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Affirmations in MI
MINT FORUM, Sitges,
June 2009
Carl Åke Farbring
Carl Åke farbring 2009
…
It happens, but rarely
that one of us really sees the other
person
one moment a person is seen
as on a photo but more clearly
and in the background
something that is bigger than his shadow
--TOMAS TRANSTRÖMER
(The Gallery: The Truth Barrier, 1978)
Carl Åke farbring 2009
The Use of Affirmations in MI
 Attributing interesting qualities to a person (MINUET,




2002) – making the person feel ”seen” as a person (not
just as a client).
Bill Miller (2007): ” ”It seems clear that we have not
enough understood or emphasized the importance of
affirmations in MI.” (ref. Linehan, 2002)
Self Affirmation Theory (Steele, 1988)
Extends and elaborates on the present definition and
practice of affirmation in MI
Sherman & Cohen (2006) – The Psychology of SelfDefense Advances in Experimental Social Psychology, 38, 183-242.
Carl Åke farbring 2009
Favourite teacher… From Carolina Yahne
•What was your favourite teacher like when you went to
school? What were your grades like in that subject?
Opinion
about the
teacher
+
-
Is there a correlation?
-
+
grades
• What made you perform so well? What was the
characteristic that made the teacher important to
you...?
• What do you think the counselor means as a person
in motivational work?
Carl Åke farbring 2009
Affirmation ”intuitively”: the importance of
being seen as a person
HYPOTHESIS: TO
IMPART TO A
PERSON THAT
HE/SHE IS A
SIGNIFICANT
PERSON MAKES
CHANGE MORE
LIKELY
Carl Åke farbring 2009
Basic tenets in Self Affirmation
Theory (Steele, 1988)
 People are strongly motivated to uphold self
integrity and self respect and a positive image of
themselves on domains that are important!
 This motivation often results in defensive
responses, more rationalizing than rational.
 The self system is flexible. You compensate
failures in one domain by increasing the
importance in another one. (Your are fighting
very hard to uphold the image of yourself as a
positive person and upholding self worth.)
Carl Åke farbring 2009
Defensive attitudes
 Defensive attitudes are adaptive and natural.
They reduce threat against positive self image
and self worth.
 People downplay threatening information
 They are maladaptive when change is
necessary (e.g. to survive).
 ”It doesn´t concern me. They have only proved
that rats shouldn´t smoke” … ”I just drink like
everybody else…”
Carl Åke farbring 2009
Defensive bias as self protection
 People want to feel valuable and important
(in their own eyes at least)
 To protect and uphold self integrity is a
strong motivational process (thoughts…)
 Can you help people to accept
”threatening” information and
consequently to be more open to change?
Carl Åke farbring 2009
AFFIRMATIONS (Steele, 1988)
 Problem: People often do not accept and
reject information and resist treatment (to
protect their own positive image of
themselves)
 Affirmations reduce defensive attitudes
and increase willingness from clients to
accept ”problem” and treatment
 Affirmations strengthen the psychological
immune system (Sherman & Cohen, 2006)
Carl Åke farbring 2009
AFFIRM in MI
 Alluding and referring to what has been said or
done earlier:
- I understand that it is hard for you to talk about this.
- You have lots of resources that will help you to deal with
this problem
- It must have been difficult for you… and you made it!
- I appreciate that you could come here today
- I think that it is very good that you want to deal with this
problem
- You showed that you really could!
Carl Åke farbring 2009
AFFIRM (cont.)
 Attributing interesting qualities to a person;
making him/her seen as a (-n) (interesting)
person:
- You are a bit of a philosopher really. You are saying
some really interesting things here.
- You have qualities of a leader. People look up to you.
- You look a little bit lika a professional athlete!
- You are the kind of person who cares a lot for others.
- You are a person with very high integrity!
(Farbring, 2002)
Carl Åke farbring 2009
Effect of affirmations
 When global measures of self integrity are
strengthened the need to uphold defense
against threatening information is reduced,
since it can be seen, understood and dealt
with in a bigger context.
 Self integrity can be actively upheld, by
engaging in activities that strengthen your
conception of ”who you are” and what you
are worth.
