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FALL 2013 MOTIVATING FOR CHANGE. Ray Caesar LPC, LADC-MH Director of Addiction Specialty Programs Oklahoma Department of Mental Health & Substance Abuse.

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Presentation on theme: "FALL 2013 MOTIVATING FOR CHANGE. Ray Caesar LPC, LADC-MH Director of Addiction Specialty Programs Oklahoma Department of Mental Health & Substance Abuse."— Presentation transcript:

1 FALL 2013 MOTIVATING FOR CHANGE

2 Ray Caesar LPC, LADC-MH Director of Addiction Specialty Programs Oklahoma Department of Mental Health & Substance Abuse Services (405)

3 OUTLINE Achievement Motivation Theory Self-Determination Theory Operant Conditioning Motivational Interviewing

4 MOTIVATING INDIVIDUALS

5 ROMAN LEGION

6 DECIMATION

7 BREAD AND WATER

8 AMERICAN MILITARY

9 FRENCH REVOLUTION

10 MOTIVATION DEFINITION Motivation The process of arousing and sustaining goal-directed behaviors. NEEDSDRIVES DRIVESINCENTIVES

11 MOTIVATION WHAT IS MOTIVATION? External motivation Internal motivation

12 WHY WE WORK Support ourselves and our families. Pay bills. Most people enjoy work. Sense of purpose. Social aspect of being with other people.

13 MOTIVATION MOTIVATION IS NOT Directly observable Synonymous with satisfaction Always conscious Directly controllable

14 STAGES OF CHANGE

15 ACHIEVMENT MOTIVATION THEORY

16 ACHIEVEMENT MOTIVATION THEORY LOW ACHIEVEMENT MOTIVATION HIGH ACHIEVEMENT MOTIVATION

17 ACHIEVEMENT MOTIVATION THEORY LOW ACHIEVEMENT MOTIVATION Prefer very easy tasks Failure is unlikely or very difficult tasks Failure not embarrassing

18 ACHIEVEMENT MOTIVATION THEORY HIGH ACHIEVEMENT MOTIVATION Prefer moderately difficult tasks Success is attainable Success is attributable to skill and effort

19 EXTRINSIC AND INTRINSIC MOTIVATION

20 MOTIVATION EXTRENSIC AND INTRINIC MOVIVATION Extrinsic motivation A desire to perform based on external reward or threat of punishment Intrinsic motivation A desire to perform a behavior based on internal (personal) reward or punishment

21 MOTIVATION

22 EXTERNAL VERSUS INTERNAL Better to have intrinsic motivation. Behave not because you fear punishment or expect reward (external), but because you want to behave in a certain way (intrinsic). Motivation from within

23 COMPONENTS OF INTRINSIC MOTIVATION Autonomy:self-governing Competence:self-efficacy Relatedness:support and affirmation from peers.

24 INTERNAL MOTIVATION

25 EXTRINSIC MOTIVATION ~ Needed when there are no intrinsic motivators. An example is paying taxes ~ Hopefully the behavior will alter to intrinsic motivation over time. An example is seat belt use. At first extrinsic: avoid tickets, alarms, nagging children Over time this behavior becomes internalized

26 EXTRINSIC MOTIVATION Environment controls behavior External rewards and punishments Praise increases the likelihood of participation Criticism decreases the likelihood of participation Principles of operant conditioning are at work*

27 MOTIVATION Exposure to commercial media prompt a focus on materialism which provides fleeting satisfactions. Individuals may seek extrinsic rewards in order to compensate for deficits in fulfilling basic psychological needs. Extrinsic rewards are insufficient and poor compensation. Ryan & Deci

28 MOTIVATION

29 MOVING FROM EXTERNAL TO INTERNAL MOTIVATION

30 WHY WE WORK Support ourselves and our families. Pay bills. Most people enjoy work. Sense of purpose. Social aspect of being with other people.

31 SAFER TO WEAR SEATBELTS. It is well-known that seatbelts save lives. Compliance varies greatly. 91% in California 78% in Connecticut 51% in Mass before law, now 76%. Requirement and enforcement make a difference

32 PUNISHMENT AND REINFORCEMENT. “Click it or ticket” Threat of punishment. Random checks. Cars come with warning buzzers that stop if you buckle up. Reinforces compliance

33 EVENTUALLY INTERNALIZED Starts extrinsic. Not wearing seatbelt might lead to punishment. Wearing reinforced by others and by vehicle. Seat belt usage becomes a matter of habit. Becomes intrinsic.

