MI Flashcards
What is Ambivalence ?
1.simultaneous and contradictory attitudes or feelings (such as attraction and repulsion) toward an object, person, or action
2a: continual fluctuation (as between one thing and its opposite)b: uncertainty as to which approach to follow
motivational interviewing is…
Motivational interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change.
focused and goal-directed.
The helping conversations continuum
Directing, Guiding, Following
4 Processes of Motivational Interviewing
Engaging – The process of establishing a mutually trusting and respectful helping relationship. A prerequisite for everything that follows.
Focusing – The process of identifying & maintaining a specific direction in the conversation about change.
Evoking –Eliciting the client’s own motivations for change. The “heart” of MI. Avoid the “righting reflex.” Developing discrepancy.
Planning – Developing commitment to change & plan of action. When readiness to change increases, the conversation becomes one of planning as the patient begins to discuss when and how to change (and less of whether and why). It is a conversation about action (listening for clients solutions), continue to elicit & strengthen change talk.
Core communication skills (OARS)
Open questions
Affirmation
Reflective listening
Summary
Open-Ended Questions- OARS
Designed to help the patient start to explore their reasons for change
They hear themselves saying what they want
Asking questions – the answer to which is change talk
“How has this problem impacted your life?”
Affirmations- OARS
Accentuate the positive, strengths, personal qualities, efforts, intentions (supporting self-efficacy) and a genuine valuing of the person
Genuine, respectful, individualized
“Thanks for coming in this week.”
Reflective Listening-OARS
Making a guess (hypothesis), in the form of a statement, about what the patient feels or means.
The purpose is to make sure you understand the patient.
Creates a sense of safety for the patient.
A gentle guiding that helps the patient explore their problem/concern further
Help the patient explore their ambivalence about their smoking/substance use/diet
Helps the patient reflect on change
Summary- OARS
Summaries draw together various aspects (main themes) of the patient’s thoughts and concerns shared over a longer period of time.
A pulling together of what may have seemed to be unrelated pieces.
They demonstrate that you are listening, remembering, and want to understand
Summarizing in this way helps the patient to reflect and encourages continued exploring.
You might follow a summary by asking “what else” to check whether you have missed something important.
Preparatory Change talk
DARN- C
The things people say that are their arguments for change
& which are components of motivation
DARN-C
Desire: What they would like to do.
“If I could just eat healthier I am sure I’d feel better“
Ability: How they would do this.
“If you could give me some suggestions on healthy diet, I am sure I could stick with it.”
Reasons: Why change, what would be good about it. (most predictive of actual change).
“If I stopped eating junk food, I might sleep better at night.”
Need: Why does it matter. Emotional reasons, based on values.
“I need to stop drinking or I will lose my family.”
Mobilizing change talk (DARN-C)
Commitment Language
Statements of commitment, things people say- that indicate some sort of intention, agreement. Predicts actual change
“Well, I guess tomorrow I will try to take a walk.”
“I will take a walk tomorrow.”
Sustain Talk
Their arguments against change.
Listen, validate, accept
Also help them move back toward change.
“I have tried before, and I cant.”
“I don’t have time.”
“I don’t like how sugar-free sodas taste.”
“I have never liked running or going to a gym.”
Transtheoretical Model of Change (TTM)
Precontemplation ”I won’t” Contemplation “I might” Preparation “I will” Action “I am” Maintenance “I have” Termination
more mobilizing change talk, DARN-CATS
Commitment: Some sort of intention, agreement.
“I could take a walk tomorrow morning.”
Activation: Signals movement toward action
“I am willing to give it a try.”
Taking Steps: Has already taken steps toward change
“I bought a bathing suit so I can swim.”
DARN-CATS
