How do you Develop Discrepancy in Motivational Interviewing?

Introduction

Developing Discrepancy is and has been an important part of Motivational Interviewing across it’s lifespan. It helps to show people the difference between one outcome and another, it can be as small as a stream or as big as a canyon.

It was born from Festinger’s (1957) Dissonance Theory. You have cognitive dissonance when you hold two or more conflicting beliefs or behaviours

Examples of Cognitive dissonance
– Being a smoker, and believing smoking is bad for you.
– Thinking stealing is wrong and taking things that aren’t yours.

What is Developing Discrepancy?

Building awareness and creating a gap in the difference between one’s current behaviour and a desired different outcome or behaviour.

It seeks to, with respect and compassion, highlight the person’s behaviours in front of them to decide what, if anything, to do about them.

When is Developing Discrepancy useful?

Developing discrepancy is useful when a desired change is
– wanted by the person, but no action is taken
– wanted but not important
– not even on the person’s radar

How to Develop Discrepancy!

Use Scaling Questions
– Confidence
– Importance

Talk about decisional balance
– What is good/enjoyed about the behaviour
– What is bad/not enjoyable about the behaviour

Refer to values
– Keep the person’s values at the forefront, what to they believe

Ask how these two things fit together
– “How does that fit” / “How do those two things go together” e.g.
– Your goal is for the person to say something like “Well they don’t really”
– You can then reflect

“You’ve said you’re eating all the calories and you need to lose weight for your wedding, how do those two things go together?”

“Well….. I suppose they don’t”

“And things might stay the same and then you get to your wedding day…”

“They can’t, I need to do it!!“

“You’re committed to seeing this through, it’s something you’ve got to do. So what happens now?”

Bonus

Using Affirmations will have a big impact on reducing sustain talk and discord during developing discrepancy, it will also keep partnership in the interaction

Most of all, stay out of judgement, and keep curious!

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