facilitating change and MI Flashcards
how did we used to get people to change
confront addictive personalities using coercion eg, shame, guilt, threats, force
what did the old way of getting change lead to?
resistance, arguments, reduced change
what happens when you confront people that drink
it leads to them drinking more
what are the 5 important assumptions
motivation is a state not a trait
resistance is not a force we must overcome
ambivalence is normal
person seeking help should be an ally rather than an adversary
recovery and change are innate, constant and intrinsic to the human experience
centrality of ambivalence
ambivalence is central to addictive behaviours
- awareness of risks, costs and harm
- also attached and attracted to behaviour
confrontation about adverse consequences often results in arguments which reinforces reasons for continuing
transtheoretical model
change is a process rather than an event
- process of changing addictive behaviours happens via a series of stages from pre-contemplation to maintenance
what are the stages in transtheoretical model
pre-contemplation contemplation preparation action maintenance then either: termination relapse
what is the pre-contemplation stage
not planning to change in foreseeable future uninformed or under informed families/friends can see the problem resistant to change sometimes demoralised following relapse
what is the contemplation stage
aware of the problem
seriously thinking about/considering change
not yet made commitment to change
ambivalence eg, weighing up the pros and cons
ambivalence
normal, understandable, acceptable and expected
strong and sometimes long held attachment to problem behaviour eg. physical dependence, social affiliation, conditioned responses, self medicating
perparation stage in transtheoretical model
plan for action in next month
open to information and support
may have made some small steps
action stage in transtheoretical model
putting plan into action
behavioural changes
high potential for relapse
maintenance stage in transtheoretical model
changes maintained for 6 months or longer
focus is on preventing relapse
more confident living the change
a lapse vs relapse
a lapse is a short term slip up and a relapse is a return to past usage patterns
the prevalene of relapse
relapse is a common occurrence- the rule rather than the exception
90% of clients will experience a lapse within 12 months of contemplating treatment
60% of clients will experience a relapse within 12 months
stages of change spiral
in practice, the stages of change are not usually linear
typically cycle back and forth multiple times
what percentage of relapsers return to contemplation
85%
what percentage of relapsers return to pre-contemplation
15%
what is MI
an important therapeutic intervention for facilitating movement through contemplation to preparation
the spirit of MI
PACE partnership acceptance compassion evocation
what is partnership in MI
a collaboration between the clinicians professional expertise and the clients personal expertise in their own life. Not expert/recipient but a partnership that utilises shared resources
what is acceptance in MI
includes empathy
the position of respecting the clients autonomy, affirming their strengths, and valuing each persons absolute worth as a human being
what is compassion in MI
the intention to put the clients best interests, growth and welfare first
what is evocation in MI
eliciting the clients wisdom, ideas, plans and values
the 4 processes of MI
- engaging
- focussing
- evoking
- planning
stage 1 engaging
uses client centred counselling skills to develop a therapeutic alliance
relational foundation
client centred
acceptance facilitates change
skilful reflective listening is fundamental
express empathy
empathy through reflective listening
the engaging skills of MI
OARS
open-ended questions
affirming
reflecting your understanding back to the client
summarising shows you’ve been listening and value their words enough to remember them, also can link material together and can help emphasize certain points
the focussing stage of mI
clarifying the goals and direction of counselling
ask the client to identify a target area
evoking stage of mI
eliciting the clients reasons for change
attention is paid to the clients “change talk” in order to explore, understand and summarise
uses clients own motivators to highlight discrepancy between present behaviour and important personal goals or values
planning stage of MI
when readiness for change seems apparent, proceed to determine what the next steps will be
client responsible for change and solutions
