Motivational Interviewing Techniques_Final

>> Do you like to take a hands-on approach when working with your clients? If you're a fan of exercises and worksheets or if you're just looking for something new to try with your clients then you are going to love this lecture. My favorite thing about motivational interviewing is a number of simple but powerful techniques offered by this approach. Many of these exercises are great in the context of coaching, and can be easily incorporated into your work with clients. In this lecture, I'll share with you five of my favorites. Scaling questions, the decisional balance, the Columbo approach, the therapeutic paradox, and affirmations. First, scaling questions. Scaling questions ask you to measure your opinion or the way you feel about something by choosing a numeric value from a range of numbers to represent your answer. Like, if someone asked you, "On a scale of 1 to 10, how much do you like ice cream?" Typically, with scaling questions, the lowest number represents the least likelihood or complete disagreement, while the highest number represents the most likelihood or complete agreement. Scaling questions are really useful for helping your clients assess their degree of importance, level of confidence, and willingness around an issue or idea. This type of question can help clients work through their ambivalence by clarifying their values and weighing them against one another and their readiness to change. Asking a sequence of scaling questions that elicits how a client rates the importance of a change followed by a rating of their confidence and willingness to change can help highlight the discrepancy of where they are and where they want to be. This opens up the door for clients to take an honest look at their barriers to change before they materialize in disrupt progress. Scaling questions are closed questions, but when paired with a simple why or open ended question, they can help your client to really think about where they stand on an issue or how they feel about something. For example, you can ask questions like, "On a scale of 1 to 10, how important is it for you to do this?" Take a moment to pause and let them answer, and then ask them why. And then you could ask, "How confident are you that you could make this change right now on a scale of 1 to 10? What would it take to go from a six to an eight? On a scale of 1 to 10, how willing are you to do all of the things that need to be done to get you to your goal? What would need to happen for that number to be higher?" The readiness to change ruler is a handy tool that utilizes scaling questions to assess a client's level of readiness to make a change. To help you incorporate scaling questions into your practice, we've included the readiness to change ruler in this module which you can use with your clients. Along with this handout is a list of powerful scaling questions you can ask while using the ruler to help track your client's level of confidence and willing to change throughout your work together. Pause the lecture here to check it out and then come back to learn about the four remaining techniques. Hi again. The second technique is the decisional balance. This is a great and easy-to-use tool to help your clients weigh the pros and cons of making a change, particularly for our clients who have visual, reading, or writing learning styles. We've included a blank worksheet in this module for you to use with your client, so be sure to check it out. Your clients are likely thinking about all the reasons why they want to make a change and all of the things that are holding them back. They come to us as coaches with this information floating around in their heads, overwhelming and confusing them. This often prevents them from thinking clearly and rationally about their goals, and so they're stuck, which is why they are seeking you out. So with the decisional balance worksheet, you're asking your clients to evaluate their current behaviors or habits while at the same time looking at what is and isn't serving them through their actions. The goal is to lead them to their own conclusion that they're deriving some kind of benefit from their current problem behavior, and that there will, therefore, be some kind of cost or sacrifice involved if they do decide to make their desired change. To do this, simply walk them through the worksheet by asking them to think about and jot down in the appropriate boxes the benefits to changing, the costs of changing, the benefits of staying the same, and the costs of staying the same. So let's take a look at an example. Let's say your client Sarah is thinking about eliminating her consumption of alcohol. She's been thinking about why she wants to do it, but also her reservations, and she's feeling confused, overwhelmed, and unsure about what to do. You suggest that she complete the decisional balance worksheet with you to help her map out her thoughts more clearly and look at the costs and benefits involved in making this change. You hand her the worksheet and guide her through it. You ask her, "How will you benefit physically and emotionally from giving up alcohol?" She writes down that she'll save money, improve her relationship, have more productive mornings, sleep better, and take in less calories. Then you say, "Okay, now let's think about the cost of quitting drinking. How will that affect you?" She writes down that her social life might change, going out with friends to bars might become boring, her friends might perceive her as boring, and she may find herself feeling socially awkward or left out of social situations where everyone else is drinking. Next you ask Sarah, "So let's say, you decide to keep alcohol in your lifestyle. What will you get out of this?" She writes down that she'll still have fun on the weekends, and get to enjoy going to parties and bars with her friends. She'll feel included and like she's part of the group. Lastly, you ask her to think about the cost of continuing with this lifestyle. She writes down hangovers, the financial cost of drinking, tired mornings, drunk arguments with her boyfriend, and feeling unhealthy and bloated after drinking. Now all of this information is clearly laid out on the table. You're in a place to ask some really great high-mileage questions, and Sarah has all of her thoughts about making this change right at her fingertips in an easily digestible way. You can ask her, "Which of these outcomes feels most powerful to you? What are some ways you could navigate a social life without alcohol?" You might want to do some role playing here so she could try it on for size and help her generate some alternatives such as joining a Meetup group instead of going out to the bar. You could even use scaling questions to assess her readiness to change. You could ask, "On a scale of 1 to 10, how ready do you feel at this moment to make those sacrifices you defined as the costs of giving up drinking?" The decisional balance is a way for your clients to see all sides of a given situation in a clear and concise way that's not cluttered by shoulds and maybes. By thinking through what they've gained as well as lose as a result of a behavior change they want to make, they can really consider what it is that they want, and what exactly they'll do, what will life be like if they continue down this path. You can guide them to take a look at how changing will create a better future for them, and ask them, "Which