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Clinicals CLSC SAPA > Entretien motivationnel > Flashcards

Entretien motivationnel Flashcards

1
Q

What term is currently coined in psychological literature to indicate opposition to treatment from patients?

A

Resistance

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2
Q

What is the natural response of practitioners who encounters resistance?

A

Reiterate health advice with greater authority.

Adopt a more coercive style in order to educate the patient about the imminent health risks if they don’t change.

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3
Q

How are patients usually labelled when coercive strategies don’t succeed?

A

Unmotivated

Lacking insight

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4
Q

How can an authoritative or paternalistic therapeutic style influence resistance?

A

It may deter change by increasing resistance.

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5
Q

What model has been developed to to understand the incremental processes that people pass through as they change a particular behaviour?

A

The Stages of Change model

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6
Q

How is readiness for change described in the “Stages of Change” model?

A

Readiness is a dynamic process where the pros and cons of changing generates ambivalence.

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7
Q

What is ambivalence?

A

Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual.

They are stuck between simultaneously wanting to change and not wanting to change.

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8
Q

In which situations does ambivalence manifests more often?

A

It is particularly evident in situations where there is conflict between an immediate reward and longer term adverse consequences.

EX: - Substance abuse
- Weight management

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9
Q

What is an example of ambivalence?

A

A patient with serious health problems as a result of heavy drinking.

They show genuine concern about the impact of alcohol on their health.

However, they keep drinking at harmful levels in spite of advice from practitioner.

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10
Q

What are the stages in the “Stages of Change” model?

A
  1. Precontemplation (Not ready)
  2. Contemplation (Getting ready)
  3. Preparation-action (Ready)
  4. Maintenance (Sticking to it)
  5. Relapse (Learning)
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11
Q

Is “Relapse” the final step in the “Stages of Change” model?

A

No.

Relapse is normalised in MI and is used as an opportunity to learn about how to maintain long term behaviour change in the future.

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12
Q

What are 3 critical components of motivation?

A
  • The importance of change for the patient (willingness)
  • The confidence to change (ability)
  • Whether change is an immediate priority (readiness)
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13
Q

Why is motivational interviewing (MI) an effective counseling method?

A

It enhances motivation through the resolution of ambivalence.

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14
Q

In what situations could MI have possible applications?

A
  • Medication adherence
  • SNAP (smoking, nutrition, alcohol and physical activity) risk factors
  • Diabetes and cardiovascular health
  • Substance abuse problems
  • Problem gambling or sexual risk taking
  • Pain management
  • Stress management
  • Completion of recommended screen/diagnostic tests/referral
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15
Q

What are the practitioner’s tasks in the “Precontemplation”phase?

A
  • Raise doubt and increase the patient’s perception of the risks and problems with their current behaviour.
  • Provide harm reduction strategies
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16
Q

What are the practitioner’s tasks in the “Contemplation”phase?

A

Weigh up the pros and cons of change with the patient and work on helping them tip the balance by:

  • Exploring ambivalence and alternatives
  • Identifying reasons for change / risks of not changing
  • Increasing the patient’s confidence in their ability to change
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17
Q

What are the practitioner’s tasks in the “Preparation-action”phase?

A

Clear goal setting.

Help the patient to develop a realistic plan for making a change and to take steps toward change.

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18
Q

What are the practitioner’s tasks in the “Maintenance”phase?

A

Help the patient to identify and use strategies to prevent relapse.

19
Q

What are the practitioner’s tasks in the “Relapse”phase?

A

Help the patient renew the processes of contemplation and action without becoming stuck or demoralised.

20
Q

What attitude should a therapist adopt within MI?

A

The therapist is viewed as a facilitator rather than an expert.

They should adopt a nonconfrontational approach to guide the patient toward change.

21
Q

What are the traits that describe the MI spirit?

A
  • Collaborative
  • Evocative (of their strengths)
  • Honouring of patient autonomy
22
Q

With which population is MI effective to promote engagement?

A

The MI approach is effective at engaging apparently “unmotivated” individuals.

When considered in the context of standard practice, it can be a powerful engagement strategy.

23
Q

What are the 2 phases of practical application of MI?

A
  1. Building motivation to change
  2. Strengthening commitment to change
24
Q

Describe “Collaboration” in the spirit of MI.

A

A partnership between the patient and practitioner is formed.

Joint decision making occurs.

The practitioner acknowledges the patient’s expertise about themselves.

25
Q

Describe “Evocation” in the spirit of MI.

A

The practitioner activates the patient’s own motivation for change by evoking their reasons for change.

The practitioner connects health behaviour change to the thing the patient cares about.

26
Q

Describe “Honoring Autonomy” in the spirit of MI.

A

Although the practitioner informs and advises their patient, they acknowledge the patient’s right and freedom not to change.

