Midterm Flashcards
Ten Things MI is NOT
MI is not based on the transtheoretical model
MI is not a way of tricking people into doing what they don’t want to do
MI is not a technique
MI is not a decisional balance
MI does not require assessment feedback
MI is not a form of cognitive behavioral therapy
MI is not just client-centered counseling
MI is not easy
MI is not what you were already doing
MI is not a panacea
MI Spirit Branches
partnership, acceptance, compassion, and empowerment.
Partnership
- No one has more experience with or knows more about them than they do, so a helping relationship is a partnership of your expertise and theirs
-You both bring strengths and capability to the relationship
People are the experts of their own lives
MI is not done “to” or “on” someone, but “for” and “with” a person
Acceptance
- Nonjudgmental acceptance- does not mean agreement or approval
- Acceptance is importantly conveyed by what you are not doing - judging, disapproving, criticizing, or shaming
Compassion
-An intention to give top priority to the health and well-being of the one you are serving
-Commitment to benevolence, and intent to alleviate suffering and support positive growth
MI is compassion in action!
Empowerment
- Help people realize and utilize their own strengths and abilities- people have within them much of what is needed and your task is to evoke it.
-Is not primarily giving people something they lack but rather helping them appreciate and use what they already have!
Simple Affirmation
comments on something specific that the person has done or said
Complex Affirmation
comments on an enduring strength or admirable attribute (about the person going beyond simple actions to appreciating some abiding positive characteristic)
Simple Reflection
stays fairly close to what the person said, though it doesn’t have to be parroting
Complex Reflection
Makes a bit of a guess about what the person means (usually it’s not a big leap but rather a possible extension of what the person said)
Fixing Reflex
- People who enter the helping professions want to help, to fix things and set them right.
- Helpers have a natural inclination to want to make change happen
Time Trap
- Feeling in a hurry can lead you to rush, trying to make up for too little time. If you act and feel like you only have a few minutes, it may take all day; if you act and feel like you have all day it may only take a few minutes.
- May fall into this trap when you try to focus on a particular course of action too soon and find the person is not keen to go with you
Wandering Trap
- Most people love to be listened to and will carry on for hours on end while you follow whatever they are saying.
- If your conversation wanders from topic to topic wherever the client heads, it’s probably time to clarify what you hope to do in this helping relationship.
Persuasion Trap
- Finding yourself taking responsibility to convince someone to do something
You take up the pro arguments with the predictable effect that your client argues against it
Expert Trap
- You assume an authority stance and proceed to solve someone’s problems for them.
- No one knows more about your clients than they do, and particularly when you hope is to facilitate change in their behavior or lifestyle, you need their expertise
MI vs CBT
-MI focuses on helping people overcome resistance to change, build motivation, and make decisions that align with their values
- CBT focuses on helping people change their behaviors and learn how to modify their thoughts
Preparatory Change Talk
-heard when people are considering whether do something
- DARN (Desire Ability Reason Need)
Desire
- Wanting to make change - signals some inclination toward action
- Hear words like want, wish, like, and love
Ability
- Provides information about how confident people are that they would be able to take the action in question
- Hear words like can, could, able, and possible
Reasons
- States specific reasons for doing something
- Has an if-then quality (example if I don’t save money then I can’t buy a house)
Need
- Imperative quality emphasizing some urgency of change
- Imply that a change is important without specifying why
- Hear statements like I have to, I need to, I really must, I’ve got to
Mobilizing Change Talk
Tends to get people moving
CATS (commitment, Activation, Taking Steps)
Commitment
- Offers an assurance that it will happen - it is how we make promises to or contracts with each other
- Hear statements like I will, I promise, I swear
Activation
- You hear people leaning towards action- they haven’t quite decided or committed to do it, but they are almost there
- Hear statements like I’m willing to, I would consider it, I’m thinking about it - These signal an openness but not quite a decision to do something
Taking Steps
Indicates that the person has already taken some action in the direction of change
Sustain Talk
-Ambivalence- inner debate between the arguments for and against change
-Language that supports the status quo
Sometimes termed counterchange talk
OARS
open ended questions affirmations reflections summaries
Open ended questions
Invite people to talk to you, unlike closed questions they give the person room to decide what to say
Affirmation
Noticing and commenting appreciatively on something real that you can affirm.
Reflection
- Offer the other person’s content back to them in a non-threatening way
-Invite the other person to continue speaking on a topic or delve deeper - Help the person to organize their thoughts
-Help the person recognize his/her own change talk
Summarizing
- Collected reflections recounting several things you have heard
- Pulling together particular pieces of the person’s experience this way they hear what they said yet again a third time and in the context of other things they said
Types of Summaries
Collecting summaries:
Linking summaries:
Transitional summaries:
Recapitulating summary: I
Collecting summaries
Collecting summaries: list items discussed in the order they were spoken
Linking Summaries
Linking summaries: incorporate previously shared info with the current discussion
Transitional Summaries
Transitional summaries: Wrap-up a topic or session by highlighting important details
Recapitulating Summary
Recapitulating summary: Include all the change talk gathered through evocation, and partner with the client to confirm everything has been included, ask for agreement, and end with an open question.
