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
complex reflection?
paraphrases and moves beyond clients words:
may reflect affect
infers underlying meaning
cognitively reframe material
amplified reflection?
exaggerates an absolute statement made by the client
metaphor?
a kind of reflection statement
use of example to demonstrate a point
double-sided reflection?
acknowledges both sides of ambivalence
Four key elements of change talk
Client talks about change
Change talk linked to specific behaviors
Change talk comes from the client
Change talk in the present tense
Four types of change talk
DARN Desire (I want to...) Ability (I probably could...) Reasons (I think it would be good for me because...) Need (I really need to...)
Change talk leads to____ and that leads to _____
commitment (I will… I’m ready too… I’m going to…)
commitment leads to “steps toward change” (examples of small changes made
What is sustain talk?
Client wants to sustain “status quo”
Expresses inability to change
Emphasizes benefits of current situation
Desire for the status quo, stability, sameness
Goal: Move client from Sustain Talk to Change Talk
Strats for managing resistance
CARS
Client sets agenda
Agreeing with a twist (simple reflection + reframe)
Reframing
Siding with the negative (acknowledging the challenges)
Strats for working with ambivalence
PEEP Picking flowers Evocative questions (elicit reasons) Exploring values (why is change important) Presenting bouquets
Tips for providing information
Offer, don’t impose
Ask for permission first
Discuss information in context of other clients
Provide options when giving advice
Use client statements that they’ve made
Stick to the facts, not opinions
Ask clients what the information means to them
Strats for providing information
Elicit - Provide - Elicit
Chunk - Check - Chunk
