How to overcome harmful behaviors

Motivate clients with harmful behaviors to behave in a health-promoting manner. Possible solutions

Table of Contents

1 Introduction

2. Change is a process

3. Accompany change processes with motivating conversations
3.1. What is motivational interviewing?
3.2 The effectiveness of motivational interviewing
3.3 The application of motivational interviewing
3.3.1 The principles and skills of the motivational approach
3.3.2 Accompanying the client from case study 1
3.3.3 Accompanying the client from case study 2

4. Conclusion

5. Bibliography

6. Appendix

1 Introduction

Our own health is a valuable asset for us humans. According to the model of salutogenesis (salus, Latin = healthy; genesis, Greek = origin) by Aaron Antonovsky (1997), health can be understood as an ongoing process in which health and disease form a smooth transition on the health-disease continuum . Every person moves within this continuum sometimes more to one side, sometimes more to the other side. Health is therefore not a constant state, but rather to be viewed as unstable and must therefore be actively maintained.

In addition to external influences, such as stress in everyday life or the occurrence of pathogens, our own behavior patterns also play a major role in whether we tend to move in the direction of health or illness. We can promote our own health through behaviors such as active stress reduction, relaxation, regular exercise, adequate sleep or a balanced diet. However, those who hardly move, tend to eat fast food and sweets, smoke or cannot cope with stress well, damage their health and tend to move towards illness. Most people should be aware that by their own behavior they can determine for themselves in which direction they are moving.

If one regards health as an unstable state that has to be achieved again and again, this means for the individual person to perceive their own behavior again and again and, if necessary, to change them in the direction of health promotion. Some people find it relatively easy to change their behavior and cope with it very well on their own. But there are also people for whom changes are very difficult or who have little or no motivation to do so. I was now wondering how I could motivate such people in my consulting work to change their behavior in the direction of health promotion. The two key questions of my housework are therefore:

→ How can I motivate clients to adopt health-promoting behaviors that do not want to change themselves?

→ How can I help clients who would like to change behavior that is harmful to health, but who do not trust themselves to do so?

To make the whole thing a little clearer, I would like to add two case studies to which I will refer again and again in the course of my remarks:

- Case study 1: A 50-year-old executive from a medium-sized company comes to see me for advice because his wife and doctor advised him to do so. He had a minor heart attack a few weeks ago and his doctor strongly recommended that he view this as a warning and do more for his health in the future. However, he himself is of the opinion that he does not have to change anything, as it has been the case up to now and there are many things that he could not influence anyway, such as the stress at work. This client is not at all motivated at the moment to change anything in his behavior.
- Case study 2: A 30-year-old woman with weight problems turns to me because she has had knee problems for a long time and would now like to reduce her weight. She has realized that she has to change her behavior in order to get her weight problems and knee problems under control in the long term. However, she does not believe that she can do it on her own, which is why she is now looking for support from me. Thus, this client is quite motivated to change her behavior. But she lacks the confidence and trust in her abilities to cope with this task.

The inner (= intrinsic) motivation seems to play a decisive role in whether and how someone approaches a problem and changes their behavior in the future. For the clients described above, the concept of Motivational interviewing to present a suitable opportunity to work with them on their problem. I would therefore like to briefly introduce the concept in my term paper and discuss how I could apply it for the two clients.

But first, I will deal with the topic of “change” in general.

2. Change is a process

So far, no one has changed overnight. Changing one's own behavior is always a process of varying duration. One way to explain this process is that developed by Prochaska and DiClemente Transtheoretical model. This model is 'a concept for describing, explaining, predicting and influencing intentional behavioral changes' (Wikipedia, 2015, p. 1). The transtheoretical model is also referred to as the stage model of change, since Prochaska and DiClemente assumed that 'change processes go through several qualitatively different and successively building stages' (Wikipedia, 2015, p. 1). In addition, the model was adapted to different health behaviors, e.g. B. Tobacco smoking, alcohol consumption, diet and physical activity (see Wikipedia, 2015, p. 1). The six stages of behavior change are:

- Unintentionality (= Pre-contemplation): "I have no problem and don't have to change"
- Intention Formation (= Contemplation): "I should change my behavior at some point."
- preparation: "I plan to change my behavior now."
- plot: "I'm starting to change my behavior now."
- Maintenance: "I always behave differently than I used to."
- Permanent exit or relapse: A change in behavior does not always succeed immediately. Relapses happen often and the person then starts the cycle of change again at the first or second stage.