34 SELF DETERMINATION THEORY Ryan and Deci

35 SELF-DETERMINATION THEORY A meta-theory of motivation incorporating multiple “mini-theories” into a unified whole. Self-Determination Theory addresses both intrinsic and extrinsic sources of motivation. Self-Determination Theory focuses on Autonomy Competence Relatedness

36 COMPONENTS OF INTRINSIC MOTIVATION Autonomy:self-governing Competence:self-efficacy Relatedness:support and affirmation from peers.

37 SELF-DETERMINATION THEORY Self-Determination Theory proposes that the degree to which autonomy, competence or relatedness are supported and enhanced will have a significant positive effect on the individual within the specific context.

38 SELF-DETERMINATION THEORY Self-Determination Theory proposes that the degree to which autonomy, competence or relatedness are unsupported or hindered will have a significant negative effect on the individual within the specific context.

39 SELF-DETERMINATION THEORY Autonomy, competence and relatedness are recognized as basic psychological needs.

40 PSYCHOLOGICAL NEEDS Not necessary for survival like biological needs. People engage in all kinds of activities unrelated to basic needs. Make life worth living.

41 MASLOW

42 SELF-DETERMINATION THEORY THE FIVE MINI-THEORIES OF SELF-DETERMINIATION THEORY

43 SELF-DETERMINATION THEORY COGNITIVE EVALUATION THEORY ORGANISMIC INTEGRATION THEORY CAUSALITY ORIENTATIONS THEORY BASIC PSYCHOLOGICAL NEEDS THEORY GOAL CONTENTS THEORY

44 SELF-DETERMINATION THEORY Cognitive Evaluation Theory

45 SELF-DETERMINATION THEORY Cognitive Evaluation Theory Intrinsic motivation What are the effects of social contexts on intrinsic motivation? Highlights competence and autonomy. Explores reward, ego-involvement, controls

46 SELF-DETERMINATION THEORY Organismic Integration Theory

47 SELF-DETERMINATION THEORY Organismic Integration Theory Extrinsic motivation Explores the determinants, properties and consequences of extrinsic motivation Identifies a continuum from external to internal Degree autonomy will be enhanced or hindered

48 SELF-DETERMINATION THEORY Causality Orientations Theory

49 SELF-DETERMINATION THEORY Causality Orientations Theory Intrinsic/extrinsic motivation Identifies how individual differences alter how the environment is perceived. Identifies three orientations – autonomy, control (rewards) and impersonal (amotivational).

50 SELF-DETERMINATION THEORY Basic Psychological Needs Theory

51 SELF-DETERMINATION THEORY Basic Psychological Needs Theory Intrinsic/extrinsic Optimal well being is predicated on autonomy, competence and relatedness. All three are required. Contexts that support or thwart these needs must be considered.

52 SELF-DETERMINATION THEORY Goal Contents Theory

53 SELF-DETERMINATION THEORY Goal Contents Theory Intrinsic/extrinsic Compares and contrasts the effects of internal and external motivators. Goals have varying effects on need satisfaction.

54 SELF-DETERMINATION THEORY LEVELS OF SELF-DETERMINATION

55 SELF-DETERMINATION THEORY AMOTIVATION The individual does not pursue a behavior as success is seen as unlikely or impossible – there is no point in trying

56 SELF-DETERMINATION THEORY EXTERNAL REGULATION The individual pursues a behavior for a reward (pay) or due to coercion.

57 SELF-DETERMINATION THEORY INTROJECTED REGULATION The individual pursues a behavior because of an internalized guilt or shame related sense of “ought to” or “should”.

58 SELF-DETERMINATION THEORY IDENTIFIED REGULATION The individual pursues a behavior because the outcomes are important to the individuals goals

59 SELF-DETERMINATION THEORY INTEGRATED REGULATION The individual pursues behaviors because they symbolize what is important to the person’s sense of worth.

60 SELF-DETERMINATION THEORY TRUE INTRINSIC MOTIVATION The individual pursues behaviors for the pleasure of accomplishing, knowing, or for the stimulation.

61 SELF-DETERMINATION THEORY ITRUE INTRINSIC MOTIVATION IIINTEGRATED MOTIVATION IIIIDENTIFIED MOTIVATION IVINTROJECTED MOTIVATION VEXTERNAL REGULATION VIAMOTIVATION

62 REGULATORY STYLES

63 AMOTIVATION Non-regulation Don’t care about rewards and punishments. Lack of control. “They pretend to pay us and we pretend to work.”