Carl Åke farbring 2009
The global self integrity (Karin)
ATTRACTIVE
+2
GOOD
MUM
+3
BEING
POPULAR
+3
JOB
- 3
PHYSICAL
SHAPE
+ 3
DANCING
+2
ALCOHOL
-3
Carl Åke farbring 2009
The global self integrity (Rolf)
ART &
LITERATURE
+1
The
Choir
+3
YOUTH TRAINER
+2
JOB
-5
PIANO
+2
Parish
+ 3
Family
+2
Carl Åke farbring 2009
My furious friend Peter, hcp 13
And after
returning to the
game:
- You know I could
run all this way
without even
losing my breath
and…:
- (to himself) At
least I am good at
saving money
Carl Åke farbring 2009
Self affirmation theory (Steele,
1988)
 Where is the evidence?
 Sherman, D.K., & Cohen, G. L. 2006. The psychology of
Self-Defense: Self AffirmationTheory. Advances in
Experimental Social Psychology, Vol 38. 183-242
Carl Åke farbring 2009
Accept threatening information
 You accept and even look for information according to your beliefs and
ideology etc. Defensive bias will be reinforced by interpreting this new
information. Many studies are about the view on capital punishment = ”law
and order” or ”liberal”. = a way to show and uphold your identity as safe
guard against crime or humanist/liberal .
 Participants in the study had their personal values explored: Half of them
were affirmed on a domain unrelated to death punishment. Both groups
were confronted with information that was in conflict with their ideology
about capital punichsment.
 Result: A-group was more balanced in their judgment of the information
than the non-A (they were more critical and thought the whole information
was biased.) Within the A-group people were influenced in both directions–
i.e. those who supported capital punishment were influenced to find capital
punishment inhuman and those who were against capital punishment were
influenced and could find some good arguments for capital punishment
(Cohen et al., 2000; Jacks & O´ Brien, 2004).
 The need to protect an important part of your identity or ”self worth” is an
important source for bias and closing the door to information, even when it
is supported by facts, logic or convincing evidence. (”I don´t believe in
that…”).
Carl Åke farbring 2009
Accepting threatening information
Capital punishment
 Participants in the study had their personal values
explored: Half of them were affirmed on a domain
unrelated to death punishment. Both groups were
confronted with information that was in conflict with their
ideology about capital punichsment.
 Result: A-group was more balanced in their judgment of
the information than the non-A. Within the A-group
people were influenced in both directions – (Cohen et al.,
2000; Jacks & O´ Brien, 2004).
 The need to protect an important part of your identity or
”self worth” is an important source for bias and closing
the door to information, even when it is supported by
facts, logic or convincing evidence.
Carl Åke farbring 2009
Can behavior also be influenced?
 Sherman (2000) studied if A could reduce risky and
harmful sexual behavior by showing a video that pointed
to the hazards of AIDS. Half of the participants were
affirmed before the video.
 Those who were not affirmed tended to show resistance
to the informationen but the A-group showed not only
more acceptance of the information but it also influenced
their behavior: 50% of the participants in that group
bought condomes after the video compared to only 25%
in non-A. 78% took a brochure about AIDS compared to
54% in non-A.
 Conclusion: Affirmations seem to ”buffer” people from
the threating part of the information; affirmations make it
possible for people to ”open up” for the possibility that
they are themselves at risk and help motivate them for
preventive behavior. Carl Åke farbring 2009
Correlation between coffee and fibrocystic disease (often
precedes breast cancer)
 Sherman, Nelson & Steele (2000) Do messages about health risks
threaten the self. Increasing acceptance of threatening health
messages via self-affirmation. Personality and Social Psychology
Bulletin, 26, 1046-1058
a
c
c
e
p
t
a
c
e
Blue = coffee
drinkers
Red: not coffee
drinkers
8
7
6
5
4
3
2
1
0
non- Affirm
Affirm
Carl Åke farbring 2009
Stress cortisol as a function of time and
status of affirmation
 Cresswell, Welch, Taylor, Sherman, Gruenewald & Mann (2005).
Psychological Science, 16, 846-851. (The Tries Social Stress Task for job
applicants and an arithmetic task 2083 by 13´s))
Affirmations can
buffer self
integrity not only
on psychological
measures but on
a psyshiological
level as well!
