Lecture 4: Motivational interviewing Flashcards
What is motivational interviewing?
- increases motivation to change behaviour and developed in addiction-focused treatment
- often more behavioural change
- main goal is to enhance intrinsic motivation by resolving ambivalence
- dysfunctional behaviour is recognized and acknowledged to have a certain function
- client-centred and directive
Why is change difficult?
There can be demoralization through past failures to change, effort and time required can be too much, feeling of loss of autonomy, resistance shown through sustain talk and discord, automatic thinking process, environmental factors. Discord is not being on the same wavelength and can be moving too fast, deal with it by acknowledging autonomy and reflectively listening.
What is motivation?
- not a personality trait
- degree of willingness or readiness to change
- changes through time
- ambivalence which can stem from conflicting motivations and create discomfort.
- includes: wanting to change, confidence for change and readiness to change
What are the basic principles of motivational interviewing?
- Showing empathy
- Unconditional acceptance of client (no pulling or pushing, this does not work!! only works if the “therapist” has nothing to gain from interaction, should accept even if nothing happens)
- Avoiding discord and discussions
- Judo
- Affirmation (increasing self-confidence of client by highlighting good things they’ve already done!)
- Develop disbalance - increasing discrepancy between current and wished-for state of existence
What is the spirit of motivational interviewing?
→ partnership (cooperation with client!! working together as equals, MI for the client, interest and support expressed by clinician)
→ acceptance (absolute worth - accurate empathy - autonomy support (need for self-determination) - affirmation)
→ compassion (putting the client’s needs first)
→ evoking(client has plenty of resources to use for behavior change!!)
⇒ healthy change is the result if these are done well!!
⇒ also RULE: resist (giving unsolicited advice), understand, listen (empathetically), empower (with hope and optimism)
When should advice be given?
If the client does not have the right info and if they ask for advice explicitly. Ask for permission to give advice also with the right timing. Be honest and open about the information presented and the options in the restricted framework
Righting reflex
Natural tendency of people to try to repair things that are not right due to powerlessness
Engagement phase
- entering therapeutic alliance and understanding the client’s perspective and values
- provide safety
- techniques: comforting, asking for permission, talking about values, open questions, affirmations, reflections, summaries (to connect parts of the story), checking in with how correct it is
Focusing phase
This determining what should be changed, the exact goal and direction and any assumptions should be let go. Then clarifying and prioritizing substeps
Evocation phase
Exploring and increasing ambivalence, evoking change talk vs sustain talk and getting more change talk despite discomfort and ambivalence but with affirmations and support. Clients should give reasons to change themselves. Desire, ability, reason, need, commitment, activation and taking steps are all important
What other techniques are used in the evocation phase?
- reflections and open ended questions to highlight disadvantages of current behaviour and advantages of change
- reflections which require educated guesses
- reflect change talk to lead to more change talk
-give responsibility for change to client - constructive self-confrontation which are reflections to elicit cognitive dissonance and ambivalence
- others: discussing values and goals, looking back and ahead, third person view, two futures, normalize ambivalence, scaling questions
What happens in the planning phase?
- client has decided to change, initiating with a key question after summarizing key points from change talk
- discussing indicators of success and methods for achieving change
- change plan (setting and clarifying goals and arriving at a plan)
- commitment to change plan
- only initiate if sustain talk has decreased and change talk has increased
- prevent from moving too fast to prevent failures
What is involved in act 1 (openings and beginnings)?
- engagement phase which involves explaining role and what one hopes to accomplish
focussing phase with agenda examined in more detail and a menu of options could be presented to choose the topic of focus - avoid question answer trap which is the counsellor mostly asking questions
- target behaviour should be identified
- avoid counselor advocacy responses like arguing for change, criticizing, shaming, labeling etc
- scaling question can be used to assess motivation and then asking about client’s confidence
Questions to identify target behaviour
- 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 happens in act 2 the middle of the session?
- ambivalence can induce anxiety but should remain in this state to consider the benefits of motivation
- delusional balance work sheet which uses open questions to explore and resolve ambivalence like what the advantages of changing and of the status quo etc
- affirmations of strength to increase client’s confidence is scaling questions revealed it to be low, but need to be genuine and honest
