motivating patient change · •no point is worth arguing if the result is a student feeling...

Motivating Student Change

It Is So Hard When They Have To, But Easy When They Want To

Robert J. Chapman, PhDAssociate Clinical Professor (Retired)

Behavioral Health Counseling

Drexel University

Sometimes if you give students what they want

you get the chance to give them what they need

Some Introductory Thoughts

People do not care about what you know until they know about if you care

Unknown

Most people do not listen with the intent to understand…

…they listen with the intent to reply.

Stephen Coveynail

So the question to ask is…

…do you seek to add life to a student’s college years, or simply prevent harm in a student’s life?

Motivational Interviewing

If you act like you only have 15-min, your interview can take all day; if you act like you

have all day, it may only take 15-min

Rollnick

What M.I. “Is”

Motivational interviewing is a directive, client-centered counselling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style

for interpersonal relationship.Rollnick, S., & Miller, W. R. (1995). What is motivational

interviewing? Behavioural and Cognitive Psychotherapy, 23(4), 325-334.

Getting Started

• students are more likely to share their stories than to tell us their business.

– Explore your student’s views on being seenAsk permission to start the interview

– Use open ended questions to prompt spontaneity and demonstrate listening

Recognizing the True student Expert

You are the student affairs expert, but your student knows what she or he has learned and learned what has been taught.

Remember:

Unsolicited advice is the junk mail of counseling.

Try Asking…

• What are the good things about use?

• What are the less good things about use?

• Where do “good things/less good things” intersect with use?

So, What’s the Point?

• You can lead a horse to water, but you can’t make it drink…

• …but you can make it thirsty…so “salt the oats”

• Ask when good things happen when using…

• …when less good things happen

Fostering Awareness…but of what?

• Help students to see typical behavior through a new set of lenses

– Revisit “how much” is consumed or spent related to using one’s usual amount

Where do We Direct Student Attention?

• students are more likely to move towards what they want than away from what we challenge or question

Understanding Unsolicited Advice

Remember: Do Not Argue

• No point is worth arguing if the result is a student feeling humiliated or coming to see the practitioner as a know-it-all

• An argument (with a student) to avoid risk may actually become his/her argument for continuing a risky course of action

When Does Change Become Possible?

• When one can differentiate “I want” from “I need”

• You can hasten the process with decisional balance exercises

Facilitating the “Ah-ha” Experience

• It is so hard when I have to and so easy when I want to.

Sondra Anise Barnes

How Does Behavior Change

Behavior A Behavior B

The Trick in Engaging Students

1. To recognize where on the continuum of readiness to change the student is

2. Strive to move to the next stage of readiness then…

3. Use a “stage appropriate” intervention

Five Basic Change Questions

1. Why would you want to make this change?

2. How might you go about it in order to succeed?

3. What are several; ‘best’ reasons for your doing it?

4. How important is it for you to make this change?

5. So, what do you think you will do?

Four Common FactorsClient or Extra-therapeutic Factor

• Optimism, persistence, hopefulness, etc

• Supportive family or religious community

Relationship Factor

• The alliance between practitioner & consumer

• Consumer’s positive rating of alliance best predictor of outcome

Expectancy or “Placebo” Factor

• Consumer’s belief that he or she is being helped

• Hopeful expectations related to method of therapy being used

Model or Technique Factor

• Theoretical orientation of practitioner

• “Type of Therapy” used, e.g., Psychodynamic, CBT, Person Centered

Four Aspects of Acceptance

Acceptance

Affirmation

Absolute Worth

Autonomy

Accurate Empathy