Facilitating change

Question 1

what does this thought process display

“drugs are bad… but i like being high”

Answer 1

ambivalence.

Question 2

understanding ambivalence

Answer 2

normal, understandable, acceptable and expected in facilitating change

strong and sometimes long held attatchment to problematic behavour
- e.g. physical dependence, social association, conditioned association, help with coping etc.)

Question 3

what is the stages of change model?

Answer 3

process of change rater than change as an event

process of changing addictive behaviours happens via a series of stages from pre-contemplation to maintainance

Question 4

what are the stages of change according to

Prochaska and DiClemente’s model

Answer 4

pre-contemplation

contemplation

preparation

action

maintenance

REPEAT - learning from each relapse

Question 5

what does pre-contemplation stage look like

Answer 5

“i dont have a problem”

happy user

not planning to change in foreseeable future

uninformed or under informed
- not that there isn’t a solution but they cant see the problem

family/friends see the problem

resistant to change

sometimes demoralised following relapse

Question 6

what does contemplation stage look like

Answer 6

on the fence

aware of the problem

seriously thinkng about/considering change

not yet made a commitment for change

ambivalence - weighing up the pros and cons

Question 7

what does preparation stage look like

Answer 7

making a plan for change

plan for action in next month

open to information and support

may have made small changes
- reduced smoking slightly

Question 8

what does the action stage look like

Answer 8

making changes

putting plan into action
- modifying behaviour, thoughts, environment

behaviour changes (1 day - 6 months)
- considerable commitment of time and energy 

high potential for relapse

Question 9

what does the maintenance stage look like

Answer 9

changes tht last

changes maintained for 6 months+

focus on preventing relapse

more confident

Question 10

what does lapse stage look like

Answer 10

lapse = a slip up, using foe a brief time and getting back on track

common after long periods of maintenance

rule rather than exception - most people dont make it on the first attempt

can go back to any stage

can happen on multiple occasions

does nto mean the person is not motivatied

Question 11

what does relapse stage look like

Answer 11

going back to old patterns or use

go back to contemplation/preparation stages

Question 12

prevalence of lapse/relapse

Answer 12

common occurance

90% of clients will experience a lapse within 12 months of competing treatment
(breif return to use)

60% of clients will relapse within 12 months
(return to old patterns)

Question 13

what is motivational interviewing?

Answer 13

a collaborative person centred form of guiding to elicit and strengthen motivaition to change

Question 14

what are the assumptions of Motivational interviewing ?

Answer 14

5 important assumptions

1. motivation is a state not a trait
2. resistance is not a force we must overcome
3. ambivalence is normal
4. person seeking help should be an ally rather than an adversary
5. recovery and change are innate, constant an dintrinsic to the human experience

Question 15

what are the three deviations of the motivational interviewing “spirit”

Answer 15

collaboraiton - client centred, partnership nto expert/recipient

evocation - designed to elicit clients own motivations, “change talk”

autonomy - client is responsible for change, freedom to choose the direction

Question 16

what are the four processes of MI

Answer 16

engaging

focusing

evoking

planning

Question 17

what are the key concepts of the engaging process of MI

Answer 17

relational foundation

client centred

acceptance facilitates change

skilful reflective listening is fundimental

express empathy

Question 18

what are the key concepts of the focusing process of MI

Answer 18

assist clients to identity the target area in which they are struggling to make change by:

• setting an agenda
• askign the client whats important to them
• once identified, be transparent about what the target is

Question 19

what are the key concepts of the evoking process of MI

Answer 19

evoking change talk

use clients own motivators to highlight discrepancies between present behaviour and improtant personal goals or values

ambivalence is normal

recognise and respond

“psychological squirm”

Question 20

in the evoking process of MI what do the acronyms

DARN
and
CAT

stand for?

Answer 20

D- desire to change
A- ability to change
R- reason to change
N- need to change

C- Commitment
A- Activation
T- taking steps

Question 21

what is change talk

Answer 21

speech that favours a movement towards change and motivation

Question 22

how do you evoke change talk

OARS skills

Answer 22

open ended question s

affirmations

reflective listening

sumarising

Question 23

what are the key goals of the planning process of MI

Answer 23

the bridge to change - negotiating goals and plans and strengthening commitment

development of a change plan

review change plans to determine if more support is needed

Question 24

in the planning process of MI, what are the important things to consider when developing a plan?

Answer 24

clients belief in possibility for change - important motivator

client responsible for change

counsellor’s belief in client is also important

client is primary resource of solutions

Question 25

where does motivational interviewing fit in to the stages of change model?

Answer 25

during the contemplation stage

Question 26

assessing change

how do you assess when a client is prepared for change ?

Answer 26

assess importance, confidence and readiness to assess how ambivalent or how prepared a client is for change

Question 27

in assessing change what does assessing importance confidence and readiness tell us

Answer 27

importance - how much change matters

confidence - how strongly you believe you can change and how self assured you feel

readiness - how ready you feel right now to make the changes you desire, is this the right tiem

Question 28

what is decisional balance,

Answer 28

perceived advantaged and disadvantages of problem vs. change

Question 29

what is the assumption of decisional balance

Answer 29

motivation for change affected by decisional balance

Question 30

what can a clients decisional balance tell us

Answer 30

can assist in assessment of what stage of change the client is in

Question 31

what differs between the traditional view and alternate view of change

Answer 31

trditional -
use pressure and force&raquo_space; short lived changes

alternate -
develop personal desire&raquo_space; long lasting change

Question 32

what are the steps in completing a moticational interview ?

Answer 32

1. gain rapport
2. assess readiness to change
3. cost benefit analysis
4. explore concerns,
5. build confidence
6. summaries and assist decision making

Question 33

what is sustain talk?

Answer 33

speech favouring staying the same

Question 34

what is the desired relationship between sustain talk and change talk

Answer 34

elicit change talk to reduce sustain talk