Motivational Interviewing Flashcards
Definitions of
Motivational Interviewing
Motivational Interviewing is a person-centred counselling style for addressing the common problem of ambivalence about change
Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”
Motivational interviewing is a collaborative, goal
orientated style of communication with particular
attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance & compassion
William Miller and Stephen Rollnick Motivational Interviewing (3rd Edition).
Will & Way
Two aspects of readiness
to change
If you want to build a ship, don’t drum up the men to gather wood, divide the work and give orders.
Instead, teach them to yearn for the vast and endless sea. Antoine de Saint Exupery - The Wisdom of the French writer (1900 1944).
And at the same time If you merely increase a person’s urgency for change but not their belief that it is possible, you haven’t done them any favor.
Do Not
ASIST
Advise
Suggest
Interpret
Solve
Tell
What are the four key elements
for the Spirit (or philosophy) of MI?
PACE
MI is a person-centered counseling method for
addressing the common problem of ambivalence about change.
Four key elements:
- *Partnership** (each of you brings expertise)
- *Acceptance** (their life, their choice)
- *Compassion** (acting in their interests, not manipulation)
- *Evocative** (drawing out from them).
What is the sessional framework of an MI session?
EFEP
Engaging
Focusing
Evoking
Planning
What are the main strategies in
Motivational (Reflective) Interviewing?
EFEP
Engagement (Who?): Getting on the same page, who are they, why are they here? what’s important to them? Building empathy, trust and rapport
Focusing (What?): an ongoing process of seeking and maintaining direction.
Evoking (Why?): tapping into and drawing out deeper resources of motivation and confidence
Planning (How?): mapping out specific steps towards achievable WHO? desired goals
OARS
Core Tools of Motivational Interviewing
Open ended Questions - like a door opening into new ground. They invite someone to reflect and elaborate, helping us understand their view and what is important to them. eg what would make you pleased you came?
Affirming - when you notice them use a strength or take a positive step, recognise that. Affirming supports the growth of confidence and trust.
Reflective listening - this is at the heart of motivational interviewing. Simple reflections echo back what you hear, complex reflections reflect back deeper meanings or multiple elements in what you hear.
Summarising - using longer reflections to gather together aspects of what has been said. Collect what they say and offer it back.
Elicit
Provide
Elicit
Whatever meaty information you provide is sandwiched between two wholesome slices of asking.
- *Elicit** – ask permission, clarify information needs and gaps. What do you know already? What would you like?
- *Provide** – share feedback or information, offer, invite, leave them to choose how to use
- *Elicit** – check how it has landed – what sense they make of it, how they might respond
Prokashka
Change Model
Consonance
Dissonance
A relational understanding of resistance
Move from ‘they’re resistant’ to ‘there’s a gap between us’
Consonance – agreement or compatibility between opinions and actions, harmony between musical notes
Dissonance – lack of agreement or harmony between people or things or musical notes
Insight 3 – see resistance as a signal that you might be jumping ahead of your client.
Eliciting
Change Talk
Consider what ‘stage of change’ are they at
Nudge
Listen
Summarise
See your first task as to understand your patient’s
dilemma and then to reflect this back to them.
This is ‘expressing empathy’
What are three types
of Reflective Listening?
the primary skill of MI
You take in your understanding of what they’ve said and reflect it back to them
This shows interest and expresses empathy
Above the surface what they say
Beneath the surface – thoughts, feelings and beliefs behind what they say
Simple Reflection
repeating back what they’ve said
Complex Reflection - taking a guess at what you think they mean or feel, reflecting what’s below the surface.
Doublesided reflection reflecting both sides
of their ambivalence
Reflection Types
Much of what is needed is already there
it’s a matter of drawing it out, calling it forth
Selective reflection ‘You had intended to try it out’
Evocative question ‘what would make this more
- *Culture setting statement** that emphasises their choice coupled with…
- *Double sided reflection** ––‘I hear you’re not keen on this, but part of you can see some reasons here’ (re smoking)
Reflective Listening
It is a way of shining a spotlight on particular elements of what they say.
The combination of open ended sentences and reflection draws them out, making it easier for them to tell you what’s under the surface for them.
In engagement reflecting helps check and build your understanding.
With evoking and planning processes reflection can be more selective.
What are the the 2 levels
of reflective Listening?
Understand what they’ve said and reflect it back to them. Show interest and expresses empathy
Notice the above the surface what they say
Notice the beneath the surface – thoughts, feelings and beliefs behind what they say
What are the three Focusing Styles?
Directing – you set the agenda – “this is where we’re going”
Following – client-centred - “which way would you like to go?”
Guiding – lies between the above two styles, with a collaborativeprocess of finding mutually agreeable direction
Agenda Mapping
Unfolding Process
Developing & maintaining a specific agenda
Discovering what’s important for the client.
The goal may be unclear – you explore more and draw out pieces of the puzzle.
The goal may be clear – confirm this, then move to evoking
There may be a range of options – agenda mapping is useful
Change Talk
Key predictor of change is balance between change talk and sustain talk.
If change talk increases during a session, the patient is more likely to change.
Our conversational style can influence this
Sustain talk - Any talk that resists change
and supports the status quo
Change talk - Any talk that supports change and
opposes the status quo
What is DARN?
Preparatory
Change Side ofambivalence
Desire I want to, would like to etc
Ability I can, this is possible for me
Reasons if… then…, seeing benefits
Need imperative language, I must, I should…
Types of Change Talk
DARN Questions
Evocative Questions
Desire
What do you hope our work together will accomplish?
What don’t you like about how things are now?
Ability
If you really wanted to, how could you do this?
What ideas do you have for how you could …?
Reasons
Why do you want to..?
What could be the advantages of …?
What’s the downside of staying with same?
Need
What do you think has to change?
How serious or urgent does this feel for you?
What is CAT?
Mobilising Change Talk
Seeks to resolve ambivalence
through making change
Commitment I intend to, I will..
Activation I’m willing to, I’m ready to
Not a binding contract, but leaning towards change
Taking Steps already doing something in the direction of change
CAT
Questions
Commitment:
You’ve made a decision to address this…
Activation:
What are some steps you do feel ready to take?
Affirming
Taking Steps:
I want to acknowledge the step you’re taking
just by talking about this today.
Discrepancy
What feeds motivation?
Value Action Gap
Supporting someone to make their own
argument for change.
Discrepancy: an uncomfortable gap between
Find the want behind the should
Move from current state to preferred state
What is decisional balance?
Bringing ambivalence into view so that it can be worked with.
What are the advantages and disadvantages of
addressing this?
No change: Advantages vs Disadvantages
Change: Advantages vs Disadvantages
Oliver Sacks
I find every patient I see,
everywhere, vividly alive, interesting
and rewarding: I have never seen a
patient who didn’t teach me
something new, or stir in me new
feelings and new
