Introduction to behaviour change counselling - South African Health ...

Introduction to behaviour change counselling - South African Health ...

Introductionto behaviourchangecounsellingProf Bob Mash,Division ofFamily Medicineand Primary Care,Stellenbosch University

Levels of motivationalinterviewingMIBehaviourchangecounsellingCorridor conversations

What behaviours do we ask ourclients to change?


Definition of MI“We emphasize that MI is a method ofcommunication, rather than a set oftechniques. It is not a bag of tricksfor getting people to do what theydon’t want to do. It is not somethingone does to people: rather, it is afundamental way of being with andfor people – a facilitative approachto communication that evokesnatural change” Miller and Rollnick,2002Miller&Rollnick (2002) MotivationalInterviewing;

Definition of MI“Motivational Interviewing is aclient-centred, directive method forenhancing intrinsic motivation forchange by exploring and resolvingambivalence”Millar and Rollnick, 2002Miller&Rollnick (2002) MotivationalInterviewing;

Key concepts

Ambivalence – the conceptualanchorThe coexistence inone person ofcontradictory andincompatibleemotions or attitudesand the tensionarising as aconsequence“I need to but I don’t want to”Miller&Rollnick (2002) MotivationalInterviewing;

Motivational tension: inside the mind of a smoker--the desire to stopversus the need to smokeAveyard, P. et al. BMJ 2007;335:37-41Copyright ©2007 BMJ Publishing Group Ltd.

Motivational tension – inside the mind of a woman who isexpected to negotiate use of a condomMash R, Mash B, de Villiers, P. ‘Why don’t you just use a condom?’: Understanding the motivational tensions in the mindsof South African women. Afr J Prm Health Care & Fam Med. 2010;2(1), Art. #79, 4 pages. DOI: 10.4102/phcfm.v2i1.79

What behaviours haveyou thought aboutchanging?

Motivational tension – inside your mind!The advantages of CHANGINGmy behaviour are… / thedisadvantages of notchanging my behaviour are…The advantages of NOT CHANGINGmy behaviour are… / thedisadvantages ofchanging my behaviour are…

Stages of readiness tochangeProchaska & DiClementecontemplation2 3preparation /determinationprecontemplation14actionrelapse6permanent exit?5maintenance

Where would you placeyourself in this cycle?

How do you feel aboutchanging?• On a scale of 1 to 10 how IMPORTANT isit for you to change your behaviour?• On a scale of 1 to 10 how CONFIDENT areyou that you could change yourbehaviour?

Dimensions of readiness tochangeHIGHIMPORTANCEA“I’d liketo, buthow?”READIN ESSC“I’m willing,able & ready”B“I could, butwhy should I?”CONFIDENCELOWHIGHSource: Rollnick, Mason & Butler 1999

Change talk…Amount ofchange talkActualchangeMotivationalinterviewingAmount ofchange talk

We talk ourselves intochangingWhat is change talk?

Recognising change talkin normal conversation• I’ll be there now now• I’ll try to get to it• I’ll think about it• I might be able to• I promise I’ll do it today• I need to do this

Summary• Ambivalence• Readiness to change– Stages of change– Dimensions of importance / confidence• Eliciting change talk

Three styles ofinteraction

Three communicationstylesFollowingDirectingGuiding

“MI is a refined form ofguiding”

Video 1What are the characteristics ofthis style in behaviour changecounselling?

Video 2What are the characteristics ofthis style in behaviour changecounselling?

Key global characteristics•Empathy•Evocation•Collaboration•Autonomy/support•Direction

Dancing or wrestling?

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