Intervention L7 - Motivational Interviewing Flashcards
What is motivational interviewing?
- COUNSELLING technique designed to promote change.
- more of a PROCESS than a therapy technique - it’s about the way you interact with the client. How your style is designed to influence the client.
- Change = a natural process, although many RESIST to change.
- Change is important when it’s maladaptive.
- MI PROMOTES CHANGE, but allows for change to occur within person’s own time - ASSISTING the client, rather than DEMANDING.
What are the origins of motivational interviewing?
- Stems from work with addiction
- commonly seen in drug and alcohol settings
- through series of questions designed to increase the importance of change from a client’s perspective.
- therapist does not advocate for change
- involves a PROCESS and can include ASSESSMENT - which relates to the stages of change model.
Describe the stages of change model.
- Precontemplation- awareness that change may be a positive thing. Thinking about self in relation to others.
- Contemplation - More specific, weighing up the decision, more likely to go ahead.
- Preparation - Identifying specifically what they might do
- Action
- Maintainence - Relapse prevention
What stages of change are dealt with in MI?
Stages 1-3 at most - Precontemplation, Contemplation and sometimes preparation.
Stages 4-5 are moreso CBT.
The aim is the shift people down the model.
Describe a person who is in precontemplation.
- NOT READY to change
- could be UNAWARE of need to change, and resists any efforts to change
- change could mean GIVING UP something valuable
- AMBIVALENT about change - the behaviour could be attached to their identity.
- may not believe change is necessary - realise it’s not great but believe they are doing OK.
- will JUSTIFY their position.
you will be unlikely to influence someone if you lecture them at this stage.
As a psychologist, what is must you think about with an individual who is in precontemplation?
Have a sophisticated understanding of WHY they do it, what MAINTAINS it, and how you can BEST INFLUENCE them.
What action can be taken with someone who is precontemplating?
Information can be given to the client.
Must be done in a NON-CONFRONTING manner - “soft start-up”
eg. Brochure - it is neutral - “if you have any questions come back to me later.”
Questions that can be asked at the precontemplative stage?
- How will you know when it is time to think about changing?
- What signals will tell you to think about making a change?
- What qualities in yourself are important to you?
- What connection is there between those qualities and not changing?
- -> umming and ahing process - useful to look uncertain
- -> simplying raising awareness, not trying to make them do anything.
Describe a person who is in contemplation.
- Recognised that there is a problem - less likely to justify their position
- Considering the possibility of change
- Open to NEW INFORMATION in an attempt to
understand the problem - AMBIVALENT about change and struggling with
the benefit of change versus the negative of change. - Can be stuck in this stage for years.
- ## often look for easy solutions and feel the situation is unfair (want best of both worlds)
What should a therapist do when their client is in the comtemplative stage?
- DO NOT jump on it - too soon and fast
- Client may be open to new info - still ambivalent
- Respect their opinions, do not assume they want to change.
- Talk about change in a slow way - if they are not keen, then leave them be, they are still contemplating - eg. cut down one drink a week.
- Acknowledge how HARD it is - maybe even emphasise it. This gives them PERMISSION TO FAIL - leads to internal motivation.
- DECISION MAKING MATRIX - pros and cons - maybe 4 way - include SHORT TERM and LONG TERM outcomes.
- Client must do this on their own. This will be more powerful, and you want to promote their own decision, not yours.
- do NOT debate with them you are NEUTRAL
- it is legitimate if they decide NOT to change.
What questions can you ask in the contemplative stage?
- What is one barrier to change?
- What are some things that could help you overcome this barrier?
These questions are designed to generate views about HOW they could begin to take action.
What questions can be asked in the preparation stage?
- What are the good things about the way you are currently trying to change?
- What are the things that are not so good?
- What would be a good result of changing?
They may have already started to change at this point:
- What is/not working?
- How do we overcome barriers?
- How do you maintain these changes?
What questions can be asked in the action stage?
- What made you decide on that particular step?
- What has worked in taking this step?
- What helped it work?
- What could help it work even better?
What techniques can be used at the action stage?
- Self monitoring
- Identifying triggers
- Planned changes
- Identifying cognitions and feelings for maladaptive behaviour.
These are CBT techniques, no longer MI process.
Describe the Maintenance stage.
- By now, the person has changed.
- Prevent relapses - it is a cycle of going back and forth through the stages! No one has a linear experience.
- How to manage with situations that cause problems - how to deal with others assertively.
