Motivation is positive and a key to change. It “harnesses” energy to use to accomplish a task. It is important to realize that motivation is multidimensional including what will make the client feel happy, have more energy, reduce pain, improve health, improve relationships, earn more money, or be more successful.

However, motivation can fluctuate over time and in relation to different situations. People may be motivated to get healthier and start exercising, but not motivated to address their eating or sleeping habits. To achieve their goals they will need to do all three, exercise, eat healthfully and get quality sleep. It is important to help people see all of the components of their goal. Another example would be getting a promotion. If a person wants to get a promotion and starts working extra long hours, but is not a team player, they may not succeed. They need to maintain their motivation to put in the hours, but also increase awareness of how their interpersonal behaviors may be hindering their ability to get the promotion.

Additionally, motivation may falter in response to doubts. If Therefore, as doubts are resolved and goals are envisioned more clearly motivation will return.
Motivation is Dynamic
~ Motivation can be modified/changed
~ Social Influences
~ Environmental Pressures
~ Distress Levels
~ Critical Life Events
~ Motivation is influenced by clinician's style
~ Nonpossessive warmth & Friendliness
~ Genuineness
~ Respect
~ Ability to affirm
~ Empathy
~ Motivation is purposeful and intentional
Why Enhance Motivation?
~ Inspiring motivation to change
~ Preparing clients to enter treatment
~ Engaging and retaining clients in treatment
~ Increasing participation and involvement
~ Improving treatment outcomes
~ Encouraging a rapid return to treatment if symptoms recur
~ Creates a therapeutic partnership
Help Increase Motivation
~ Counselor Techniques OARS
~ Open ended questions
~ Respect the client's autonomy
~ Affirm their ability to succeed
~ Recognize co-occurring disorders, acknowledge difficulties
~ Employ client centered treatment
~ Reflective listening
~ Using empathy more than authority, Validate client experience
~ Summarize
~ Focus on client strengths, successes and personal power

Help Increase Motivation
~ Help clients
~ Recognize behavior that is not in their best interest
~ Regard positive change to be in their best interest
~ Feel competent to change
~ Developing a plan for change
~ Begin to take action
~ Continue to use strategies that discourage a return to the old behavior

3 Critical Elements of Motivation
~ Ability refers to the extent to which the person has the necessary skills, resources, and confidence to carry out a change.
~ Willingness involves the importance a person places on changing—how much a change is wanted or desired.
~ Readiness represents a final step in which the person decides to change a particular behavior.
Elements Of Current Motivational
Approaches
~ The FRAMES approach
~ Decisional balance exercises
~ Discrepancies between personal goals and current behavior
~ Flexible pacing
~ Personal contact with clients in treatment
FRAMES
~ Feedback regarding personal risk or impairment
~ Responsibility for change is placed squarely and explicitly on the client
~ Advice is clearly given to the client by the clinician in a nonjudgmental manner.
~ Menus of self-directed change options and treatment alternatives are offered to the client.
~ Empathic counseling
~ Self-efficacy is engendered in the client to encourage change.
Feedback
~ Should be straightforward, respectful, easy-to-understand, and culturally appropriate.
~ Not all clients respond to feedback in the same way.
~ One person may be alarmed to find that she drinks much more in a given week than her peers but be unconcerned about potential health risks.
~ Another may be concerned about potential health risks of drinking.
~ Personalized feedback can be useful throughout treatment.
~ Feedback about improvements is especially valuable as a method of reinforcing progress.
Feedback
~ Feedback should help a client
~ Understand the information
~ Interpret the meaning
~ Gain a new perspective about the personal impact of the behavior
~ Consider changing.
~ Recognize a discrepancy or gap between future goals and current behavior.
~ When people see that their actions conflict with important personal goals such as health, success, or family happiness, change is more likely to occur.
Roll with Resistance and Avoid Argument
~ Simple reflection
~ Amplified reflection: Reflects the client’s statement in an exaggerated form
~ Client: I don’t know why my wife is worried about this. All guys get angry sometimes
~ Clinician: So your wife is worrying needlessly.
~ Double-sided reflection: Acknowledges what clients have said but also states contrary things they have said in the past
~ Client: Maybe I should just stop caring about anything. Then I wouldn’t worry!
~ Clinician: You can see that there are some real problems here, but stopping caring clearly is not what you want to do.
Roll with Resistance and Avoid Argument
~ Shifting focus: Helps the client shift focus from obstacles and barriers
~ Client: I can’t take medication. I’m in recovery and can’t take mind altering substances of any type.
~ Clinician: You’re way ahead of me. We’re exploring how your anxiety is impacting your relationship with your kids. We’re not ready to talk about that yet.
~ Agreement with a twist
~ Client: Why are you and my wife so stuck on my drinking? What about all her problems? You’d drink, too, if your family was nagging you.
~ Clinician: You’ve got a good point. There is a bigger picture here. It’s not as simple as one person’s drinking. I agree with you that we shouldn’t be placing blame here. Drinking problems like these involve the whole family.
~ Reframing: Acknowledges the validity of the client’s perception, but offers a new meaning for consideration.
Responsibility
~ Give individuals the responsibility and opportunity to decide when and whether they will change their behavior
~ Encourage clients to choose their treatment and be responsible for changing
~ Do not impose views or goals on clients.
~ When clients are free to choose whether to change, they
~ Feel less need to resist or dismiss the clinician’s ideas
~ Feel empowered and more invested in treatment
~ May be more willing to negotiate common treatment goals with the clinician.
Advice
~ The most appropriate time to give advice is when a client requests it.
~ As with feedback, the manner in which the clinician advises clients determines how the advice will be used.
~ Suggesting yields better results than telling clients what they should do.
~ If a client requests direction, the clinician can—
~ First clarify what the client wants rather than give advice immediately
~ Give simple advice that is matched to the client’s level of understanding and readiness, the urgency of the situation, and the client’s culture.
Menu of Options
~ When clients make independent decisions, they are likely to commit to them.
~ Offer a menu of options decreases dropout rates and resistance to treatment and increases overall treatment effectiveness.
~ Provide accurate information about each option and a best guess about the implications of choosing one particular path
~ Elicit from clients what clients think would be effective or what has worked for them in the past
~ Reinforce clients’ ability to make informed choices.

