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Substance Abuse and Brain Injuries

Motivational Interviewing

Background
General Principles
Three Phases
PDF Version of Motivational Interviewing

Three Phases

Phase 1
Build Motivation to Change

In this phase, strategies are used to help a person move from Precontemplation to Contemplation. (See Stages of Change Theory also in Utilities Series.)

Therapists build motivation to change in the following ways:

Educating clients on the effects of substance use on brain injury recovery. The goal of education is to provide factual information which will develop discrepancy in personally held beliefs about use.
Providing structured feedback of assessment instruments. The purpose of feedback is again to educate and develop discrepancy.
Listening with empathy.
Reflecting client statements.
Questioning the client about personal feelings, ideas, concerns and plans. Work within the client's personal agenda.
Affirming the client. Maintain an atmosphere in which the client is encouraged to initiate actions and responses that are appropriate.
Handling resistance with reflection and shifts of focus. Recognize resistance as a hallmark of Precontemplation and not an invitation to be confrontive in a combative way.
Reframing client statements. Use reframing to open up other options and possible solutions or responses.
Summarizing Repeating information and client responses, as well as summarizing decisions and agreements throughout the session, helps to maintain agreement, eliminate misconceptions, and reinforce decisions and self-motivational statements.

Phase 2
Consolidate Commitment to Change

In this phase, strategies are used to help a person move from Contemplation to Action. (See Stages of Change Theory also in Utilities Series.)

Therapists consolidate commitment to change in the following ways:

Creating a balance sheet Give reasons to change. Make a chart with the reasons for change on one side and the reasons not to change on the other.
Recognizing readiness to change Watch for self-motivational statements or statements of doubt about current status or changes in behavior, posture or other non-verbals.
Timing the move between strategies to match the client's need. The therapist's decision of when to ask for commitment, when to involve others, and when to move from one strategy to another must be natural and not contrived. Beware of premature closure. Be sure the decision is the client's.
Offering a menu of plan alternatives. Provide a range of options, developed with the help of the client.
Stressing personal choice and responsibility for decisions increases initiative.
Recapitulating Summarize the progress to date and build on the client's successes.
Asking for commitment Timing is critical, but ask for commitment for action rather than assuming it. Optimally, put it in writing and give each party a copy.
Involving the significant other If the significant other is supportive of recovery, then use these social supports to consolidate commitment for change.
Emphasizing abstinence, but not demanding it as the only alternative. Accept smaller steps toward abstinence.
Handling resistance with reflection, reframing, or returning to Phase 1 strategies - Developing a change plan worksheet.