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Motivational Interviewing > Midterm > Flashcards

Midterm Flashcards

1
Q

Ten Things MI is NOT

A

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

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2
Q

MI Spirit Branches

A

partnership, acceptance, compassion, and empowerment.

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3
Q

Partnership

A
  • 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
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4
Q

Acceptance

A
  • Nonjudgmental acceptance- does not mean agreement or approval
  • Acceptance is importantly conveyed by what you are not doing - judging, disapproving, criticizing, or shaming
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5
Q

Compassion

A

-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!

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6
Q

Empowerment

A
  • 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!
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7
Q

Simple Affirmation

A

comments on something specific that the person has done or said

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8
Q

Complex Affirmation

A

comments on an enduring strength or admirable attribute (about the person going beyond simple actions to appreciating some abiding positive characteristic)

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9
Q

Simple Reflection

A

stays fairly close to what the person said, though it doesn’t have to be parroting

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10
Q

Complex Reflection

A

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)

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11
Q

Fixing Reflex

A
  • 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
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12
Q

Time Trap

A
  • 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
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13
Q

Wandering Trap

A
  • 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.
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14
Q

Persuasion Trap

A
  • 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
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15
Q

Expert Trap

A
  • 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
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16
Q

MI vs CBT

A

-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

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17
Q

Preparatory Change Talk

A

-heard when people are considering whether do something
- DARN (Desire Ability Reason Need)

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18
Q

Desire

A
  • Wanting to make change - signals some inclination toward action
  • Hear words like want, wish, like, and love
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19
Q

Ability

A
  • 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
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20
Q

Reasons

A
  • 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)
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21
Q

Need

A
  • 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
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22
Q

Mobilizing Change Talk

A

Tends to get people moving
CATS (commitment, Activation, Taking Steps)

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23
Q

Commitment

A
  • 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
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24
Q

Activation

A
  • 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
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25
Q

Taking Steps

A

Indicates that the person has already taken some action in the direction of change

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26
Q

Sustain Talk

A

-Ambivalence- inner debate between the arguments for and against change
-Language that supports the status quo
Sometimes termed counterchange talk

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27
Q

OARS

A

open ended questions affirmations reflections summaries

28
Q

Open ended questions

A

Invite people to talk to you, unlike closed questions they give the person room to decide what to say

29
Q

Affirmation

A

Noticing and commenting appreciatively on something real that you can affirm.

30
Q

Reflection

A
  • 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
31
Q

Summarizing

A
  • 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
32
Q

Types of Summaries

A

Collecting summaries:
Linking summaries:
Transitional summaries:
Recapitulating summary: I

33
Q

Collecting summaries

A

Collecting summaries: list items discussed in the order they were spoken

34
Q

Linking Summaries

A

Linking summaries: incorporate previously shared info with the current discussion

35
Q

Transitional Summaries

A

Transitional summaries: Wrap-up a topic or session by highlighting important details

36
Q

Recapitulating Summary

A

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.

37
Q

Importance/Confidence Ruler

A

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?

38
Q

4 Tasks of Change Talk

A

Engaging, Focusing, evoking, and planning

39
Q

Engaging

A

Involves empathic listening to establish a nonjudgmental human relationship

40
Q

Focusing

A

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

41
Q

Evoking

A

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

42
Q

Planning

A

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

42
Q

Decisional Balance

A

The relative strength of positive and negative motivations toward change; an intervention that equally explores the pros and cons of a change or plan

43
Q

Focusing
Straight Forward Goal

A

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

44
Q

Focusing
Choosing a Path

A
  • 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
45
Q

Focusing
Clarifying

A
  • 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
46
Q

Steve Rollinicks 20%

A

spend 20% of your time doing nothing but engaging with the client- reaps considerable rewards making much faster progress as a result

47
Q

Conditions that make MI unethical

A

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

48
Q

Ask offer Ask

Get permission
Support autonomy
Offer Choices

A

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.

49
Q

Ask Offer Ask
Get Permission

A

First guideline is to offer information or advice with permission as most people do not respond well to unsolicited advice

50
Q

Ask offer Ask
Support Autonomy

A

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

51
Q

Ask offer Ask
Offer Choices

A

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

52
Q

Discord strategies
Reflective Listening

A

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

53
Q

Discord strategies
Amplified Reflection

A

Restating the person’s experience with increased intensity may help them to rethink or qualify it.

54
Q

Discord strategies
Double Sided Reflection

A

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

55
Q

Discord strategies
Support autonomy

A

Acknowledge freedom of choice

56
Q

Discord strategies
Reframing

A

Suggests a possible different meaning or interpretation of information - invites people to consider other options

57
Q

Discord strategies
Shifting Attention

A

Shifting attention away from a contentious issue to a more helpful topic
You may also be inviting an alternative perspective

58
Q

Discord Strategies
Apology

A

An apology to take at least partial responsibility for dissonance may be helpful

59
Q

MET vs MI

A

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.

60
Q

Health Belief Model

A

Modifying variables, Perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, self efficacy, likelihood of engaging

61
Q

Role of Values

A

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

62
Q

Dubious Change Talk

A

Term used to describe when a clinician believes a client’s expressed desire for change is unrealistic.
Implement OARS and explore values

63
Q

Ceary Article

A

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

64
Q

Emma Lewis Essay

A

Nonjudgmental acceptance
Partnership
Empowerment
Focus on what the patient comes to see you today

Motivational Interviewing (2 decks)

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