Ch 5 - MI and NVC

Question 1

Define motivational interviewing.

Answer 1

A client-centered, directive method for motivating change by exploring and resolving ambivalence.

Question 2

What is the goal of MI?

Answer 2

To encourage change talk and discourage resistance talk.

Question 3

Why does MI encourage change talk and reduce resistance talk?

Answer 3

The more clients make the case for change themselves, the more likely they are to actually make changes.

Question 4

What are the 4 general principles of MI?

Answer 4

1 Expressing empathy
2 Developing Discrepancy
3 Rolling with Resistance
4 Supporting Self-efficacy

Question 5

True or False: the 4 General Principles of MI: 
Expressing Empathy
Developing Discrepancy
Rolling with Resistance
Supporting Self-efficacy
Only apply to the MI menthod.

Answer 5

False.

These also apply to other methodologies including Appreciative Inquiry.

Question 6

When is it important to use MI in coaching?

Answer 6

When the clients are stuck in ambivalence and conflicted about their ability to move forward. At this point empathy and techniques of developing discrepancy and rolling with resistance are helpful.

AI positive inquiry is used to start the session as it can help clients to move beyond their reluctance, ambivalence and resistance to change.

Question 7

Define empathy and discuss how to use it in coaching.

Answer 7

The respectful understanding of another person’s experience, including their feelings, needs, and desires.

Empathy is the work of coaching.

Question 8

What is the difference between empathy and sympathy?

Answer 8

Sympathy means identifying with someone’s experience primarily on an emotional level.

It means “I feel your pain” or “I share your joy”

Sympathy can interfere with our listening because it turns our attention to our own feelings, needs and desires.

Question 9

What is the difference between empathy and pity?

Answer 9

Pity means grieving someone’s experience, usually because of circumstantial hardships.

A person who pities someone communicates “I feel sorry for you”

This attitude undermines self-efficacy and has no place in coaching.

Question 10

Why is it ineffective for a coach to push a client (promote the coach’s agenda) who seems not to be making progress in the area of health risky behaviors?

Answer 10

Because this can provoke resistance talk from the client which is counter productive. Using the tools of MI can help elicit change talk.

It is helpful for the coach to recognize that health risky behaviors are an expression of the client’s unmet needs. No change is possible until those needs are fully and respectfully recognized and expressed.

Question 11

What is it helpful for coaches to remember when their client is engaging in health-risky behaviors?

Answer 11

health risky behaviors are an expression of the client’s unmet needs. No change is possible until those needs are fully and respectfully recognized and expressed

Question 12

What is Non-violent Communication?

Answer 12

A method for expressing empathy.

It is based on an awareness of the causal connection between a person's feelings and their needs (which are seen as universal)

Developed by Marshall Rosenberg

Question 13

According to NVC what happens when universal needs are met? When needs are not met?

Answer 13

When universal needs are
met - people feel positive emotions
Not met - people feel negative emotions

Question 14

Describe the 4 steps and distinctions made in the NVC communication process.

Answer 14

1 Make observations, not evaluations
2 Express feelings, not thoughts
3 Identify needs, not strategies
4 Make requests, not demands

Question 15

What are some universal needs?

Answer 15

Autonomy
Connection
Honesty
Meaning
Peace
Physical well being
Play

Question 16

What does developing discrepancy mean?

Answer 16

To use open-ended inquiry and reflections and rulers to help the client develop an awareness of any discrepancies that exist between their present behavior and their important goals and values.

The coach should not point out discrepancy as this may trigger resistance. Clients should be encouraged to notice the discrepancies themselves.

Question 17

What tools can a coach use to develop discrepancy?

Answer 17

Open-ended questions
Reflective listening statements

Question 18

What % of questions in a motivational interview should be open-ended questions?

Answer 18

More than 50%

Question 19

Name the 4 types of reflections used in MI and the 1 from NVC.

Answer 19

Simple
Double-sided
Amplified
Shifted-focus
(empathy reflection - from NVC)

Question 20

Give an example of a simple reflection.

Answer 20

A simple reflection paraphrases and restates what the client said, utilizing their own words without interpretation, exaggeration, or distortion.

Client: I don’t have time to exercise. My friends and spouse don’t either.

Coach: I hear you saying you don’t have time to exercise and that your friends and spouse don’t either.

Question 21

Give an example of an amplified reflection.

Answer 21

A amplified reflection maximizes or minimizes what clients say to evoke disagreement from them in the direction of change talk.

