What Works Curriculum
Thinking for a Change, Motivational Interviewing & Communicating for a Change
Thinking for a Change (T4C) Training:
The T4C curriculum was developed by the National Institute of Corrections (NIC), and consists of 22 group sessions. Groups are limited to 12 participants and may be delivered up to three times per week. Each group is led by certified facilitators who have completed a National Institute of Corrections (NIC) developed training program for Thinking for a Change. Facilitators are required to follow a scripted manual explicitly stating the content and objectives of each session. Sessions include role-play illustrations of concepts, a review of previous lessons, and homework assignments in which participants practice skills learned in the group.
Cognitive Restructuring; Sessions 1 - 9:
- Sessions 1-4 include introductions, expectations of participants, and a course overview with illustrations of the three main parts of the program: cognitive restructuring, social skills, and problem solving. Beginning sessions focus on cognitive restructuring and cognitive self-change, involving self-evaluation and self-correction. These sessions attempt to teach youth to self-reflect, to recognize underlying attitudes, beliefs, and feelings, and to change those when they are maladaptive.
- Sessions 5-6 focus on teaching and practicing the objective observation of thoughts, feelings, and attitudes. Participants learn to use “thinking reports” (structured, objective reports of thoughts and feelings) to recognize their thoughts, feelings, attitudes, and beliefs in an objective, non-argumentative manner.
- Session 7 teaches juveniles to recognize those cognitive processes that lead them to trouble, where “trouble” is defined as “breaking a rule or hurting someone.”
- Session 8 is devoted to helping participants find new, more adaptive thinking that reduces their risk of doing something hurtful or criminal.
- Session 9 focuses on practicing all of the steps of cognitive self-change via “thinking check-ins.” A thinking check-in consists of participants reporting a situation in which they were at risk of doing something harmful, recording the accompanying thoughts and feelings they had, identifying the risk in those thoughts and feelings, and describing the new thinking they used or could have used.
Social Skills Training
Sessions 10 - 15: Although social skills training is embedded in the program curriculum from the first session, Sessions 10-15 focus explicitly on building social skills while continuing to strengthen and reinforce cognitive restructuring.
- Sessions 10-12 constitute exercises in empathy training and perspective taking: Session 10 is devoted to extra practice focusing on identifying feelings; Session 11 is designed to help participants understand the feelings of others; Session 12 equips participants to respond to others’ feelings.
- Session 13 teaches participants to prepare for, and have, stressful conversations.
- Session 14 provides group members with skills to manage and respond to their anger in a manner that will reduce the risk of acting out.
- Session 15 teaches participants adaptive ways of dealing with accusations of wrong-doing, whether true or false.
Sessions 16 - 22: These sessions provide participants with tools they can use to more effectively “navigate their world” and avoid trouble. Problem solving in this program is designed to integrate the skills of cognitive restructuring and social skills; concepts from the first 15 sessions continue to be practiced and reinforced.
- Session 16 teaches group members to recognize the “conflict cycle,” a cycle of thoughts, feelings, beliefs, and actions that tend to escalate problem situations.
- Sessions 17-22 Participants are introduced to 6 problem solving steps, each of which is addressed and practiced in its own lesson in . These steps are: 1) stop and think; 2) describe the problem; 3) get information to set a goal; 4) consider choices and consequences; 5) choose, plan, do; 6) evaluate.
Motivational Interviewing (MI) Training
Motivational interviewing is a directive, client-centered helping style for eliciting behavior change by helping clients explore and resolve ambivalence. MI is a technique that gets youth to change themselves by increasing their own desire to change. It helps them see the benefits of moving in a new direction by leading the youth through a comparison between his or her goals and his or her current behavior. The goal is to create tension in the youth, and to place the youth in charge of the process of resolving the tension in pro-social ways. The focus is on getting the person to rely on inner motivation rather than external control. Rollnick and Miller summarize the characteristics of MI as:
- Motivation to change is elicited from the client, and not imposed from without. Other motivational approaches have emphasized coercion, persuasion, constructive confrontation, and the use of external contingencies (e.g., the threatened loss of job or family). Such strategies may have their place in evoking change, but they are quite different in spirit from motivational interviewing which relies upon identifying and mobilizing the client's intrinsic values and goals to stimulate behavior change.
- It is the client's task, not the counselor's, to articulate and resolve his or her ambivalence. Ambivalence takes the form of a conflict between two courses of action (e.g., indulgence versus restraint), each of which has perceived benefits and costs associated with it. Many clients have never had the opportunity of expressing the often confusing, contradictory and uniquely personal elements of this conflict, for example, "If I stop smoking I will feel better about myself, but I may also put on weight, which will make me feel unhappy and unattractive." The counselor's task is to facilitate expression of both sides of the ambivalence impasse, and guide the client toward an acceptable resolution that triggers change.
