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Midterm Flashcards

1
Q

The Central Balance

A

Often more like a ladder at the very beginning – acceptance of at least some aspect must occur before change (or effective communication) is even possible.

Acceptance/Empathy and Change are balanced by Therapy.

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2
Q

One of the biggest predictors of treatment success

A

Empathy

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3
Q

Stress–Diathesis Model

A

Biological Vulnerability (Heredity), Environment (modelling by family members, adverse environ. physical abuse, sexual abuse, etc), and Difficulty Tolerating/Regulating Painful Emotions (Often judges own emotions and tells self not to feel them. When can’t stop feeling, gets even more anxious, distressed, etc. It becomes a spiral – and often feels unbearable.)

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4
Q

Why do people use?

A

Stops pain. Also tends to decrease shyness, increase perception of having social skills and being liked, increase feelings of belonging, and – in the short term – increase positive experiences.

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5
Q

adaptive solutions as replacements and…

A

also to help the client tolerate negative emotions.

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6
Q

Right Reflex

A

When people see discrepancy b/t how things are and how they think things OUGHT to be, they want to fix it.

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7
Q

Resistance is a sign that

A

the therapist needs to change strategies.

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8
Q

Self-motivational talk (change talk) is a sign of

A

consonence

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9
Q

Resistance is a sign of

A

DISSONANCE

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10
Q

Four Processes of MI

A

Engaging, Focusing, Evoking, and Plan

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11
Q

Engaging

A

establish connection and working relationship; prerequisite for everything that follows

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12
Q

Focusing

A

develop and maintain direction for change

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13
Q

Evoking

A

elicit client’s own motivation for change

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14
Q

Plan

A

commitment to change and formulating concrete action

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15
Q

Discrepancy

A

difference b/t how life is and how client wants it to be (between current life and values)

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16
Q

OARS

A

Ask Open Questions
Affirm
Reflective listening
Summarize

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17
Q

Question/Answer trap

A

S.t. leads to client agreeing just to agree.

Try to ask questions and then reflect; never more than 3 Qs in a row.

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18
Q

Open Questions

A

Avoid 3 questions in a row, try to follow each question with a reflection

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19
Q

Listening Reflectively

A

Guessing what client means/feels

Can be simple –even word or two

Don’t just parrot the client

Should make up about half of what’s said

Can be used to direct session – help guide where session flows

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20
Q

Affirm

A

Recognizing, encouraging, and supporting the client’s efforts and strengths.

Include compliments or statements of appreciation

Examples

Can help build rapport, confidence, motivation, and feelings of self-efficacy.

Can also increase target bxs

Affirm bxs you want to increase
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21
Q

6 Levels of Reflection/Affirmation

A

1) Staying wake/listening
2) Accurate reflection
3) Articulating unverbalized emotions, thoughts, or bx
4) Reflection/Validation in perms or past learning or biological dysfunction (based on past exp., it makes sense you feel that way)
5) Reflection/Validation in terms of present circumstances (most people would feel nervous about a job interview)
6) Radical Genuineness

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22
Q

Summarize

A

Link material that has been discussed separately
Can help increase understand and “improve” perspective
Can also be an effective way to transition without the client feeling like you weren’t listening/caring.
(Also can help if you need to stall before saying anything.)
Also use at end of session to wrap up

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23
Q

5 Stages of Change

A

Pre-contemplation, contemplation, preparation, action, and maintenance.

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24
Q

Focus versus engagement

A

Can work on engagement at times without immediately focusing. Don’t always have to have an immediate purpose.

