Lecture 5: Motivational interviewing Flashcards
obstacles for change
- Demoralisation
- Effort and Time
- Resistance
- Automatic cognitive processes
- Environmental factors
resistance often arises out of…
fear
what is motivation?
- degree of willingness/readiness for change
- can vary over time
- can be influenced
- underlies the actual change of behaviour
3 components of motivation
- will to change
- confidence in own ability to change
- readiness to change
ambivalence =
conflicting motivations (i would like to change but i still find it too difficult)
-> ambivalence evokes discomfort and is often the start of change (cognitive dissonance)
motivational interviewing=
a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
principles of motivational interviewing
- show empathy
- unconditional acceptance (of the person, not necessarily the behaviour)
- avoid discord/discussion
- roll with the resistance (judo)
- affirmation
- develop disbalance (cognitive dissonance)
the ‘spirit’ of motivational interviewing
collaboration
compassion
evocation
acceptance
so, what does not work?
- Convincing
- Direct Confrontation
- Discussion
- Tips & Tricks
- Stressing negative consequences usually doesn’t work
- Unsolicited advice
giving advice is fine if…
- a decision is already made
- someone asks for it
- the other does not have the right information
what does work?
- moving along (judo)
- exploring the other’s point of view
righting reflex=
repair reflex/for your own good reflex (mensen echt gaan proberen te overtuigen)
4 processes of MI
- engaging
- focusing
- evocation
- planning
stages of change model
pre-contemplation (engaging)
contemplation (focusing/evoking)
preparation (focusing/evoking/planning)
action
maintenance
relapse/fixed
engaging =
shall we get to work together?
- therapeutic alliance
- can take long or be immediately
- provide feeling of safety
- techniques: comforting, asking for permission, giving options, talking about their values
focusing =
which change are we talking about?
clarifying and prioritizing
evocation =
why change?
- explore and increase ambivalence
- evoke change talk
- The balance between change and sustain talk predicts change
- Influenced by the clinician
- Increase of intrinsic motivation by evocation of change language
oke
change talk =
Disdvantages of status quo
Advantages of Change
Confidence about changing
Determination to change
DARN-Cat =
desire
ability
reason
need
commitment
how to use OARS to evoke change talk
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!
other techniques of MI
- 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 (next slide)
- Optional: decisional balance
scaling questions
- op een schaal van een tot tien, hoe graag wil je veranderen?
- op een schaal van een tot tien, hoe veel vertrouwen heb je er in dat dit gaat lukken?
planning=
how to change?
- hoe zou je vanaf hier verder willen gaan?
- kleine, haalbare stappen (SMART)
- terug naar vorige fase als dat nodig is
- hier start het behandelingsprotocol
wanneer is iemand klaar om te veranderen?
- meer change talk/commitment talk
- minder sustain talk
- praten over oplossingen
- visualiseren