• In what ways does our (your) agency support or not support offering clients a menu of treatment options?
• What are some of the choices you can give clients in your agency?
Empathy
~ Empathic counseling can be particularly effective with clients who are angry, resistant, or defensive.
~ Explore the reasons why the client might be angry, afraid or resistant
~ Allow the client to do most of the talking in a safe environment
~ Allow the client’s change process to unfold, rather than directing or interrupting it
~ Communicates respect for and acceptance of clients and their feelings
~ Encourages a nonjudgmental, collaborative relationship
Self-Efficacy
~ Clients must—
~ Believe they are capable of undertaking specific tasks
~ Have the skills and confidence needed to change.
~ Clinicians help clients develop self-efficacy by—
~ Reinforcing clients’ beliefs in their capacities and capabilities
~ Believing in clients’ ability to change
~ Helping clients identify how they have coped successfully with problems in the past and build on those successes
~ Reinforcing small steps and positive changes
~ Foster hope and optimism in clients
~ Reframing past “failures” as partial successes
~ Using questions beginning with “What else”
Activity
~ What kind of feedback is effective and how can it be delivered?
~ What to do when client does not want to change
~ Empathic—Clients are their harshest critics
◦ Give examples of struggles your clients are facing

Decisional Balance
~ Individuals naturally explore the pros and cons of any major life choices to make a decision

Flexible Pacing and Personal Contact
~ Pacing
~ Meet clients at their levels
~ Use as much time as necessary with the essential tasks of each stage of change.
~ Personal Contact: letters or telephone calls
~ Effective for encouraging clients to—
~ Return for another clinical consultation
~ Return to treatment following a missed appointment
~ Stay involved in treatment
~ Adhere to a plan for change.
Summary—End Part 1
~ Motivation is dynamic, influenced by multiple types of motivation including emotional, cognitive, social, environmental
~ Motivational Interviewing increases client’s hope and enhances treatment participation
~ Identify 3 critical elements of motivation: Ability, willingness and readiness
~ Delineate the 5 elements of motivational approaches
~ The FRAMES approach
~ Decisional balance exercises
~ Discrepancies between personal goals and current behavior
~ Flexible pacing
~ Personal contact with clients in treatment
Summary—End Part 1
~ FRAMES
~ Feedback
~ Responsibility
~ Advice
~ Menu of options
~ Support Self-Efficacy
~ OARS
~ Open Ended Questions
~ Affirmation
~ Reflective Listening
~ Summarize

Summary—End Part 1
~ Identify ways to deal with resistance
~ Reflection
~ Amplified Reflection
~ Reflection with a Twist
~ Decisional balance exercises highlight the benefits and drawbacks in number AND value of change AND staying the same