I teach Motivational Interviewing to many different audiences, and am often asked how the behavior change theories such as Stages of Change interface with MI. Are they separate? Competing? How can I use them together in my practice?
The table below is from a wonderful manual designed for use with college students, to help them assess their use of alcohol and to decide if they wish to change. The manual relies on MI theory and techniques. The author, Linda Dimeff, has done a wonderful job of putting these 2 sets of ideas, Stages of Change and Motivational Interviewing, together.
Let me highlight one of the important ideas in this table. People who are in the precontemplation stage are not at all interested in changing. As a counselor/therapist, your only job is to raise doubt about the person’s current behavior. Trying to convince someone at this stage that change would be a good idea doesn’t work, and may actually alienate them. Your job is to talk with the person, and learn more about their personal goals and values. You are looking for a possbile discrepancy between what is important to this person and their current behavior.
Let’s look at the example of a college student to whom academic performance to maintain his scholarship is very important. He tells you that he drinks 2 or 3 nights a week, and often feels hung over the next day. Here is the discrepancy for this student, between what is very important to him, and his use and possible abuse of alcohol. In MI we say discrepancy is the engine of change.
Therapist Motivational Tasks
| Client’s Stage of Readiness |
Therapist Motivational Tasks |
|
Precontemplation |
Increase doubt; raise client’s perception of risk and problems with current behavior |
|
Contemplation |
Tip the balance of ambivalence in the direction of change; elicit reasons to change, and identify risks of not changing. Strengthen client’s self-efficacy for changing behavior. |
|
Preparation |
Help client ID best course of action for initial change. Reinforce movement in this direction. |
|
Action |
Continue to help the client take steps towards change. Provide encouragement and reinforcement for action steps. |
|
Maintenance |
Teach client relapse prevention skills. |
*From: Dimeff. L, Brief Alcohol Screening and Intervention for College Students (BASICS), 1999.
