Lecture 4: Motivational Interviewing Flashcards
What are 5 things that make change difficult
- demoralization
- effort and time
- resistance
- automatic cognitive processes
- environmental factors
Ambivalence
= evokes discomfort and is often the start of change (= cognitive dissonance)
What are 6 principles of motivational interviewing
- Show empathy
- Unconditional acceptance
- Avoid discord/discussion
- Roll with resistance (judo)
- Affirmation
- Develop disbalance (cognitive dissonance, ambivalence)
When is giving advice allowed
- when a decision is already allowed
- when someone is asking for it explicitly
- when the other does not have the right info
—> always ask whether people want to hear it
What are the 4 processes of motivational interviewing
- Engaging; entering therapeutic alliance, agenda setting —> comforting, asking, giving options, talking about values
- Focusing; determining goal/direction (identify target behavior/direction in which to proceed)
- Evocation; explore and increase ambivalence, evoke change talk
- Planning; how to change, start with the key question, small attainable steps (SMART goals)
OARS
Open questions = more directed than in engagement phase, let people elaborate on the disadvantages of continuing and advantages of quitting
Affirmations = compliment, reframe, validate; statements that recognize strengths
Reflections = content, emotion, ambivalence; simple reflections (at the start); more provoking/complex (further in the session) —> order of the reflection is important, end with change talk
Summaries = not summarizing everything; use this to transition to new topic, highlight some motivational statements, connect different things, check understanding, use when you feel stuck
What are two scaling questions that one can ask and how would you proceed with this
- How badly do you want to change? (From 0-10)
- How much confidence do you have that you will succeed (from 0-10)
—> always ask why they did not pick a lower number to evoke change talk (not ask why not higher, evokes sustain talk)
DARN-CAT
Desire = expressions of “wanting”, “wishing” and “hoping for”
Ability = expression of “i can”, “i want to” and “i am able to”
Reason = benefits for change
Need = expressions of “need to”, “got to” and “have to”” and expressing having problems with the current situation
Commitment = implies action
Activation
Taking steps
What are 6 additional ways to elicit change talk
- Asking for it; evocative questions
- Asking for elaboration
- Querying extremes; best/worst things that could happen if they (don’t) change behavior
- Looking back; ask about a time in the past when things were different
- Looking forward; ask about imagined time in the future if change would or would not occur
- Exploring values and goals; ask how target behavior fits with values and goals
What is the difference between resistance and discord
Resistance = function/characteristic of the interaction styles between client and counselor (social interaction view)
Discord = different from sustain talk, includes disagreement, not being on the same wavelength, disturbance in the relationship
SMART goals
Specific = focus on what exactly the client want
Measurable = clear methods to know whether goal was achieved/progress is being made
Attainable = should be something the client can accomplish
Realistic = should be doable based on where the client is right now
Timely = there’s a time frame for the accomplishment of the goal
what are the 6 stages of change in MI
- pre-contemplation; someone is not talking about change yet
- contemplation; some change talk, considering it
- preparation; preparing change, thinking of ways to change things
- planning; planning things to change, saying what they’re going to do
- maintaining; making a plan on how to maintain this behavior, showing commitment
- relapse; making a plan for what to do if someone relapses, where to go from there
what are the 4 concepts related to the spirit of MI
- collaboration
- acceptance
- compassion
- evocation
what does the acronym RULE stand for and when is it used
R = resist
U = understand
L = listen
E = empower
–> used specifically when preparing your mind; keep this in mind when doing MI
