MI in health care/bx change Flashcards
Broadly, what is MI?
- Patient centered “approach” to facilitate change by activating patient’s own motivation for change
- Collaborative, respectful, honors client’s autonomy
- Evocative, directive (not passive; despite misconceptions), engaging
- emphasizes self-efficacy and agency
- Consist of specific skill sets
- often called “resistance therapy”
Broadly, who might MI benefit
Clients who are capable of making a change
the change that has positive implications for their life, but they are “stuck”
Who might not benefit from MI?
cognitively impaired individuals
young children
Why might cog. impaired individuals and young children not benefit from MI?
Too abstract; Not concrete enough
Doesn’t provide direct guidance in decision making
Doesn’t model the exact behavior
Roadblocks to tx change (Thomas Gordon, 1970)
- Ordering client or directing them as an authority
- Focusing on negative outcome; threatening tone
- Advice giving, providing solutions to problems
- Persuading, arguing a point
- Moralizing, preaching
- Disagreeing, criticizing, judging, blaming
- Agreeing, approving, praising
- Shaming, ridiculing, name calling
- Interpreting, analyzing
- Reassuring, sympathizing, consoling
- Questioning, probing
- Withdrawing, distracting, changing topic
Examples if presenting issues in health care that MI has been shown to be effective for:
substance use/dependence smoking cessation wt mgmt increased PA improved diet increased medical adherence (e.g. HIV, diabetes, HTN)
Four principles of MI
DEERS Develop discrepancy Express empathy Roll with resistance Support self-efficacy
Three general communication styles
Following (follow clts lead; through their eyes; “back seat”)
Directive (tx’pist takes lead; expertise/authority; “take over”)
Guiding (in between; present and involved but not directive)
Which comm style does MI tend to follow?
None of them; moves between them
Within each general communication style there are ______?
Three different communication skills
Asking (assessing)
Listening (active)
Informing (providing)
Re: comm styles health care pros tend to be more _____; re: skills, tend more _____ and less_____? What are some reasons for that?
directive asking and informing; listening little time allotted per patient (approx 20 mins) productivity expectations see role as experts the setting is routinized/standarized health consequences can be severe Directive style lends itself to Informing
As a health psychologist, re: comm styles/skills, you ideally…
incorporate more Guiding and Listening, but do need to be more directive (MI takes a more directive flavor at times in health care settings)
Four basic MI skills
OARS
Open-ended questions (strategic, move in certain direction)
Affirmations (highlight strengths)
Reflections (paraphrasing/reframing)
Summaries (collecting, linking, transitioning)
Different forms of relfection
SCAMD
Simple, Complex, Amplified, Metaphor, Double-sided
simple reflection?
close to clients words, paraphrase
communicates listening
keeps therapist present/attentive
