Motivation

Motivation

Motivation can be considered a “tipping point” for making change happen. The mental process, function, or instinct that produces or sustains incentive or drive in behavior

Ambivalence is a normal part of the change process—need to tap into motivation to overcome ambivalence.

Like the change process, motivation is personal 

How to increase Motivation

  • Tailor to clients’ stage of change
    • ​The stages map the journey and give reference points for providers to know what to focus on
  • Consider the components of motivation
    • Ability, readiness, and willingness give an overall impression of what facets of motivation may need additional support to encourage change
  • Use Motivational Enhancement strategies:
    • MI based strategies can be very helpful as an implementation of this knowledge!
    • Specific skills (OARS)
    • Bring the “Spirit 

Spirit of enhancing motivation

  • Partnership -> Collaboration
    • “MI is done for and with a person, not “to” them”.  It is an active collaboration between experts.  MI is not a way of tricking people into changing, but rather a way of activating their own motivation and resources for change.
  • Acceptance -> Absolute Worth
    • This is an attitude of profound acceptance of what the client brings.  To accept a person in this sense does not mean that you approve or acquiesce to status quo.  It means you believe they have absolute worth and potential, you accept that they are an autonomous being capable of being independent.  To communicate this acceptance requires accurate empathy and affirmation (seeking to acknowledge the person’s strengths and efforts). 
  • Compassion -> Pursuing Best Interests
    • This is a deliberate commitment to pursue the welfare and best interests of the other. 
  • Evocation -> Drawing Water From a Well
    • Like drawing out water from a well, it is understanding that all of what is needed for change is already within the individual, your job as a practitioner is to help the individual pull that out.  You want to evoke and strengthen the change motivations that are already present.

Techniques of Motivational Interviewing: OARS

  • Open-ended Questions
    • Allow the patient to give a full, complete response
    • Not yes/no
    • Not a one-word answer
    • Examples:
      • “How might you go about quitting smoking?”
      • “What do you think about NRT?”
  • Affirmation
    • Statements that acknowledge the patient’s strengths or positive behaviors
    • Examples:
      • “You are definitely capable of making this change, as you were able to quit smoking in the past.”
      • “Not smoking in your new car is an excellent start!”
  • Reflective Listening
    • There are two very important values to reflective listening:
      • it communicates that you are interested and care in that you are understanding what the person is saying,
      • it clarifies meaning in what the person is saying.
    • Demonstrates understanding through rephrasing or reflecting the patient’s thoughts/feelings in a way that enhances the interaction.
      • Listen to what the patient says and means.
    • Example:
      • Client: “I sometimes feel like I’ve tried everything before and I still go back to smoking.”
      • Provider: “You’ve found it difficult to quit smoking in the past.”
    • Reflections help you manage the conversation and explore motivation by choosing what to reflect.
    • How do you know what pieces to reflect?
      • The most effective reflection isn’t random…
      • Reflections are crucial in enhancing motivation, especially when you reflect change talk and not sustain talk.
    • Change vs. Sustain Talk
      • When someone is ambivalent, you often hear both types of talk occurring naturally, even within the same sentence:
      • I need to do something about my smoking but I’ve tried quitting and it never lasts. I mean, I know I need to quit because of my health, but it just helps me deal with things.”
  • Summary Statements
    • Statements that tie together pieces of information from various points in the interaction through the use of 2+ reflections, in a way that enhances the interaction.
    • Example:
      • “Let me see if I understand: It sounds like your life has been more stressful over the past few months, and you’ve been smoking more than usual.”