64 INTERNAL REGULATION Synthesis with self-congruence. Agreement conforms to beliefs Goal is to get people to accept goals as their own. Move from compliance to self-regulation.

65 FACILITATING INTERNALIZATION Relatedness Desire to belong and feel connected. Group projects, share tasks Self-efficacy Improves chances of success Work to avoid early failures

66 PSYCHOLOGICAL NEEDS Self-determination theory relates to psychological needs. Extrinsic motivation is not strongly related to well- being Wealth, fame and image. Well-being not enhanced by achievement of extrinsic goals.

67 MASLOW

68 SELF ACTUALIZING Promotes autonomy and competence. Encourages natural potential for growth. Facilitates human achievement and well-being Provides the social environment to support growth.

69 STAGES OF CHANGE

70 OPERANT CONDITIONING

71 MOTIVATION OPERANT CONDITIONING Also referred to as Instrumental Conditioning

72 EXTRINSIC MOTIVATION Environment controls behavior External rewards and punishments Praise increases the likelihood of participation Criticism decreases the likelihood of participation Principles of operant conditioning are at work

73 EFFECTS ON BEHAVIOR Reinforcement Leads to an increase in behavior. Punishment Leads to a decrease in behavior.

74 TYPES OF REINFORCEMENT Positive reinforcement (reward): behavior leads to reward. Negative reinforcement (reward): behavior removes pain or anxiety The goal is to increase a wanted behavior

75 TYPES OF PUNISHMENT Behavior leads to unpleasant outcome or takes away something pleasant. The goal of punishment is a decrease in unwanted behavior.

76 MOTIVATION

77 REWARDS AND PUNISHMENTS Add toTake away from Pleasant Unpleasant

78 REWARDS AND PUNISHMENTS Add toTake away from PleasantPositive reinforcement Negative punishment UnpleasantPositive punishment Negative reinforcement

79 PROBLEMS WITH PUNISHMENT I Negative feelings towards person giving punishment. II Physical or psychological pain. III Escalate in severity.

80 INTRINSIC MOTIVATION

81 MOTIVATIONAL INTERVIEWING

82 Hope Expectancy The belief that one can change and will be successful at making changes. 15% Therapeutic Relationship The degree to which counseling conveys a nonjudgmental, empathic, accepting, warm environment. 30% Client Traits S trengths, temperament, resources, and skills. 40% Technique/Orientation The skills and counseling orientation. 15%

83 EVALUATING MI Set goals Report &discussCreate plan findings Evaluate Implement Changes Measure satisfactionIdentify issues & & assess Adjustcomponents implementation

84 MOTIVATIONAL INTERVIEWING Encourages a respectful counselor-client relationship. Aids in resolving discrepancies in client values & behaviors promoting homeostasis. Emphasizes consultation not confrontation. Honors the clients ability to use personal strengths in recovery. Engages client in the recovery process.

85 STAGES OF CHANGE

86 “I don’t have a problem.”

87 STAGES OF CHANGE “I don’t have a problem.” “I may have a problem.”

88 STAGES OF CHANGE “I don’t have a problem.” “I may have a problem.” “I need to do something different.”

89 STAGES OF CHANGE “I don’t have a problem.” “I may have a problem.” “I need to do something different.” “I am taking action.”

90 STAGES OF CHANGE “I don’t have a problem.” “I may have a problem.” “I need to do something different.” “I am taking action.” “I’m living differently.”

91 MOTIVATIONAL INTERVIEWING Directive

92 MOTIVATIONAL INTERVIEWING Directive Client-Centered

93 MOTIVATIONAL INTERVIEWING Directive Client-Centered Elicits positive behavior change

94 MOTIVATIONAL INTERVIEWING Directive Client-Centered Elicits positive behavior change Addresses client ambivalence

95 MOTIVATIONAL INTERVIEWING Directive Client-Centered Elicits positive behavior change Addresses client ambivalence Respects Autonomy

96 MOTIVATIONAL INTERVIEWING FUNDAMENTAL PRINCIPALS OF MI Express empathy

97 MOTIVATIONAL INTERVIEWING FUNDAMENTAL PRINCIPALS OF MI Express empathy Develop discrepancy

98 MOTIVATIONAL INTERVIEWING FUNDAMENTAL PRINCIPALS OF MI Express empathy Develop discrepancy Roll with resistance

99 MOTIVATIONAL INTERVIEWING FUNDAMENTAL PRINCIPALS OF MI Express empathy Develop discrepancy Roll with resistance Support Self-efficacy

