Congratulations! Because of your finetuned Motivational Interviewing skills and strategies, your client has moved to the Contemplation Stage. At this stage, we want to help a client move to the Preparation Stage, which increases commitment on the part of the client to change.
Our client is considering the possibility of change, he acknowledges concerns about target behavior but he is ambivalent and uncertain about change. His commitment to change is moderate, his self- efficacy/confidence is low, his temptation is high and his information seeking is high. In order for our client to move to the next stage, his decisional balance must shift in favor of change and commitment must be made to change his behavior.
There are 3 Stages or Specific Processes of Change in the Contemplation Stage:
Self-Evaluation-Client assesses and explores one’s self-image in relation to the target behavior in order to create dissonance toward the target behavior.
Environmental Reevaluation-When the client recognizes the impact of the target behavior on others and the risks of continuing behavior vs. the rewards/benefits of changing the behavior
Social Liberation-Client identifies how others support and encourage behavior change
There are certain specific Motivational Strategies that we use to help the client move from the Contemplation Stage to the Early Preparation Stage
Normalize and explore ambivalence associated with target behavior (“I want to change, I think?)
Assist the person to “tip the decisional balance” in favor of change by: Eliciting and weighing the pros and cons of target behavior and change. Changing focus from extrinsic motivation (“My husband wants me to do this”) to intrinsic motivation (“I want to change to make my life better”) Examine personal values in relationship to change and target behavior (“I know stealing is wrong but in my addiction I do it often”) Emphasize free choice, self-determination, responsibility and self-efficacy for change. (“You get to decide what course of action you want to take and how you’re going to do it”)
Elicit self-motivational statements of intent and commitment to change
Elicit beliefs, attitudes, and expectations regarding self-efficacy/ confidence for change and treatment
Summarize, reflect, and emphasize self-motivational statements as the focus of treatment
Develop discrepancies between values, goals and hopes for the future as well as current situation and behavior
As our client moves through this Stage, our job is to continue to motivate client toward commitment to change. In the late Preparation Stage, the client’s commitment to change must still be reinforced. They are starting to think about goals, but vacillation is to be expected at anytime. The following are strategies for enhancing commitment at this point:
Take small steps-The client is exploring options and we continue to remind him he gets to make his own choices. The client can feel overwhelmed at this point and our job to reassure him he can moderate the pace of change. It might be helpful to provide a case history of someone who made large and seemingly impossible life changes by taking one step at a time.
Going public-Disclosing the desire to change to another person besides the clinician seems to be very important in helping clients become accountable as well as becoming aware of any inner resistance.
Envisioning-Help client envision a different life after changes are made. Ask clients to picture themselves after a year has passed, during which time they have made changes in their target behavior. Some clients may find it valuable to write a letter to themselves that is dated in the future and describes what life is like at this point.
Support the client’s self-efficacy/ confidence. Self-efficacy is a dynamic rather than a static construct. Self-efficacy can be thought of as hope or optimism. Self-efficacy for coping with each specific situation increases with success and decreases with failure. It is our job, as clinicians to give clients skills to be successful in situations that present a risk of reoccurrence of target behavior. These skills also enhance their belief that they can maintain desired changes.
We can also support their self-efficacy by stressing that change is a gradual process, by focusing on new skills versus cessation of “immoral” activity, and providing timely and specific feedback regarding progress. We can see our client has moved from Contemplation to Preparation when the client is committed to change and looking ahead to goal setting and learning skills to achieve these goals.
As counselors who use Motivational Interviewing we must always remember to use the 5 underlying principle MI techniques:
Express empathy
Develop discrepancy
Avoid argumentation
Roll with resistance
Support self-efficacy
For more information and resources, please visit SAMHSA.gov, under the Treatment Improvement Protocol (TIP) 35.
By: Ellen J. Eggert, CADCII, SASII