Client: I don’t have time to exercise. My friends and spouse don’t either.

Coach: I hear you saying that you don’t know anyone who has time to exercise and that it’s impossible for you to fit exercise into your schedule.

Question 22

Give an example of an double-sided reflection.

Answer 22

Reflects the multiple perspectives you have heard the client voice.

By encouraging clients to look at different facets, for example by comparing a current resistant statement with a prior readiness statement, the client can gain perspective.

Client: I don’t have time to exercise. My friends and my spouse don’t either.

Coach: I hear you saying that you don’t have time to exercise and that your friends and spouse don’t either. But I’ve also heard you say that exercise makes you feel better and that regular exercise would be good for your energy and health.

Question 23

Give an example of an shifted-focus reflection.

Answer 23

A shifted-focus reflection redirects the clients attention away from resistance provoking subject to focus on another area.

Client: I don’t have time to exercise. My friends and spouse don’t either.

Coach: Because you don’t have time to exercise, let’s talk about the dance class you started with your partner. You were doing pretty well with that; I remember you saying that you were enjoying the classes.

Question 24

True or False: It is important to guess correctly when making amplified and empathy reflections?

Answer 24

False
When we use amplified and empathy reflections we must make a guess as to what will stimulate change talk and what feelings and needs may lay behind a client’s words, body language, or tone.

Whether we guess right or wrong does not matter. What matters is the integrity of our intention to generate change talk and connect with honesty and empathy.

Question 25

Define decisional balance.

Answer 25

Decisional balance involves evaluating the pros and cons of change.
1 what are the costs and benefits of not changing
2 what are the costs and benefits of changing

Action is usually preceded by thought, the decisional balance conversation can assist clients to think their way through to a desired course of action.

Question 26

How is decisional balance used in coaching?

Answer 26

Clients are first asked to list the benefits and concerns about not making a change.

Then they list the benefits and concerns about making a change.

Question 27

What are rulers and how are they used in coaching.

Answer 27

Rating scales that used in MI to enable clients to think out loud about their readiness, willingness and ability to change and to engage in change talk.

Question 28

What ruler would be used to assess a client’s willingness to change?

Answer 28

On a scale of 0 to 10, how important would you say it is to change you _________ at this time?

Question 29

What ruler would be used to assess a client’s confidence about making a change?

Answer 29

On a scale of 0 to 10, how confident are you that you can change your _______ at this time?

Question 30

What ruler would be used to assess a client’s readiness to change?

Answer 30

On a scale of 0 to 10, how ready are you to change your ______ at this time?

Question 31

Why is it important to talk with clients about the number they selected on the ruler?

Answer 31

The coach can ask “Why they did not pick a lower number?” to encourage them to engage in change talke.

They can also ask “What would assist them in getting to a higher number?” to evoke change talk and support behavior change.

Question 32

What is rolling with resistance?

Answer 32

When our client demonstrates resistance to change, using empathy, inquiry and reflection to explore the clients underlying feelings, needs and desires.

“People don’t resist change, they resist being changed”

Coaches should not confront resistance directly (in most cases) by arguing, diagnosing, fixing, or any other communication pattern that fosters resistance.

Question 33

Why is it important for coaches to roll with resistance?

Answer 33

When the coach pushes for change they client is likely to engage in resistance talk and is less likely to make a change.

Question 34

What shifts help coaches roll with resistance?

Answer 34

From correction to connection
From competence (coach’s) to confidence (client’s confidence in their ability to change)
From causes to capabilities
From counter-force to counterbalance (with awareness)

Question 35

What forms of communication are likely to provoke resistance?

Answer 35

Advising
Educating
Explaining
Correcting
Consoling
One-upping
Storytelling
Shutting down
Interrogating
Commiserating

Question 36

How can you decrease the likelihood of resistance talk?

Answer 36

Use empathy, inquiry and reflections to communicate to the client that you understand their feelings,needs and desires.

Question 37

Which method AI or MI works with “rolling with resistance”

Answer 37

MI

AI does not use the language of rolling with resistance, but it works with the same principles: it is a client-based, client driven approach to change.

Question 38

Which method AI or MI works more with empathy?

Answer 38

MI

AI works best when empathy is included, but AI does not work with empathy as much as MI.

Question 39

Describe the differences and similarities between AI and MI.

Answer 39

AI and MI are complementary approaches best used in tandem to move clients forward.

Start with empathetic application of AI
When clients stuck in ambivalence, use MI and empathy.