Enhancing Motivation To Change: Pitfalls For Clinicians Symposium

Motivation for change is an important first step in treating substance use disorders (SUDs). Motivation relates to the probability that a person will enter into, continue, and adhere to a specific change strategy. Once viewed as an unmodifiable function of personality traits, motivation today is viewed as multidimensional, dynamic, and modifiable by specific clinician interventions. The transtheoretical model (TTM) and self-determination theory (SDT) are two major theoretical frameworks that explain the motivation for change. Major assessment scales and clinical guidelines base the assessment of motivation on these constructs. However, these models themselves are insufficient in portraying this multifaceted phenomenon. The assessment of motivation is complex and requires an understanding of the client and his circumstances. It runs parallel to efforts to enhance it and is often influenced by the counsellor’s style. Any clinical strategy that enhances client motivation for change is a motivational intervention (MI). Such interventions can include counselling, assessment, and feedback. They can occur over multiple sessions or during one brief intervention, and they can be used in specialty SUD treatment settings or other healthcare settings. MI comprises of multi-element approach including FRAMES, decisional balancing, developing discrepancy, flexible pacing, and maintaining contact with clients. MI is the most widely used approach in SUD treatment. This symposium is an overview of motivational counselling approaches. It describes elements of effective motivational counselling approaches, including FRAMES, and provides an overview of the spirit of MI, the principles of person-centered counselling, the core counselling skills, and the four processes of MI. We will discuss strategies physicians can use to help clients raise doubt and concern about their substance use and move toward contemplating the possibility of change, increase commitment to change, and focus on how and when to develop change plans with clients. Finally, we will be addressing strategies to help them maintain the gains they have made by stabilizing change.