Yellow = A
Red= non-A
Carl Åke farbring 2009
Open mindedness to arguments against US
foreign policy as a function of affirmations
Cohen & Garcia (2005). ”I am us”. Negative Sterotypes as Collective Threats.
Journal of Personality and Social Psychology, 89, 566-582.
The collective identity
Black line= A
Dotted line= non-A
Before: r =.58
After: r=-.05
8
7
6
5
4
3
2
1
Carl Åke farbring 2009
Steretypical threats and performance
Martens, Johns, Greenberg & Schimel (2006). Combating Stereotype threat. The
effect of self affirmation on women´s intellectual performanced. Journal of
Experimental Social Psychology, 42, 236-243.
• Stereotype : ”Women do not perform as well as men in
mathematics” (triggers stress that will influence performance
negatively)
• A test was presented as a) diagnostic --- b) basis for
research
• Result: Women in the diagnostic condition performed
worse than the other women and clearly worse than men.
• Women in the same category a) that were affirmed did just
as well as women in the research group and just as well as
men also.
Carl Åke farbring 2009
Other aspects of affirmations…
 Affirmations on the focussed area may
backfire!
 Affirmations must be unrelated to the domain
– Act counterintuitively!
 Affirmation theory offers a framework for
understanding and dealing with bias.
 Mediating factors are not understood; basis
for research
Carl Åke farbring 2009
Affirmations and cognitive
dissonance
 Upholding self integrity rather than
balance
 Looking actively for information not just to
gain balance but to restore self integrity
 Purpose: to decrease feelings of unease –
that value of the person does not depend
on the unfortunate event…
Carl Åke farbring 2009
What can we do as clinicans to reduce
defensive bias when change is important?
 Reinforce and strengthen important




alternative domains of self integrity.
Clinician behaves ”counterintuitively”!
Total concentration on the client!
Affirmations are a form of reflective
listening i.e. attributions of qualities are
statements.
Avoid saying ”I think you are…”
Carl Åke farbring 2009
Motivational distortions in social
perception
 Default in café communications and social
interplay: people are zealous ”self
promoters” in social interplay
 We often compare ”downwards” when we
feel ”threatened”.
 Prejudice and racism can (at least partly)
be explained and influenced by bias and
affirmations.
Carl Åke farbring 2009
Summary of effects
 Affirmations can …
reduce defensive bias with respect to attitudes,
cognitive receptiveness, stress and social
perception.
 Affirmations can also influence stereotypes,
prejudice and behavior
 Results are applicable over a whole lot of fields.
 Self protective strategies can be reduced and
even eliminated if other important domains
unrelated to the threatened area are affirmed.
Carl Åke farbring 2009
What happens if affirmations are
made conscious?
 People to which the domain in question is very
important are more likely to have bias, but they
are also the ones who have most to gain from
affirmations
 Affirmations work in a subtle way ”under the
surface” without mediating role for the
conscience.
 Affirmations that are made clearly conscious are
impotent.
Carl Åke farbring 2009
Suggestion: be counterintuitive!
 First two minutes: ”First I would be very
interested if you could tell who you are, what
kind of a person you are. What is important in
your life, what makes you feel really well,when
and what makes you feel that you have done
something really good…?
 Listen reflectively and return at times in
conversation and show that you know ”who this
important person is…”
Carl Åke farbring 2009
Affirmations in clinical practice
Member of parish +2
Singing in a choir + 2
Football trainer for young
boys + 3
Family: relations close
and supportive +2
Important
domains in
Tom´s life
Safe private economy + 2
Speaks Spanish +2
Carl Åke farbring 2009
Why has it worked so well for me? Are
my clients special?
 Drug users and offenders:
1) Negative assessments! Negative feedback is
2)
3)
4)
5)
often perceived as threats or even insults
(Sobell et al. 2009)
Almost always negative feedback!
Tends to create a threat against their view of
themselves!
They are extremely sensitive and ”hungry” for
affirmations?
Are they special?
Carl Åke farbring 2009
So…..
What do you think?
Carl Åke
Carl Åke farbring 2009
¡Muchas Gracias! Thank you!
Bienvenido, Welcome, Bienvenu
à ICMI II, Stockholm, June 7-9 2010
Carl Åke farbring 2009
www.farbring.com; [email protected];
[email protected]