Importance/Confidence Ruler
On a scale of 0 to 10 with zero not being confident at all and 10 being very confident, how confident are you to say that you could do this if you decided to?
Why a 7 and not a 2 or 3?
4 Tasks of Change Talk
Engaging, Focusing, evoking, and planning
Engaging
Involves empathic listening to establish a nonjudgmental human relationship
Focusing
helps you and your client gain a sense of where you are going what your helping relationships intended to achieve, and what topics will be most helpful to discuss
Evoking
is the task that particularly differentiates MI from other approaches. It involves arranging conversations about change so that the person’s pro change advocates naturally get good time to make their case
Planning
When there seems to be sufficient motivation for change, talk normally expands into how to change
Rests on and continues to use engaging, focusing, and evoking skill
Decisional Balance
The relative strength of positive and negative motivations toward change; an intervention that equally explores the pros and cons of a change or plan
Focusing
Straight Forward Goal
The goal to pursued together seems clear at the outset - little further focusing may be required although some clarification is likely helpful
Choosing a Path
Focusing
Choosing a Path
- There is a clear longer-term objective with various possible ways to help accomplish it
-The overall goal is apparent but it’s less clear how best to pursue it - You can develop list of possible paths and use a bubble sheet to lay out the possibilities visually
Focusing
Clarifying
- There is no well defined change goal to begin with or even a set of change options to choose from
- Often begins with a general concern or distress- longer engaging period may be needed
- Involves identifying possible changes and exploring the person’s priorities among them
Steve Rollinicks 20%
spend 20% of your time doing nothing but engaging with the client- reaps considerable rewards making much faster progress as a result
Conditions that make MI unethical
You have power over someone
You have a personal investment in the outcome
Your aspirations differ from the client’s
Research indicates it would be harmful or ineffective for client
Ask offer Ask
Get permission
Support autonomy
Offer Choices
After an opening ask you then offer a bit of information or advice not a whole lecture just a starting point. Then you ask again, checking on the person’s understanding or reaction.
Ask Offer Ask
Get Permission
First guideline is to offer information or advice with permission as most people do not respond well to unsolicited advice
Ask offer Ask
Support Autonomy
Even when you have permission to inform or advise, it is wise to acknowledge the person’s freedom of choice
Acknowledging people’s freedom to decide allows the to consider what you have to say and avoids triggering defensiveness
Ask offer Ask
Offer Choices
People usually respond better when they can freely choose among options than when they are being told what to do.
They are also more likely to be committed to and stick with a course of action that they have freely chosen
Discord strategies
Reflective Listening
Simply acknowledging what the person has said can have a way of softening discord
Skillful reflective listening is a good way to deescalate conflict and heated emotions - sustained reflections often have a calming effect
Discord strategies
Amplified Reflection
Restating the person’s experience with increased intensity may help them to rethink or qualify it.
Discord strategies
Double Sided Reflection
places sustain talk in the context of the other side of ambivalence- best to start with the client’s discord and follow it with the person’s own change talk.
“and” in the middle emphasizes ambivalence
“but” in the middle deemphasizes ambivalence
Discord strategies
Support autonomy
Acknowledge freedom of choice
Discord strategies
Reframing
Suggests a possible different meaning or interpretation of information - invites people to consider other options
Discord strategies
Shifting Attention
Shifting attention away from a contentious issue to a more helpful topic
You may also be inviting an alternative perspective
Discord Strategies
Apology
An apology to take at least partial responsibility for dissonance may be helpful
MET vs MI
A combination of MI with assessment feedback, originally developed and tested in project MATCH
Unique to METs is the use of clinically-relevant patient reported assessment data that is summarized and subsequently fed back to the patient in an MI, client-centered counseling style in order to enhance motivation for change.
Health Belief Model
Modifying variables, Perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, self efficacy, likelihood of engaging
Role of Values
Person’s values can be a compelling consideration in motivation for change
Understanding values can be useful in the tasks of focusing and evoking
Open ended values interview- ask them their values using open ended questions
Structured values exploration- values card sort
Dubious Change Talk
Term used to describe when a clinician believes a client’s expressed desire for change is unrealistic.
Implement OARS and explore values
Ceary Article
Results showed a strong positive between resilience and valued living.
Stressful life events do not have such a strong negative impact for those who live via their values because they are more resilient
Emma Lewis Essay
Nonjudgmental acceptance
Partnership
Empowerment
Focus on what the patient comes to see you today
