Motivational Enhancement: Counselor Toolbox Episode 117

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MET Unique Characteristics
~ Emphasis on personal choice regarding future behavior
~ Objective evaluation focused on eliciting the CLIENT’s OWN concerns
~ Resistance is an interpersonal behavior pattern indicating failure to accurately empathize
~ Resistance is met with reflection
Motivational Enhancement Therapists Do NOT
~ Argue with clients
~ Impose diagnostic labels
~ Tell clients what they “must” do
~ Seek to “break down” denial through direct confrontation
~ Imply client’s powerlessness
OARS
~ Open Ended Questions
~ Affirmations
~ Reflective Listening
~ Summaries
Stages of Change
~ Motivation needs to be enhanced and maintained in all stages of change
~ Stages
~ Precontemplation
~ Contemplation
~ Preparation
~ Action
~ Maintenance
Basic Principles: EE-DD-AA-RR-SS
~ Express Empathy
~ Reflective listening (accurate empathy) is a key skill
~ Develop Discrepancy
~ Perceive a discrepancy between where they are and where they want to be
~ Raise clients’ awareness of the personal consequences of their drinking in order to precipitate a crisis increasing motivation for change
~ Avoid Arguing
~ No attempt is made to have the client accept or “admit” a problem

Basic Principles cont…
~ Roll with resistance
~ New ways of thinking about problems are invited but not imposed.
~ Ambivalence is viewed as normal, not pathological, and is explored openly.
~ Solutions are usually evoked from the client rather than provided by the therapist
~ Support self-efficacy
~ People will not try to change unless they believe there is HOPE for success
CBT vs. MET
Cognitive Behavioral
~ Assumes client is motivated
~ Identify and modify maladaptive cognitions
~ Prescribes change strategies
Motivational Enhancement
~ Builds client motivation
~ Explores and reflects client perception without correcting
~ Elicits change strategies from the client
Nondirective
~ Client determines content and direction
~ Avoids injecting counselor’s advice and feedback
~ Empathy is used noncontingently
MET
~ Directs client toward motivation
~ Offers advice and feedback
~ Empathic reflection used selectively to reinforce certain points
Building Motivation
~ Since you are here, I assume you have been having some concerns or difficulties related to your use. Tell me about them.
~ Tell me a little about your drinking. What do you like about it? What’s positive about drinking for you? And what’s the other side? What are your worries about drinking?
~ How has your drinking has changed over time? What things do you think could be problems, or might become problems?
~ What have others said about your drinking? What are they worried about?
~ What makes you think that perhaps you need to make a change in your drinking?
More Motivational Questions
~ Tolerance—do you seem to be able to drink more than other people without showing as much effect?
~ Memory—have you had periods of not remembering what happened while drinking or other memory problems?
~ Relationships—has drinking affected your relationships?
~ Health—are you aware of any health problems related to use?
~ Legal—have you had any legal issues because of behavior while drinking?
~ Financial—has drinking contributed to money problems?
Consequences of Action or Inaction
~ Decisional Balance

Still More Motivational Questions
~ Drinking is really important to you. Tell me about that.
~ What is it about drinking that you really need to hang onto? (What are the benefits?)
~ Information and Advice
Empathy
~ Advantages
~ it is unlikely to evoke client resistance
~ it encourages the client to keep talking and exploring the topic
~ it communicates respect and caring and builds an alliance
~ it clarifies for the therapist exactly what the client means
~ it can be used to reinforce ideas expressed by the client
~ Reflect selectively, reinforcing parts of what the client has said and ignoring others.
~ Clients not only hear themselves saying a self-motivational statement, but also hear you saying that they said it.

Affirmation
~ Benefits
~ Strengthening the working relationship,
~ Enhancing a sense of self-responsibility and empowerment
~ Reinforcing effort and self-motivational statements
~ Supporting client self-esteem

Видео Motivational Enhancement: Counselor Toolbox Episode 117 канала AllCEUs Counseling Education