evoking: enhancing confidence and developing discrepancy

Question 1

“resistance”

Answer 1

sustain talk is about the target behaviour

discord is about the client-counsellor relationship

Question 2

DARN CATs

Answer 2

” I am not changing”

• desire to sustain/need for the status quo
• expressing the inability to change
• recognizing reasons to maintain the status quo
• not willing to try a new direction
• expressing commitment to the status quo

Question 3

strategies for responding to change talk

Answer 3

straight reflection
amplified reflection
double-sided reflection
reframing
coming alongside
agreeing with a twist
emphasizing autonomy

Question 4

straight reflection

Answer 4

stay close in content

I know it would be good for me, but it’s just too hard to exercise regularly. Im too busy
—-you know exercise is good (focus on change talk)

Question 5

amplified reflection

Answer 5

adds intensity to client’s statement

I just don’t have time to cook
—it would be impossible to find time to cook

Question 6

double-sided reflection

Answer 6

reflects both sides of the ambivalence

I see the benefits of doing yoga classes
LATER IN SESSION: seeing all those people is so intimidating
—-you’re intimidated by the people but you see the benefits of doing the classes
—- on one hand you’re intimidated and on the other hand you see the benefits

Question 7

reframing

Answer 7

places client words in a new light

Isn’t drinking in moderation supposed to be good for you?
—-you want to do things that are good for your health

I tend to just make a routine out of eating out
— it sounds like when you make a commitment, you follow through

Question 8

coming alongside

Answer 8

joining with the person’s sustain talk

I just don’t see this exercise stuff working out for me
— exercise is not a priority for you

I know I won’t actually do it
—- you don’t enjoy exercise

I feel like it isn’t an urgent need for me
— this might not be the best time for you to start an exercise program

Question 9

agreeing with a twist

Answer 9

coming alongside + reframe

I just don’t see this exercise stuff working out for me and I know I won’t actually do it
—-exercise might not be a priority for you despite the consequences
—- you’re not sure you can do it no matter the health consequences

Question 10

emphasizing autonomy

Answer 10

reminding the client that change is up to them

I feel like I’m being told to eat veggies everyday
— its totally up to you how often you eat vegetables

what’s important to me is not the medication
— you are the one who knows best what you need to prioritize in your life
— your medication is your decision for your health

Question 11

discord

Answer 11

is about the client and the counsellor

(sustain talk is just about the client)

Question 12

defending

Answer 12

feeling the need to defend oneself to a perceived threat

trying to justify or saying it’s really not that bad

Question 13

squaring off

Answer 13

an oppositional stance (discord)

an advocate becomes an adversary

feels like a tug or war

Question 14

interrupting

Answer 14

client talks over top of counsellor while they are speaking

when client interrupts, it means they dont feel heard

discord

Question 15

disengagement

Answer 15

discord

inattentive, distracted, ignoring counsellor

Question 16

signs of physical discord

Answer 16

negative self talk about yourself

Gut feeling, flushed, embarrassed

Question 17

dealing with discord

Answer 17

apologize: shows you’ll be working with client in collaboration

affirm: pick out strengths and efforts and let them know that its all about helping them

shift focus: change topic

Question 18

how to strengthen confidence

Answer 18

if they have low confidence: can look back at past successes

if they have low importance: use importance ruler and see where the change fits with their values

Question 19

counselling with neutrality

Answer 19

no opinion about which choice is best

feel client should make a decision without external influence

let client know you’ll be counselling with neutrality

Question 20

developing discrepancy

Answer 20

why: goal-status discrepancy is one of the most fundamental drivers of motivation for change

how: agenda mapping, scale, exploring values and goals, EPE, acceptance, exchange info

be careful: cannot work in violation of the person’s autonomy

Question 21

transitioning from evoking to planning

Answer 21

intention-behaviour gap
danger of poor timing

Question 22

Intention-behaviour gap

Answer 22

despite a person’s desire, ability, reasons and need to change, goal intention does not guarantee goal achievement

just because you hear change talk doesn’t mean they’ll actually change their behaviour

Question 23

the danger of poor timing

Answer 23

if we fail to negotiate this planning process

1. the window of opportunity may close
2. we can fall into the expert trap

Question 24

when is the right time to plan

Answer 24

signs of readiness
testing the waters

Question 25

signs of readiness

Answer 25

1. increased change talk
   
   • Darn
   • cats = sign of mental preparation
2. taking steps
   
   • could be tentative steps
   • I bought myself a pair of running shoes
3. diminished sustain talk
4. resolve
5. envisioning: imagining possible outcomes (can also be negative)
6. Questions about change: asking about the process

Question 26

testing the water

Answer 26

1. simply ask: would it make sense to consider how you might go about reducing smoking?

** are you willing to think about changing your diets?

2. recapitulation
   – announce a transitional summary
   – genteel recitation of the other person’s own change talk

key question: so where does all this leave you?

3. pregnant pause: a pause that gives the impression that it will be followed by something significant

Question 27

what out for trees

Answer 27

when a client starts to backpedal and become defensive, planning needs to stop and evoking needs to begin again

keep the spirit of MI
* partnership
* acceptance
* compassion
* evocation

Question 28

summary

Answer 28

sustain talk is about behaviour, discord is about the relationship

use reflections if getting sustain talk

moving from evoking to planning: use the signs of readiness to decide, and then test the waters