11.3 Motivational interviewing and behavior change

Motivational interviewing is a powerful tool for social workers to help clients change behaviors. It's all about working together, not lecturing. By using specific communication skills and understanding the stages of change, social workers can guide clients to find their own motivation.

This approach fits perfectly with social work's focus on empowering individuals. It respects client autonomy while providing support. By mastering these techniques, social workers can be more effective in helping clients overcome challenges and achieve their goals.

Motivational Interviewing Techniques

Core Principles and Approach

• Motivational interviewing functions as a collaborative, person-centered counseling method
• Aims to elicit and strengthen an individual's motivation for change
• Emphasizes exploring and resolving ambivalence about behavior change
• Employs a guiding rather than directing style of communication
• Helps clients identify their own reasons and capacity for change

OARS Communication Skills

• OARS represents four key skills used in motivational interviewing
• Open-ended questions encourage deeper exploration of thoughts and feelings
  • "What concerns you most about your current situation?"
  • "How would you like things to be different?"
• Affirmations validate client strengths, efforts, and positive behaviors
  • "I appreciate your honesty in sharing that difficult experience"
  • "You've shown great resilience in facing these challenges"
• Reflective listening involves restating or paraphrasing client statements
  • Demonstrates understanding and encourages further elaboration
  • "It sounds like you're feeling frustrated with your progress"
• Summarizing synthesizes key points discussed during the session
  • Highlights important themes and reinforces change talk
  • "Let me make sure I understand what we've covered so far..."

Eliciting and Responding to Change Talk

• Change talk refers to client statements indicating desire, ability, reasons, or need to change
• Practitioners listen for and selectively reinforce change talk
• Types of change talk include:
  • Desire statements (I want to, I wish)
  • Ability statements (I can, I could)
  • Reason statements (It would be better if)
  • Need statements (I have to, I need to)
• Responding to change talk involves reflecting, affirming, and exploring further
• Resistance manifests as arguments, interrupting, denying, or ignoring
• Practitioners roll with resistance rather than confronting it directly
• Strategies for addressing resistance include:
  • Reflecting the resistance without judgment
  • Shifting focus to a less contentious topic
  • Reframing the resistance in a new light

Stages and Factors in Behavior Change

Transtheoretical Model of Change

• Stages of change model describes the process individuals go through when modifying behavior
• Precontemplation stage involves no intention to change in the foreseeable future
• Contemplation stage includes awareness of a problem and consideration of change
• Preparation stage involves intention to take action in the near future
• Action stage entails actively modifying behavior, experiences, or environment
• Maintenance stage focuses on preventing relapse and consolidating gains
• Interventions tailored to each stage can facilitate progress through the change process

Psychological Factors Influencing Change

• Ambivalence represents simultaneous and contradictory attitudes toward change
• Occurs when individuals have both reasons to change and reasons to maintain current behavior
• Exploring and resolving ambivalence forms a key part of motivational interviewing
• Self-efficacy refers to an individual's belief in their ability to succeed in specific situations
• Influences choice of activities, effort expended, and persistence in face of obstacles
• Can be enhanced through mastery experiences, vicarious experiences, and verbal persuasion
• Decisional balance weighs the pros and cons of changing behavior
• Involves assessing perceived benefits and costs of current behavior versus change
• Shifting the balance toward change can increase motivation and commitment

Strategies for Promoting Change

Behavioral Activation Techniques

• Behavioral activation increases engagement in rewarding activities
• Aims to counter patterns of avoidance, withdrawal, or inactivity
• Process involves:
  • Identifying valued activities and goals
  • Scheduling and tracking enjoyable or meaningful activities
  • Gradually increasing activity levels
  • Monitoring mood in relation to activity engagement
• Can be particularly effective for addressing depression and anxiety
• Helps break cycles of negative reinforcement and promotes positive experiences

Effective Goal Setting Approaches

• Goal setting provides direction and motivation for behavior change
• SMART criteria guide the creation of effective goals:
  • Specific: Clearly defined and unambiguous
  • Measurable: Includes concrete criteria for tracking progress
  • Achievable: Realistic and attainable given current resources
  • Relevant: Aligns with broader objectives and values
  • Time-bound: Has a defined timeline or deadline
• Breaking larger goals into smaller, manageable steps enhances success
• Regular review and adjustment of goals maintains motivation and relevance
• Celebrating progress and achievements reinforces positive behavior change