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25
Withdrawal occurs because your brain works like a spring when it comes to addiction.
Drugs and alcohol are brain depressants that push down the spring. They suppress your brain's production of neurotransmitters like noradrenaline. When you stop using drugs or alcohol it's like taking the weight off the spring, and your brain rebounds by producing a surge of adrenaline that causes withdrawal symptoms.
26
Some drugs produce significant physical withdrawal
alcohol, opiates, and tranquilizers
27
Some drugs produce little physical withdrawal, but more emotional withdrawal
cocaine, marijuana, and ecstasy
28
Emotional Withdrawal Symptoms
* Anxiety * Restlessness * Irritability * Insomnia * Headaches * Poor concentration * Depression * Social isolation
29
Physical Withdrawal Symptoms
* Sweating * Racing heart * Palpitations * Muscle tension * Tightness in the chest * Difficulty breathing * Tremor * Nausea, vomiting, or diarrhea
30
Which drugs produce the most dangerous physical withdrawal
Alcohol and tranquilizers
31
What can happen when you Suddenly stop alcohol or tranquilizers
seizures, strokes, heart attacks, hallucinations, and Delirium tremens (DTs)
32
Alcohol and tranquilizers need _____
Medical Detox
33
Leading, Guiding, Following
Find out what this means in the book.
34
Exchanging information
Elicit Provide information Elicit
35
Therapy Questions for Open Ended Questions/Elaborating
Tell me more about that. In what way? What are other reasons you might want to (quit drinking or whatever)? What it’s like to talk about that? (What does it feel like?) How are some other ways you’d like your life to be different? Give me an example (or) tell me about at time when that happened. ETC.
36
Therapy Questions for Reflecting change talk
(clarifies meaning, encourages further elaboration, and builds rapport) Often need validate the difficulty of change and/or any ambivalence before reflecting the change talk.
37
Therapy Questions for affirming change talk
``` Sounds like a great idea. You’re showing a lot of courage. Good point. I’m proud of you. That’s very considerate of you. That’s very insightful. It’s nice to see you willing to work so hard. ETC. ```
38
How to respond to sustain talk
need change in counseling style | Sustain is normal. It’s how you RESPOND to resistance that’s important.
39
Double sided reflection
Start with reflecting resistance, and end with change (might be earlier change talk)
40
4 ways to respond to change talk
``` Shifting focus Reframing Acknowledges validity of client’s observations, but offers a new meaning or interpretation. Agreeing with a twist (reflect + reframe) Emphasizing personal choice/autonomy ```
41
Responding to change talk
Directive, in that you respond differently to different statements depending on whether they move toward or away from change
42
Treatment Plan has
long term goals and short term goals
43
Enhancing confidence
1. Evocative questions a. What do you think might be a good first step? 2. Confidence ruler 3. Reviewing past success 4. Ask about personal strengths and support a. Can also give your own opinions 5. Brainstorm 6. Giving advice (sparingly) 7. Reframing 8. Hypothetical Avoid You'll be fine & taking over
44
First 20/15 minutes (1/3rd)
Listen for/ask about client’s concerns Use MI skills especially during this time – especially reflections/affirmations! Assess substance use, craving, & high-risk situations since last session Review and discuss the practice exercise (or review difficulty completing)
45
Second 20/15 minutes
Introduce/discuss session topic Discuss how the session topic relates to client’s current concerns Continue to use MI to reinforce change, role with sustain talk, and validate difficulty of doing homework/stopping substances/attending therapy.
46
Third 20/15 minutes
Explore the client’s understanding of and reactions to topic Assign practice exercise for the next week Review plans for the week Anticipate potential high-risk situations – as well as obstacles for completing homework
47
What if client gives dirty urine but say he/she didn’t use?
Point out discrepancy gently and nonjudgmentally Mention reasons client’s may be hesitant to admit use Give client an “out.”: “Our urine screens are almost 99% accurate, so it seems like somehow cocaine got in your body. Could you have used such a small amount that you thought it didn’t count, or maybe used at the beginning of the week and forgot that you did? Please think really hard.” (Client admits)
48
Four key aspects of the underlying spirit of MI
partnership, acceptance, compassion, evocation
49
Acceptance includes...
absolute worth, accurate empathy, autonomy support and affirmation
50
MI is about evoking:
that which is already present; not installing whats missing
51
Premature Focus Trap
Trying to focus too early on a goal without sufficient engagement
52
Is Informal Chat helpful?
Not likely to be helpful beyond modest doses
53
Reflective Listening is also called
Accurate empathy
54
What is the essence of reflective listening?
A statement that makes a guess as to what the person means
55
How would you appreciate another's internal frame of reference
understand his/her core goals and values
56
Self actualization involves
moving toward one's natural, idea, mature state, or telos.
57
A Values interview explores
the persons core goals: why they are important and how they are expressed.
58
To live with integrity is to...
behave in a manner that is consistent with and fulfills ones core values
59
An example of a powerful motivator for change is..
Discrepancy between current behavior and a core value
60
Self-regulation
capacity to formulate a plan of ones own and implement behavior to carry it out
