L4: Motivational Interviewing Flashcards
How can you prepare for an MI session?
- preparing your attitude: remember spirit of MI: Partnership, Acceptance, Compassion, Evocation, Respect
- preparing your mind: RULE: Resist urge to give advice & opinions, Understand their motivations & solutions, Listen empathetically to their perspectives, Empower clients hope & optimism
- preparing your space: no mental or physical distracitons present
What makes changing so difficult?
- demoralization
- takes a lot of effort & time so need that in ordeer to change
- resistance (which often arises out of fear)
- automatic cognitive processes
- environmental factors
-> behaviour has a function or a “special meaning”
-> briefly acknowledge the reasons for problem behaviour in the initial phase
What is Motivatoin?
- degree of willingness/readiness to change
- can vary over time
- can be influence (eg by the counselor)
- underlies the actual change of behaviour
3 components - will to change
- confidence in own ability to change
- readiness to change
What is ambivalence?
- Conflicting motivations
- “i want to change but i still find it too difficult”
-> ambivalence evokes discomfort & is often the start of change (=cognitive dissonance)
What is Motivtional Interviewing?
a client-cenetered, directive method for enhancing intrinsic motivatoin to change by exploring & resolving ambivalence
What works in MI?
- show empathy
- unconditional acceptance (of the person, not necessarily the behaviour)
- avoid discord/discussion
- roll w resistance, moving along (judo)
- affirmation
- develop disbalance (cognitive dissonance)
- exploring the other’s point of view
What doesn’t work in MI?
- convincing
- direct confrontation
- discussion
- tips & tricks
- stressing negative consequences usually doesn’t work
- assuming the expert role
- critizing
- shaming
- labelling
- giving unsolicited advice
- righting reflex: repair reflex/for your own good reflex you really want to find a solution for this client
When is giving advice fine?
- when a decision is already made
- someone asks for it explicitly
- the other does not have the right info
What are the 4 processes of MI?
- engaging
- focusing
- evocation
- planning
What are the stages of change?
- precontemplation (engaging)
- contemplation (focusing/evoking)
- preparation (focusing/evoking/planning)
- action
- maintenance
- relapse
- pre contemplation
What is “engaging” in MI?
- entering therapeutic alliance & agenda setting
- can take long or can be immediate
- provide feeling of safety & appr”ciation for attending
- techniques: comforting, asking for permission, giving options, talking about values
- “what is the reason you are here”
- specifics: OARS: Open questions, Affirmations, Reflections, Summaries
What is “focusing” in MI?
“which change are we talking about?”
- determining goal/direction (clients & counsellors)
- if focus is not up to client (cause doctors orders) then give them menu of options
- if focus is clear: spend time clarifying & prioritizing (“what do you expect from this talk”)
- use OARS
- collaborative agenda setting
What are some helpful questions for identifying target behaviour in focus stage?
- What kinds of changes do you want to make in your life?
- How would you like things to be different for you?
- What things in your life would you like to be different?
- What goals do you have for changing your behavior?
What is “evocation” in MI?
“why change?” -> essential stage of MI
1. explore & increase ambivalence (this causes discomfort but increases willingness to change)
2. evoke change talk
- the balance between change & sustain talk predicts change
- influenced by clinician
- increase of intrinsic motivation by evocation of change language
What is change talk vs sustain talk?
essential in evocation stage of MI
change talk:
- disadvantages of status quo
- advantages of change
- confidence about changing
- determination to change
- 5 types: DARN-C (all talk that talks about Desire, Ability, Reason, Need, Commitment to change)
sustain talk:
- advantages of status quo
- disadvantages of change
- negatives about change
- determination to not change
How do you evoke change talk?
essential in evocation stage, but used in all stages
OARS:
- Open questions: more directed than in engagement phase & strategic use
- Affirmations: compliment, reframe, validate but stay genuine, dont overdo it
- Reflections: on content, emotions, ambivalence etc. more provoking & complex & just more of them than before (“smart guessing”). 2:1 ratio of complex to simple reflections
- Summaries: like picking a bouquet of flowers, so not everything! strategic summaries on change talk
How can you use open questions strategically to encourage change talk in the evocation stage?
- Asking for why change is wanted
- Asking for elaboration on already existing change talk
- Asking for extremes: if client committed to change or did not
- Looking back
- Looking forward (both with and without change)
- Exploring values and goals
How do you do constructive self confrontation?
big part of MI
goal: disrupt balance
- elicit cognitive dissonance / ambivalence
- double sided reflections on contradictory statements
- repeat expression client uses about change
- carefully roll w resistance (judo) & maybe take it a bit further (under or overbidding)
What are some other MI techniques?
- discuss values & goals
- looking back & ahead
- 3rd person view
- 2 futures (how will your life look
- normalize ambivalence
- “if you could give yourself advice, what would it be?”
- scaling questions (how badly do you want to change, how much confidence do you have that you will succeed?)
- decisional balance work sheet
What is a decisional balance work sheet?
method for using open questions to explore and help resolve ambivalence
- What are the advantages of changing?
- What are the disadvantages of changing?
- What are the advantages of the status quo?
- What are the disadvantages of the status quo?
⇒ + elaboration questions
Define sustain talk
statements favoring the status quo, stemming from the ambivalence inherent in considering change
How do you end an MI (after evocation stage)?
can go to planning phase now
- summarize change talk and ask a “key question” like “is this what you want to do?”
- negotiate a change plan
- use SMART goal setting
- ask for commitment to the change plan
- end session expressing confidence & appreciation
How does discord arise? how can it be avoided & addressed?
arises from communication styles or disagreements between client and counselor.
- avoid righting reflex & giving advice: offering solutions prematurely, cause can lead to discord
- address discord by: acknowledging client autonomy and shifting focus to topics of interest to the client. By maintaining warmth, curiosity, and avoiding argumentation,
What is “planning” in MI?
“how to change?”
- start w one of the key questions (eg where would you like to go from here?)
- small, attainable steps (SMART goals)
- back to previous phase if necessary
- this is where treatment protocols start
