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

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Motivating Student Change It Is So Hard When They Have To, But Easy When They Want To Robert J. Chapman, PhD Associate Clinical Professor (Retired) Behavioral Health Counseling Drexel University

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Page 1: Motivating Patient Change · •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)

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

Page 2: Motivating Patient Change · •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)

Sometimes if you give students what they want

you get the chance to give them what they need

Page 3: Motivating Patient Change · •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)

Some Introductory Thoughts

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

Unknown

Page 4: Motivating Patient Change · •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)

Most people do not listen with the intent to understand…

…they listen with the intent to reply.

Stephen Coveynail

Page 5: Motivating Patient Change · •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)

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?

Page 6: Motivating Patient Change · •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)

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

Page 7: Motivating Patient Change · •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)

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.

Page 8: Motivating Patient Change · •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)

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

Page 9: Motivating Patient Change · •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)

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.

Page 10: Motivating Patient Change · •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)

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?

Page 11: Motivating Patient Change · •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)

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

Page 12: Motivating Patient Change · •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)

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

Page 13: Motivating Patient Change · •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)

Where do We Direct Student Attention?

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

Page 14: Motivating Patient Change · •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)

Understanding Unsolicited Advice

Page 15: Motivating Patient Change · •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)

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

Page 16: Motivating Patient Change · •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)

When Does Change Become Possible?

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

• You can hasten the process with decisional balance exercises

Page 17: Motivating Patient Change · •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)

Facilitating the “Ah-ha” Experience

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

Sondra Anise Barnes

Page 18: Motivating Patient Change · •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)
Page 19: Motivating Patient Change · •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)

How Does Behavior Change

Behavior A Behavior B

Page 20: Motivating Patient Change · •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)
Page 21: Motivating Patient Change · •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)

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

Page 22: Motivating Patient Change · •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)

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?

Page 23: Motivating Patient Change · •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)

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

Page 24: Motivating Patient Change · •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)

Four Aspects of Acceptance

Acceptance

Affirmation

Absolute Worth

Autonomy

Accurate Empathy