facilitating change and MI

Question 1

how did we used to get people to change

Answer 1

confront addictive personalities using coercion eg, shame, guilt, threats, force

Question 2

what did the old way of getting change lead to?

Answer 2

resistance, arguments, reduced change

Question 3

what happens when you confront people that drink

Answer 3

it leads to them drinking more

Question 4

what are the 5 important assumptions

Answer 4

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

Question 5

centrality of ambivalence

Answer 5

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

Question 6

transtheoretical model

Answer 6

change is a process rather than an event

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

Question 7

what are the stages in transtheoretical model

Answer 7

pre-contemplation
contemplation
preparation
action
maintenance then either:
termination 
relapse

Question 8

what is the pre-contemplation stage

Answer 8

not planning to change in foreseeable future
uninformed or under informed 
families/friends can see the problem
resistant to change 
sometimes demoralised following relapse

Question 9

what is the contemplation stage

Answer 9

aware of the problem
seriously thinking about/considering change
not yet made commitment to change
ambivalence eg, weighing up the pros and cons

Question 10

ambivalence

Answer 10

normal, understandable, acceptable and expected
strong and sometimes long held attachment to problem behaviour eg. physical dependence, social affiliation, conditioned responses, self medicating

Question 11

perparation stage in transtheoretical model

Answer 11

plan for action in next month
open to information and support
may have made some small steps

Question 12

action stage in transtheoretical model

Answer 12

putting plan into action
behavioural changes
high potential for relapse

Question 13

maintenance stage in transtheoretical model

Answer 13

changes maintained for 6 months or longer
focus is on preventing relapse
more confident living the change

Question 14

a lapse vs relapse

Answer 14

a lapse is a short term slip up and a relapse is a return to past usage patterns

Question 15

the prevalene of relapse

Answer 15

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

Question 16

stages of change spiral

Answer 16

in practice, the stages of change are not usually linear

typically cycle back and forth multiple times

Question 17

what percentage of relapsers return to contemplation

Answer 17

85%

Question 18

what percentage of relapsers return to pre-contemplation

Answer 18

15%

Question 19

what is MI

Answer 19

an important therapeutic intervention for facilitating movement through contemplation to preparation

Question 20

the spirit of MI

Answer 20

PACE
partnership
acceptance 
compassion
evocation

Question 21

what is partnership in MI

Answer 21

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

Question 22

what is acceptance in MI

Answer 22

includes empathy
the position of respecting the clients autonomy, affirming their strengths, and valuing each persons absolute worth as a human being

Question 23

what is compassion in MI

Answer 23

the intention to put the clients best interests, growth and welfare first

Question 24

what is evocation in MI

Answer 24

eliciting the clients wisdom, ideas, plans and values

Question 25

the 4 processes of MI

Answer 25

1. engaging
2. focussing
3. evoking
4. planning

Question 26

stage 1 engaging

Answer 26

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

Question 27

the engaging skills of MI

Answer 27

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

Question 28

the focussing stage of mI

Answer 28

clarifying the goals and direction of counselling

ask the client to identify a target area

Question 29

evoking stage of mI

Answer 29

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

Question 30

planning stage of MI

Answer 30

when readiness for change seems apparent, proceed to determine what the next steps will be
client responsible for change and solutions