1. Understanding the factors that determine the behaviours of young people
A talk by Karim Ghalmi South Oxfordshire Food and Education Academy Didcot

2. Setting the Scene

3. Factors that determine Behaviour

4. Culture
Family
Social Group
Lifestyle
Environment
Behavioural Skills
Thoughts
Feelings
Physical factors

5. Start Exit Lapse Premature Exit Cycle of Change Contemplative
Relapse
Contemplative
Pre-Contemplative
Decision
Active Change
Maintenance
Lapse
(After Prochanska & Di Clemente, 1982)

6. (Cognitive) Games People Play
“I can’t help – I’m ill”
(Justification by using the disease model)
“My wife made me do it”
(Abdication of responsibility)
“That will show them”
(Relapse as punishment for perceived injuries)
“I can control it this time”
(Planned relapse on the basis of ill-founded prediction)
“I’ve earned it”
(Relapse as an unlikely vehicle of positive reinforcement for sustained abstinence!)
“Life’s hell anyway”
(The devaluation of abstinence as a vehicle for relapse)
“See? You can’t make me stop”
(Relapse as an assertive gesture or attempt to establish autonomy)
“Me? I’m not relapsing”
(Denial)
“I’ll never relapse – I’ve got it cracked”
(Unrealistically optimistic predictions)
“Everyone relapses – It’s just a matter of time”
(Unrealistically pessimistic predictions)

7. High Risk Situation (External) Interpersonal Determinants
Interpersonal conflict
Social Pressure
Negative Emotional States
Positive Emotional States
Testing Personal Control – trigger seeking behaviour
Urges and Temptations
(Internal)

8. Cognitive – Behavioural Model of the Relapse Process
Effective coping response
Increased self- efficacy
Decreased probability of relapse
High-risk situation
Decreased self- efficacy
Positive outcome expectancies (for sophisticated coping mechanisms)
Ineffective coping response
Increased probability of relapse
Lapse

9. Facilitating change

10. Motivational Interviewing
Motivational Interviewing is a style of ‘counselling’ that can be used in the therapeutic process with young people. However, specific motivational interviewing strategies are thought to be particularly useful during initial sessions with those who are ‘contemplators’ experiencing ambivalence about changing their behaviour.
SELF MOTIVATIONAL STATEMENTS
Willingness
Acknowledgement
Desire to change
COUNSELLING MICROSKILLS
Fundamental to the successful use of motivational interviewing strategies are a number of client centred micro skills.
Open ended questions, reflective listening, affirmation and summarising.

11. Stages of Change and Therapist Task
STAGE Pre-Contemplation Contemplation Determination Action Maintenance Relapse
THERAPIST TASK
Raise Doubt
Increase the clients perception of risks and problems with current behaviour.
Tip the balance – evoke reasons for change, risks of not changing.
Strengthen the client’s self-efficacy for change of current behaviour.
Help the client to determine the best course of action to take in seeking change.
Help the client to take steps towards change.
Help the client to identify and use strategies to prevent relapse.
Help the client to renew the processes of contemplation, determination and action without becoming stuck or demoralised because of relapse.
Giving ADVICE
Removing BARRIERS
Providing CHOICES
Decreasing DESIRABILITY
Practising EMPATHY
Providing FEEDBACK
Clarifying GOALS
Actively HELPING

12. FIVE GENERAL PRINCIPLES:
Express Empathy
Develop Discrepancy
Avoid Argumentation
Roll with Resistance
Support Self Efficacy

13. Goals
In essence, the goal of motivational interviewing is to have the young person talk him/herself into deciding to change their behaviour.
It emphasises the young persons right to choose and accept responsibility for the decision.
Method
KEY STRATEGIES
Exploring the Good Things and the Less Good Things.
Exploring Concerns.
Summarising
Life Satisfaction - Looking Back
- Looking Forward
Self vs User - Psychological Squirm
Helping with Decision making

14. Key Concepts
Motivational Interviewing Strategies avoid Confrontation.
Empathy
Style of listening so that comments are reflected back in a re-framed fashion to the client.
Non-judgemental attitude – not collusive, but allows the client the freedom to explore the possibility of change.
Ambivalence
It is a common and “natural” experience of feeling torn between wanting and not wanting to do something.
The closer to change the client is, the greater the feelings of conflict are likely to be.
The aim of Motivational Interviewing is to tip the balance of ambivalence in favour of action/determined change.

15. Summary EXPRESS EMPATHY
Acceptance and respect for young person’s position facilitates change.
Skilful reflective listening is fundamental.
Ambivalence is normal.
DEVELOP DISCREPANCY
A discrepancy between present behaviour and important goals will motivate change.
The young person should present the arguments for change.
AVOID ARGUMENTATION
Arguments are counter productive.
Defending breeds defensiveness.
Resistance is a signal to change strategies.
ROLL WITH CLIENT RESISTANCE
Statements that a young person makes can be re-framed slightly to create a new momentum towards change.
SUPPORT THE CLIENT’S SENSE OF ABILITY TO CHANGE
Belief in the possibility of change is an important motivator.
The young person is responsible for choosing and carrying out personal change.
There is hope in the range of alternative approaches available.

16. Thanks