100 ASSESSING READINESS

101 MOTIVATIONAL INTERVIEWING PHASE 1: Building Motivation PHASE 2: Strengthening Commitment to Change

102 PHASE ONE

103 MI SKILLS AND STRATEGIES PHASE I Open-Ended Questions Affirmations Reflective Listening Summarizing Eliciting Change Talk

104 MI SKILLS AND STRATEGIES PHASE II Recognizing Readiness Transitional Summary Key Question(s) Information and Advice Negotiating Plans for Change

105 MI PHASE ONE STRATEGIES OARS Open-Ended Questions Affirmation Reflective Listening Summary

106 MOTIVATIONAL INTERVIEWING CLOSED vs OPEN QUESTIONS Open Requires more than a yes or no response Eliciting—more person-centered Aids individual cognitions Closed Quick, easy, & efficient Less client-centered Less engaging

107 AFFIRMATIONS Compliments. Statements of appreciation. Highlights strengths. A form of Reflective Listening. Client-focused. Accurate.

108 ROADBLOCKS Order and, direct Warn or threaten Advise, suggest and solve Persuade, argue and lecture Moralize, preach - “shoulds” Disagree, judge and blame

109 ROADBLOCKS Agree, approve and praise Shame, ridicule or label Interpret and analyze Reassure, sympathize and console Question or probe Withdraw or distract with humor or change subject

110 COMMUNICATION MODEL The words the The words the speaker listener hearssays What the speaker What the listener really means thinks the speaker means Thomas Gordon

111 REFLECTIVE LISTENING Hearing the meaning behind client words Building hypothesis vs. making assumptions A non-judgmental, accepting environment

112 REFLECTIVE LISTENING Simple  Repeat  Rephrase Complex  Paraphrase  Reflection of Feelings  Summary, Metaphors

113 REFLECTIVE RESPONSES Simple Amplified Double-Sided

114 SUMMARIZING This is a special form of reflection. Counselor chooses what to include and emphasize. Include client’s concerns about change, problem recognition, optimism about change and ambivalence toward change. Let client know you are listening. Invite the client to respond to the summary.

115 CHANGE TALK What are the advantages of change What are the disadvantages of the status quo Stating optimism for change Stating an intention to change Stating a commitment

116 CHANGE TALK STRATEGIES Evocative Questions Desires, Ability, Reasons, Needs & Commitment for Change (DARN-C) Elaboration Importance Confidence Rulers Decisional Balance Looking Forward– Looking Back Exploring Goals and Values

117 MI CHANGE TALK STRATEGY PROCESS ASK FORASSESSHEAR THESEE THE COMMITMENTCHANGE DesiresReadinessStrong self-talkpositive Abilitiesbehaviors Reasons Needs

118 PHASE ONE TRAPS Question/Answer Trap Taking Sides Expert/Labeling Premature Focus Blaming

119 OARS AND CHANGE TALK Open-ended questions Affirmation Reflective Listening Summary Eliciting change talk Evocative question Elaboration Important Confidence rulers Decisional balance Looking forward— looking back Exploring goals and values

120 CLIENT RESISTANCE INVOLVES FEELINGS, ACTIONS, AND BEHAVIORS OF AN INTERPERSONAL NATURE WHERE THERE IS A LACK OF COLLABORATION.

121 RESISTANT BEHAVIORS Arguing Denying Blaming Interrupting Taking over Not responding

122 MOTIVATIONAL INTERVIEWING FUNDAMENTAL PRINCIPALS OF MI Express empathy Develop discrepancy Roll with resistance Support Self-efficacy

123 STRATEGIC RESPONSES Shifting focus Agreement with a twist Emphasizing personal choice Reframing Siding with the negative Supporting self- efficacy

124 REFLECTIVE & STRATEGIC RESPONSES TO RESISTANCE Shifting focus Agreement with a twist Emphasizing personal choice Reframing Siding with the negative Support self-efficacy Simple Amplified Double-Sided

125 PHASE TWO

126 PHASE 2 STRATEGIES  Recognizing Readiness  Transitional Summary  Key Questions  Information and Advice  Negotiating Plans for Change

127 CHANGE PLAN ELEMENTS Negotiating the plan Identify the barriers to change Implement the plan Enlist support Identify outcome measures Measure success and revise the plan if necessary

128 PHASE TWO HAZARDS Underestimating Ambivalence Over Prescription Insufficient Direction

129

130 MOTIVATING FOR CHANGE Ray Caesar LPC, LADC-MH Director of Addiction Specialty Programs Oklahoma Department of Mental Health & Substance Abuse Services (405)


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