?  Reinforce and strengthen important alternative domains of self integrity.  Clinician behaves ”counterintuitively”!  Total concentration on the client!  Affirmations are a form of reflective listening i.e. attributions of qualities are statements.  Avoid saying ”I think you are…”

27. Carl Åke farbring 2009 Motivational distortions in social perception  Default in café communications and social interplay: people are zealous ”self promoters” in social interplay  We often compare ”downwards” when we feel ”threatened”.  Prejudice and racism can (at least partly) be explained and influenced by bias and affirmations.

28. Carl Åke farbring 2009 Summary of effects  Affirmations can … reduce defensive bias with respect to attitudes, cognitive receptiveness, stress and social perception. reduce defensive bias with respect to attitudes, cognitive receptiveness, stress and social perception.  Affirmations can also influence stereotypes, prejudice and behavior  Results are applicable over a whole lot of fields.  Self protective strategies can be reduced and even eliminated if other important domains unrelated to the threatened area are affirmed.

29. Carl Åke farbring 2009 What happens if affirmations are made conscious?  People to which the domain in question is very important are more likely to have bias, but they are also the ones who have most to gain from affirmations  Affirmations work in a subtle way ”under the surface” without mediating role for the conscience.  Affirmations that are made clearly conscious are impotent.

30. Carl Åke farbring 2009 Suggestion: be counterintuitive!  First two minutes: ”First I would be very interested if you could tell who you are, what kind of a person you are. What is important in your life, what makes you feel really well,when and what makes you feel that you have done something really good…?  Listen reflectively and return at times in conversation and show that you know ”who this important person is…”

31. Carl Åke farbring 2009 Affirmations in clinical practice Member of parish +2 Singing in a choir + 2 Football trainer for young boys + 3 Family: relations close and supportive +2 Safe private economy + 2 Speaks Spanish +2 Important domains in Tom´s life

32. Carl Åke farbring 2009 Why has it worked so well for me? Are my clients special?  Drug users and offenders: 1) Negative assessments! Negative feedback is often perceived as threats or even insults (Sobell et al. 2009) 2) Almost always negative feedback! 3) Tends to create a threat against their view of themselves! 4) They are extremely sensitive and ”hungry” for affirmations? 5) Are they special?

33. Carl Åke farbring 2009 So….. What do you think? What do you think? Carl Åke

34. Carl Åke farbring 2009 www.farbring.com; carl.a.farbring@telia.com; ake.farbring@kriminalvarden.se ake.farbring@kriminalvarden.se ¡Muchas Gracias! Thank you! Bienvenido, Welcome, Bienvenu à ICMI II, Stockholm, June 7-9 2010 Bienvenido, Welcome, Bienvenu à ICMI II, Stockholm, June 7-9 2010