HC - motivational interviewing (nog niet af)

Question 1

obstacles to change

Answer 1

• demoralisation (=the process of making someone lose confidence, enthusiasm, and hope)
• effort and time
• resistance
• automatic cognitive processes
• environmental factors

Question 2

wat moet je als eerste doen

Answer 2

briefly acknowledge the reasons for problem behavior in the initial phase!

(Want: Behaviour has a function or a ‘special meaning’ & Resistance often arises out of fear)

Question 3

motivation=

Answer 3

• degree of willingness/readiness to change
• can vary over time
• can be influenced
• underlies the actual change of behaviour

Question 4

3 components of motivation

Answer 4

• will to change
• confidence in ability to change
• readiness to change

Question 5

what is ambivalence?

Answer 5

conflicting motivations (i want to stop if it really became a problem, but not yet)

-> ambivalence evokes discomfort and is often the start of change (cognitive dissonance)

Question 6

motivational interviewing =

Answer 6

a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

Question 7

6 principles of motivational interviewing

Answer 7

1. show empathy
2. unconditional acceptance (of the person, not of the behaviour)
3. avoid discord/discussion
4. roll with resistance
5. affirmation
6. develop disbalance (cognitive dissonance)

Question 8

the spirit of MI =

Answer 8

collaboration
compassion
acceptance
evocation

Question 9

so what does not work?

Answer 9

• convincing
• direct confrontation
• discussion
• tips and tricks
• stressing the negative consequences
• unsolicited advice

Question 10

giving advice is okay if…

Answer 10

• a decision has already been made
• someone asks for it explicitly
• the other does not have the right information

Question 11

hoe heet het als je patienten op een onproductieve manier probeert te overtuigen

Answer 11

righting reflex

(repair reflex/for your own good-reflex)
-> has to do with our own norms, sense of tasks/responsibilities, powerlessness etc.

Question 12

4 processes of MI

Answer 12

1. engaging
2. focusing
3. evocation
4. planning

Question 13

stages of change model (prochaska & di clemente)

Answer 13

1. pre-contemplation
2. contemplation
3. preparation
4. action
5. maintenance
6. (eruit of) relapse

Question 14

engaging =

Answer 14

(shall we get to work together?)

• entering the therapeutic alliance/agenda setting
• can take long or be immediate
• provide feelings of safety

Question 15

techniques of engaging (globaal)

Answer 15

• comforting, asking for permission, giving options
• talking about values, eg: what you enjoy, what you are good at, proud of (not random, goal-directed)

Question 16

techniques of engagement (specifiek)

Answer 16

OARS:

open questions
affirmations
reflections
summaries

Question 17

focusing =

Answer 17

(which change are we talking about?)

• determining goal/direction (of both client and clinician)
• if the focus is clear: spend some time clarifying and prioritizing (what do you expect from this talk/you are in a rehab centre, how would you describe your drinking yourself?)

Question 18

evocation

Answer 18

(why change?) -> this is what makes it MI

1. explore and increase ambivalence
2. evoke change talk

Question 19

ambivalence causes…

Answer 19

discomfort

Question 20

sustain talk vs change talk

Answer 20

sustain talk: advantages of status quo, disadvantages of change, negative about change, determination not to change

change talk: disadvantages of status quo, advantages of change, confidence about changing, determination to change

Question 21

DARN-cat=

Answer 21

desire
ability
reason
need
commitment
activation
taking sta=eps

Question 22

uitleg van OARS

Answer 22

Open questions
- More directed than in engagement-phase
Affirmations
- compliment, reframe, validate

Reflections
- Content, emotion, ambivalence etc.
- More provoking, more complex. (‘smart guessing’)
- Simple reflections : Complex reflections = 1:2
Summaries
- Like picking a bouquet of flowers (not everything!)

Question 23

constructive self-confrontation goal

Answer 23

disrupt balance (= elicit cognitive dissonance/ambivalence)

1. i dont want to give up gambling
2. my husband said he will leave me if i dont quit

-> you want to continue gambling, but not at the expense of your marriage

(altijd beginnen met meer sustain, en daarna change)

Question 24

hoe constructive self-confrontation uitvoeren

Answer 24

• Use goals, expectations, objective data
• Repeat expressions based on change
• Carefully roll with resistance (Judo)
• Join the client in the resistance
• And maybe take it a bit further (under- and overbidding) but stay respectful!

Question 25

other techniques

Answer 25

• Discuss values and goals: “What do you hope will be different in your life in a few years?/What role does ….have in that process?”
• Looking back and ahead: “How was your life before…What will your life look like when…?”
• “Third-person” view
• Two futures: How will your life look in 5 years if…
• Normalize ambivalence: “If you could give yourself advice, what would it be?
• Scaling questions: “How badly do you want to change on 1-10?”/”how much confidence do you have that you will succeed?”
• Optional: decisional balance