building motivation for change as a platform for return to work

Michael Sainsbury

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“I’m in too much pain to work – I don’t think I could ever go back!”

“I’m in too much pain to work – I don’t think I could ever go back!”

“There’s no point searching for a job – no one’s going to employ me!”

“There’s no point searching for a job – no one’s going to employ me!”

“I’m too scared to do anything – because I might reinjure myself!” “I’m too scared to do anything – because I might reinjure myself!”

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“After all, when you seek advice from someone, it’s certainly not because you want them to give it. You just want them to be there while you talk to yourself.”

“People are more likely to be persuaded by the reasons they have themselves discovered, than by those that come into the minds of others.”

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It’s not that the individual is ‘unmotivated’!

What drives the individual?

What is it that motivates their behaviour?

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Willingness to change

Ability to change

Readiness for change

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Explore the individual’s feelings of ambivalence to understand their motivations For what is the injured worker motivated?

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Ambivalence

“I want to, but I don’t want to” dilemma

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Motivational Interviewing

A worker-centred, directive method for enhancing intrinsic motivation to change by exploring & resolving ambivalence

A soft way of asking workers to take a hard look at themselves

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Develop Discrepancy

Express Empathy

Avoid Arguing

Roll with Resistance

Support Self-Efficacy

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Develop Discrepancy

Motivation for change can occur when the worker recognises the discrepancy between where they’re at & where they want to be in their life

Explore ‘looking back’ & ‘looking forward’

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Express Empathy

Reflective listening to understand & accept

the worker’s perspective-without judging, criticising or blaming

When the worker feels understood-more able to open up & share their experiences

Acceptance & respect facilitates a positive

working relationship

- builds self-esteem for promoting change

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Low Empathy

Low Control

High Empathy

High Control

Low Empathy

High Control

HIGH EMPATHY

LOW CONTROL

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Avoid Arguments

Positive approach that avoids direct confrontation & arguing

Don’t push for change

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Roll with Resistance

Avoid challenging the worker’s resistance to change-‘roll with it’ or it may lead to strongly defending their current position

Use the worker’s ‘momentum’ to further explore their views

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Support Self-Efficacy

Individual’s belief in their ability to succeed Worker’s belief that change is possible is an important motivator

Highlight changes the worker has previously made in their lives to develop a belief that change is possible

Enhance the worker’s confidence in their capacity to cope with obstacles & succeed in change

Stages of Change

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