“Its up to you”

27
Q

Describe “Confrontation” in the authoritative therapeutic style.

A

The practitioner assumes the patient has an impaired perspective and consequently imposes the need for “insight”.

The practitioner tries to persuade and coerce a patient to change.

28
Q

Describe “Education” in the authoritative therapeutic style.

A

The patient is presumed to lack the insight, knowledge or skills required to change.

The practitioner tells the patient what to do.

29
Q

Describe “Authority” in the authoritative therapeutic style.

A

The practitioner instructs the patient to make changes.

30
Q

OARS: What are the basic skills of motivational interviewing?

A
  1. Ask Open-ended questions
  2. Make Affirmations
  3. Use Reflections
  4. Use Summarising
31
Q

Describe MI skills OARS “Open-ended questions”

A
  • The patient does most of the talking.
  • Gives the practitioner the opportunity to learn more about what the patient cares about (values and goals).
32
Q

Describe MI skills OARS “Make Affirmations”

A
  • Can take the form of compliments or statements of appreciation and understanding.
  • Helps build rapport and validate and support the patient during the process of change.
  • Most effective when the patient’s strengths and efforts for change are noticed and affirmed.
33
Q

Give examples of MI skills OARS “Make Affirmations” in practice.

A
  • I appreciate that it took a lot of courage for you to discuss your drinking with me today.
  • You appear to have a lot of resourcefulness to have coped with these difficulties for the past few years.
  • Thank you for hanging in there with me. I appreciate this is not easy for you to hear.
34
Q

Give examples of MI skills OARS “Open-ended questions” in practice.

A
  • I understand you have some concerns about your drinking. Can you tell me about them?

VERSUS: Are you concerned about your drinking?

35
Q

Describe MI skills OARS “Use Reflections”

A
  • Involves rephrasing a statement to capture the implicit meaning and feeling of a patient’s statement.
  • Encourages continual personal exploration and helps people understand their motivations more fully.
  • Can be used to amplify or reinforce desire for change.
35
Q

Give examples of MI skills OARS “Use Reflections” in practice.

A

“You enjoy the effects of alcohol in terms of how it helps you unwind after a stressful day at work and helps you interact with friends without being too self-conscious.

But you are beginning to worry about the impact drinking is having on your health.

In fact, until recently you weren’t too worried about how much you drank because you thought you had it under control

Then, you found out your health has been affected and your partner said a few things that have made you doubt that alcohol is helping you at all.”

35
Q

Describe MI skills OARS “Use Summarising”

A
  • Links discussions and “checks in” with the patient.
  • Ensure mutual understanding of the discussion so far.
  • Point out discrepancies between the person’s current situation and future goals.
  • Demonstrates listening and understand the patient’s perspective.
36
Q

Give examples of MI skills OARS “Use Summarising” in practice.

A

“If it’s okay with you, just let me check that I understand everything that we’ve been discussing so far.

You have been worrying about how much you’ve been drinking in recent months because you recognise that you have experienced some health issues associated with you alcohol intake, and you’ve had some feedback from your partner that she isn’t happy with how much you’ve been drinking .

But the few times you’ve tried to stop drinking have not been easy, and you are worried that you can’t stop.

How am I doing?”

37
Q

Describe the 1st phase of MI “Building motivation to change”.

A

In phase 1, four methods represented by acronym OARS constitute the basic skills of MI.

These basic counselling techniques assist in building rapport and establishing a therapeutic relationship that is consistent with the spirit of MI.

38
Q

Describe the 2nd phase of MI “Strengthening commitment to change”.

A

This involves goal setting and negotiating a “change of plan of action”.

39
Q

What trap can happen during the 2nd phase of MI “Strengthening commitment to change”?

A

In the absence of a goal directed approach, the application of the strategies or spirit of MI can result in the maintenance of ambivalence, where patients and practitioners can remain stuck.

This trap can be avoided by employing strategies to elicit “change talk”.

40
Q

What are the four categories of questions to elicit “change talk”?

A
  • Disadvantages of status quo
  • Advantages of change
  • Optimism for change
  • Intention to change
41
Q

Describe is the “importance ruler” technique in “Change talk”?

A

This technique identifies the discrepancy for a patient between their current situation and where they would like to be.

Highlighting this discrepancy is at the core of motivating people to change.

This can be followed by asking the patient to elaborate further on this discrepancy and then succinctly summarising this discrepancy and reflecting it back to the patient.

42
Q

Provide an example of the “importance ruler” technique in “Change talk”.

A

“If you can think of a scale from zero to 10 of how important it is for you to lose weight.

On this scale, 0 is not important at all and 10 is extremely important. Where would you be on this scale?

Why are you at ___ and not 0?

What would it take for you to go to from ____ to (a higher number)?”

Clinicals CLSC SAPA (11 decks)

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