Week 7 Homework
Developing and Building Discrepancy
We found we had to make haste slowly. –Bill W.
Given a choice between changing and proving that it is not necessary most people get busy with the proof (Latchford, 2010). Change tends to occur when a person perceives a significant discrepancy between important goals or values and the status quo. In order to be motivating, a discrepancy needs to be large enough to encourage change but not so large as to be demoralizing. A variety of MI strategies can be used to instill (infuse slowly) discrepancy with the bounds of the person’s own values.
As you begin to establish a therapeutic alliance, the client will begin to acknowledge that something is not right in their environment, but may spend more time and energy in session disavowing that they really need to change. Therefore, your role is to encourage client’s to think about change, evoke and strengthen the client’s existing argument (ambivalence) for change through an honest discussion about the consequences of not changing as well as changing.
But what about clients who do not seem to be ambivalent? In the precontemplation stage, there is no change talk to evoke. Consider these examples of “unmotivated” clients. Provide commentary for each example regarding the process of how to instill discrepancy collaboratively with the client. Be specific with your chosen strategy for developing discrepancy and highlight the what, how and why.
Do not use proposed dialogue for this assignment. Please provide a narrative reflecting your general approach to what, how and why.
1. A patient being treated at a trauma center for injuries sustained in an alcohol-related crash, who blames the other driver and has no apparent personal concerns about drinking.
2. A teenager brought to treatment by concerned parents who discovered marijuana and drug paraphernalia during a room check. The teen is incensed about being check up on and regards cannabis as harmless.
3. A pregnant woman who expresses no intention to quit smoking or using methamphetamine.