Ambivalence: Helping people change

A.	What is ambivalence?
	1.	What is motivation?
	2.	What do you expect to learn here?
B.	Motivation Favorite Teacher exercise: Think of a teacher or mentor from grade school or high school that motivated you. What was it about them that motivated you?
C.	Exercise: Brainstorm
	1.	Take a couple of minutes to write down what you do or what you can do to help someone make a commitment to change.
	2.	(List on board)
	3.	Ask group to keep these in mind as we go along
D.	Exercise: Used car salesperson
	1.	Break into pairs
	2.	One is a used car salesperson--other is needing to buy a car
	3.	Do exercise
	4.	Come back as group: Start with salesperson: What worked? What didn't work? Then to client: What worked for you? What didn't work?
E.	Didactic - Stages of Change
F.	Create conditions for change: The Process:
		Recognize that ambivalence is normal
		Be aware that people are in different places and any given time. They are not in "an exact stage".
		Provide opportunities for clients to explore their ambivalence:
		>	Listen
		>	Resistance is a signal that you have to do something different.
G.	Exercise: Good vs. Less good things: A Strategy
	1.	Break into pairs.
	2.	Ask client to have something they feel two ways about
	3.	Counselor is to ask them what they like about the situation and what they LIKE LESS about the situation.
	4.	Then you are to listen, reflect and eventually summarize.
	Step 1: Ask open-ended question: "What do you like about..." "What are some of the advantages of..." "What are some of the good things about..."
	Step 2: Listen, Listen, Listen...: Listen without interruption Listen without judgement *Be attentive, but silent
	Step 3: After listening, summarize: "So lets see if I understand you. You said that the good things are... (list them).
	Step 4: Ask the reverse open-ended question: "On the other hand, what do you dislike about..." "What are some of the less-good things about..." "What are some of the disadvantages of..."
	Step 5: Listen, Listen, Listen...: Listen without interruption Listen without judgement *Be attentive, but silent
	Step 6: After listening, summarize both sides of the ambivalence. Start with the reasons for not changing, followed by reasons for changing: "So some of the good things are...(list them) "On the other hand, the less good things are...(list them)." "Some of the advantages are (list)...The disadvantages are...(list).
	Step 7: Ask if you "got it all"
	Step 8: Ask about the next step: "Where does that leave you now?" "Where does ______fit into your future?" "Where would you like to see yourself go from here?"
H.	Exercise: The Ruler
	1.	Ask the client to choose a number between 0 and 12 which indicates how "ready" they are to consider________.
	2.	Explore why they chose that number. (read exercise)
	Ask client to answer the following: "On a scale from 0 to 12, how ready are you to consider______?" ("to consider" can mean many things. It can mean considering stopping use of a substance; consider using condoms, considering getting a job etc.)
		You can also use a ruler, if available and it "fits" for your client and situation.
		Encourage elaboration: "Why a (6, 4, 10, etc.) (LISTEN!)
		Ask strategic open-ended "scaling" questions to encourage "change talk"
		Backwards questions: "Why did you pick a 4 and not a 1?"
		Forwards question: "What would it take for you to move from a 6 to an 8?"
		Future questions: "Lets suppose you were an 11 sometime in the future. Why might you be interested in _______?" "How do you think your life would be different if you were an 8 instead of a 3?"
		Summarize
		Ask if you "got it all"
		End encounter by asking: "Where does this leave you now?"
I.	Exercise: Giving Advice
		Ask them if they would like to hear about things that have worked for others. Always ASK if they want to hear what you have to say.
		List them...as many options as possible
		Ask them if any of these are things they could or would be willing to try. Which ones: Always provide choices
	Exercise:
		Break down into pairs
		Demonstrate: How to give information that is not pushing, threatening For example: One person is not eating well and is quite overweight. The other is a health worker who provides education and information on how to reduce risk, lose weight etc.