If I now apply this stage model of change to my two case studies from the introduction, I would be client number 1 in the first stage of the Unintentionality Classify (pre-contemplation). He is of the opinion that he doesn't have to change anything, since it has been the case up to now. He lacks the inner motivation to change. The client in example 2, on the other hand, would be the second level of Intention Formation (Contemplation), because she has recognized in principle that she has to change something, but does not trust herself to do so. She is self-motivated, but has doubts about her ability to make a change. As a result, she gets stuck in the non-intentional phase and cannot move on to the third stage of “preparation”.

According to Catherine Fuller and Phil Taylor, motivational interviewing is particularly useful for working with clients who are in the first two phases of change: 'Motivational principles and skills are particularly effective when working with people who are in pre-contemplation - or are in the contemplative phase of a change '(Fuller & Taylor, 2012, p. 25).

Therefore, in the following I turn to the concept of motivational interviewing and the associated principles and skills.

3. Accompany change processes with motivating conversations

3.1. What is motivational interviewing?

The concept of motivational interviewing was developed in the 1990s by William Miller and Stephen Rollnick and is also known as motivational interviewing. You yourself describe motivational interviewing as 'a client-centered, directive method to improve the intrinsic motivation for change by exploring and resolving ambivalences' (Miller & Rollnick, 2009, p. 47). In psychology, ambivalence means dichotomy or diversity, such as the simultaneous occurrence of joy and sadness. Ambivalences play a major role in change processes, which I will go into in more detail later. Miller and Rollnick explain their definition a little more precisely (see Miller & Rollnick, 2009, pp. 47 - 48):

Motivating conversation ...

→ is a further development of the client-centered approach by Carl Rogers and is therefore entirely geared towards the client's current interests and concerns

→ is deliberately directive (= the consultant deliberately steers the conversation in certain directions, author's note) and thus differs from the “non-directive” method described by Carl Rogers

→ can be seen as a communication method rather than just a collection of techniques and is not a box of tricks for manipulating people

→ works on creating intrinsic (= inner) motivation of a person for a change and thus differs from motivating strategies that want to bring about changes from the outside, e.g. through reward or punishment

→ sees the exploration and resolution of ambivalences as the key to bringing about change and thus concentrates on motivational processes within the person that promote change

Miller & Rollnick originally developed the motivational conversation approach for the treatment of alcohol patients. In the meantime, this approach has been successfully applied to many other health topics when it comes to 'supporting people in developing, implementing and maintaining their own motivation for healthier behavior' (Mück, 2014, p. 2). The case studies I have described are initially about supporting clients in developing and implementing their own motivation for healthier behaviors, which is why I consider motivational interviewing to be very suitable in both cases.

3.2 The effectiveness of motivational interviewing

I have now asked myself what advantage motivational interviewing has over other methods and which is why it is particularly valuable for my clients. Just like Carl Rogers' client-centered approach, motivational interviewing differs from other approaches in that the counselor has certain skills in dealing with clients. Through empathic understanding (= empathy), unconditional acceptance and appreciation of the client, as well as a real appearance (= congruence) of the counselor, conducive conditions for a change in behavior in the counseling session are created. (see Miller & Rollnick, 2009, p. 21). For me, that would mean facing my two clients as a “real person” without hiding behind a professional role, accepting them with all sides of their personalities, that is, appreciating them even with their lack of motivation and always trying to understand their views and actions and reflect them on them. For me, the focus is always on the interests, values ​​and goals of the clients. I find this approach very valuable for clients as it allows them to be viewed as equal partners instead of falling into the roles of the professional and the needy.


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