61
To confront means to
come face to face ; self-confrontation is usually more powerful than being confronted by someone else
62
Agenda mapping
a metaconversation by which you step back for a short time to consider with the client the way ahead
63
Agenda mapping can also be useful for:
changing direction, getting unstuck, raising a difficult topic, or clarifying roles.
64
Agenda mapping is done when
there is a reasonably clear set of possible topics for conversation and consultation.
65
Process of Orienting (Formulation)
when goals of consultation are more diffuse - you put the puzzle pieces together in a way that generates a provisional hypothesis about where to start
66
Four ethical considerations
Non-maleficence (do no harm), beneficence (provide benefit), autonomy (respect for human freedom), and justice (fairness)
67
An example of an ethical issue
whether the clinician should encourage resolution of ambivalence in a particular direction - occurs when the clinician has an aspiration for change that the client does not yet share
68
Information & Advice are offered...
with client permission
69
Elicit - provide - elicit
a sequence for information exchange that honors the clients expertise and autonomy
70
When giving advice:
engage first, use sparingly, emphasize personal choice, and offer a menu of options
71
Self-disclosure
a willingness to share something of yourself thats true when there is a good reason to expect that it will help and not harm the client
72
Ambivalence is reflected in a mixture of
change talk & sustain talk
73
Preparatory change talk
desire, ability, reasons, and need (DARN)
74
Mobilizing change talk
commitment, activation, and taking step (CAT)
75
Which process is intended to help resolve ambivalence in the direction of change
Evoking
76
Simplest method for evoking
ask open questions that elicit change talk
77
When the client offers change talk, the clinicians next response should be
one that recognizes and strengthens it, such as asking for elaboration, affirming, reflecting, or summarizing,
78
MI consistent summary
is a bouquet of the clients own change talk - pulls together most of the change talk
79
Ambivalence sandwich
ST/CT/ST
80
Sustain talk should not be misinterpreted as
resistance
81
Neutrality or equipoise
a conscious decision to avoid influencing the direction in which ambivalence is resolved
82
Decisions balance is an appropriate strategy to use when....
one chooses to counsel with neutrality rather than encouraging change in a particular direction
83
Change tends to occur when....
the client realizes a discrepancy between important goals/values and the status quo. Discrepancy shouldn't be large enough to cause demoralizing.
84
How to instill discrepancy
exchanging information, providing feedback, exploring others concerns, exploring goals and values, honoring autonomy (ultimately it is the clients decision to want to change)
85
One prcedure for ciscerning whether the client is ready for planning phase
recapitulation and a key question
86
Developing a change plan usually involves
moving from general intention to a specific implementation plan
87
Three planning scenarios:
1) the change plan is already clear 2) There are options among which to choose in path mapping 3) the way forward is unclean and a change plan needs to be developed from scratch,
88
Developing a plan is not a final but
beginning step
89
implementation intentions involve
both a specific plan and the intention/commitment to carry it out
90
How to reinforce the best of intentions
public commitment, social support, and self-monitoring
91
MI spirit
Collaboration, compassion, acceptance, and evocation
92
Assessment Trap
Having an "intake" in the beginning of treatment, feel like it is necessary to know a lot of information before being able to help. Important to implement assessment with MI.
93
The expert trap
communicating a "I'm in control here" by asking many questions and prescribing things to do.
94
The labeling trap
AKA premature focus trap ; some believe it is important for the client to accept a dx; however there is little evidence that pressuring people to accept a label works
95
the blaming trap
who's fault is the problem? whos to blame? Clinician should render blame irrevelant
96
the chat trap
just chatting; insufficient direction to the conversation. higher levels of informal hat predicted lower levels of client motivation
97
ways to engage
desires/goals, importance, positivity, expectations, and hope
98
accurate empathy is also called
active listening / reflective listening
99
Thomas Gordan listed ___ roadblocks
12 - roadblocks are self-centered; not client centered
100
Process of communication
Hearing -> Decoding -> Reflection -> Encoding
101
Q technique
structured approach for exploring values; set of cards that has personality characteristics, person sorts in 5-9 piles ranging from very unlike me to very much like me. Can also be done for values
102
Three sources of focus
the client, the setting, the clinician
103
Three styles of focusing
directing, following, and guiding
104
Issues that can arise with focusing
tolerating uncertainty, sharing control, searching for strengths and openings for change,
105
three focusing scenarios
clear direction, choices in direction (agenda mapping), unclear direction
106
reflective response to change talk
straight reflection, amplified reflection, and double sided reflection
107
other ways to respond to change talk
emphasizing autonomy, reframing, agreeing with a twist, and running head start, coming alongside
108
examples of discord
defending, interrupting, squaring off, disengagement

Drug & Alcohol (1 decks)

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