future are you committed to creating?" This exercise is also useful for helping your clients discover their subconscious beliefs and bigger wants. Does your client Sarah wan to give up alcohol or does she want to keep her friends? When posed that way, most people are going to choose the latter. So your job as a coach is to then look at how you can help her give up alcohol and maintain an active social life. In the end, this exercise should result in a higher level of commitment because your client has evaluated and taken ownership of the commitments they'd have to make if they were to decide that the benefits of changing outweighed the cost of staying the same. Next is the Columbo approach. This is a technique used to highlight the discrepancies in your client's statements or actions. The name was coined after the lead character in the 1970's television show Columbo who was a master of this skill. The Columbo approach is a way of gently challenging your client by getting them to see that they're contradicting themselves without passing judgment. Think of this approach as the on-the-one-hand-on-the-other-hand technique. What you're doing here is summarizing what your client's doing and presenting the information in such a way that it naturally points out that they're thinking of behaving in a conflicting manner. The goal is for them to recognize this for themselves without having to be straight up called out on what they're saying or doing which can run the risk of sparking defensiveness. Here's an example, your client Bill wants to eat healthier, yet despite his desire to change, he keeps finding himself at the drive-through. You say, "On the one hand, you want to eat healthy because you're at risk for another heart attack and you want to be around for the birth of your first grandchild. On the other hand, you're telling me that you had McDonald's for dinner last night. What's going on here?" Here's another example of the Columbo Approach. "So help me understand. I hear you saying you want to lose 15 pounds for your wedding, yet on the other hand, you're unwilling to cutback on your soda consumption which, we've discovered, is adding about 1,000 empty calories to your diet every single week. I'm wondering how you'd be able to reach your weight-loss goal in time for your wedding if you're going to continue down this path. What's the disconnect?" Framing this curious inquiries by opening with, help me understand, on one hand, or what I hear you saying, lets you present the contradiction in a way that's not blameful, non-judgmental, and helpful. When taking this approach, avoid starting off with you statements such as "You say you want to lose weight yet you're unwilling to give up soda." You statements sound critical and tend to put people on the defensive. Number four is the therapeutic paradox. This is another technique aimed to help clients through their ambivalence by raising their awareness of their contradictions. Think of the therapeutic paradox as a gentle confrontation that's designed to call your client's bluff when they're acting in a way that's contradictory to their goals. It's a helpful little trick to use with clients who've been working with you for a while but are making very little progress. Use the therapeutic paradox only after you've established a high level of rapport. A therapeutic paradox might sound something like, "You've been continuing to eat snacks and dessert every night and then you say you really want to release your excess weight. Maybe now isn't the right time for you to work on this goal." As you can see the therapeutic paradox is a little more challenging and confrontational than the Columbo approach. The goal is to get your client to argue for the importance of this change. This can be extremely powerful. These statements are designed to catch your client off guard and provoke them to correct you, thereby reaffirming their value of the outcome to you and to themselves. Obviously, there is a risk that your client will in fact agree with you, and say that maybe it's not as important to them as they originally thought it was or that the benefits of staying the same outweigh the cons of changing, but this is okay too. If your client's not really committed to their goals, or their needs and desires have shifted, you want to assess this and change the course of your work as soon as possible to make the most of your time with them. This type of statement, if it doesn't provoke a strong rebuttal by your client, it's designed to make them think. If they react with silence, hold this space for them. It's really important to sit with them in this silence while they think over the contradiction that they've been presented with, and the possibility that maybe they aren't really ready to change after all. If time passes and they don't have a response, usually the best way to proceed is to let it simmer. Tell them to think about it between now and your next session and be sure to bring it up and explore their thoughts the next time you meet with them. Finally, number five, affirmations. For our final technique, I'll leave you with this easy way to boost your client's confidence, love them up, and strengthen rapport. Affirmations in motivational interviewing are supportive responses you can make to positive things your client share with you in a way that sounds both genuine and encouraging. Affirmations are straight-forward, positive remarks that show your clients that you support them without sounding too over the top which can come off really fake. We want to convey to our clients that we support them and we want to love them up. But sometimes when trying to do this, we exaggerate our response. This actually ends up coming of insincere because our clients pick up on the fact that we are trying to sound supportive instead of actually being supportive. It also runs the risk as coming off as sarcasm. For example, if your client says they went jogging in extra time this week, and you respond with, "Wow, Kenneth, that's amazing. I'm so proud of you and your efforts. I knew you could do it." You could be trying to love them up and empower them, but they might interpret this level of enthusiasm as patronizing. An affirmation might sound something like, "It's so clear to me that you're committed to your goal, and I really admire the effort you've put in this week. I hope you're as impressed with yourself as I am." Or "With all of the stressful situations and obstacles you're navigating right now, I think it's amazing that you've been able to continue to abstain from smoking this week." Use affirmations to positively reinforce, and recognize your client's successes, strengths, and efforts. You can affirm their positives as frequently as you see fit, which will make your clients feel valued without running the risk of sounding too sugar-coated. In this lecture, we've gotten over how to use scaling questions, the decisional balance, the Columbo approach, therapeutic paradox, and affirmations as techniques to use with your clients to help them work through their ambivalence, and move them forward toward being and staying committed to their goals. Which one of these techniques appeals to you the most? Pick one to try out with your clients or a coaching partner this week, and then let us know how it worked out in the comment section of the Facebook group page. Thank you so much for joining me today. I hope you've enjoyed this lecture, and I'll see you next time.