- Direct persuasion is not an effective method for resolving ambivalence. It is tempting to try to be "helpful" by persuading the client of the urgency of the problem about the benefits of change. It is fairly clear, however, that these tactics generally increase client resistance and diminish the probability of change (Miller, Benefield and Tonigan, 1993, Miller and Rollnick, 1991).
- The counseling style is generally a quiet and eliciting one. Direct persuasion, aggressive confrontation, and argumentation are the conceptual opposite of motivational interviewing and are explicitly proscribed in this approach. To a counselor accustomed to confronting and giving advice, motivational interviewing can appear to be a hopelessly slow and passive process. The proof is in the outcome. More aggressive strategies, sometimes guided by a desire to "confront client denial," easily slip into pushing clients to make changes for which they are not ready.
- The counselor is directive in helping the client to examine and resolve ambivalence. Motivational interviewing involves no training of clients in behavioral coping skills, although the two approaches are not incompatible. The operational assumption in motivational interviewing is that ambivalence or lack of resolve is the principal obstacle to be overcome in triggering change. Once that has been accomplished, there may or may not be a need for further intervention such as skill training. The specific strategies of motivational interviewing are designed to elicit, clarify, and resolve ambivalence in a client-centered and respectful counseling atmosphere.
- Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction. The therapist is therefore highly attentive and responsive to the client's motivational signs. Resistance and "denial" are seen not as client traits, but as feedback regarding therapist behavior. Client resistance is often a signal that the counselor is assuming greater readiness to change than is the case, and it is a cue that the therapist needs to modify motivational strategies.
- The therapeutic relationship is more like a partnership or companionship than expert/recipient roles. The therapist respects the client's autonomy and freedom of choice (and consequences) regarding his or her own behavior.
Motivational Interviewing is used in conjunction with a "Stages of Change" approach. This conceptualization of the change process helps staff understand where the youth is in terms of readiness for change.
- Pre-contemplation: The juvenile is not aware of the need to change. "My life would be great if you would just get off my back!" Youth is not interested in change and is resistant to the suggestions that they need to change.
- Contemplation: The youth considers and likely rejects change, makes excuses, attempts avoidance, minimization, generally trying to talk her/himself out of the realization that there is a problem. The task is to "tip the balance" by evoking contradictions and reasons for change, helping the youth to discover the risk in not changing, and developing "ends-means reasoning skills."
- Determination: “I see the problem—I'm on board to make a change.” Commitment takes place here, but commitment and behavior are two different things. The youth wants to change. However, s/he probably has no idea how to begin, and most likely cannot do it alone.
- Action: The youth is doing lots of things to bring about positive change (attending counseling, new support systems, and avoiding criminal associations.) The greatest evidence of change is changing their associations.
- Maintenance: New skills and good intentions are not enough to sustain change. Different skills are needed for long-term success.
- Relapse: An important task is to differentiate between a genuine failure and the repetition of an old behavior the youth had not really intended to change.
MI and the stages of change approach helps eliminate power struggles and conflict that often is the result of direct confrontation through blaming, negative attributions, unsolicited advice, or lecturing.
Five Principles of Motivational Interviewing
- Express Empathy Through Reflective Listening
- Communicates respect for, and acceptance of, youths and their feelings
- Encourages a nonjudgmental, collaborative relationship
- Allows you to be a supportive and knowledgeable consultant
- Sincerely compliments rather than denigrates
- Listens rather than tells
- Gently persuades, with the understanding that the decision to change is the youth's
- Provides support throughout the change process
- Develop Discrepancy
- Motivation for change is enhanced when youths see discrepancies between their current situation and their hopes for the future.
- Your task is to help focus the youth's attention on how their current behavior differs from their personal values.
- Avoid Argument and Direct Confrontation
- Arguments are counterproductive.
- Defending breeds defensiveness.
- Resistance is a signal to change strategies.
- Labeling is unnecessary and can produce hostility.
- Roll with Resistance
- The simplest approach to responding to resistance is with nonresistance.
- Repeat the youth’s statement in a neutral form.
- Support Self-Efficacy and Optimism
- Self-efficacy refers to people's beliefs about their capabilities.
- Many youths do not have a well-developed sense of self-efficacy, and find it difficult to believe that they can begin or maintain behavioral change.
- Improving self-efficacy requires eliciting and supporting hope, optimism, and the feasibility of accomplishing change.
- This requires you to recognize the youth's strengths and bring these to the forefront whenever possible.