Miller and ollnick Motivational Interviewing REAL

Question 1

Who are involved in the history of motivational interviewing?

Answer 1

Developed in the the 1980s by: William Miller, PhD (professor of psychology & psychiatry)
Steven Rollnick, PhD (Professor of General Medicine, clincial pyschologist)

Question 2

What is motivational interviewing history and how did it begin

Answer 2

Began as a frame work for counseling clients with alcolhol problems
Adapted as a broader framework for changing behavior:
- Social Work
- Corrections
- Relationship Counseling
- General Medicine

Question 3

What is it, MI?

Answer 3

A reaction to the more confrontational counseling methods (“Tough love”) of the 1970s and 1980s
A recognition that classic psychological concepts (e.g. avoidance of pain/punishment) don’t always work the way we predict

Question 4

Definition of Motivational Interviewing.

Answer 4

Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

Question 5

What is motivation?

Answer 5

Readiness
Willing
Able

Question 6

What is ready?

Answer 6

Client perceives change to be a relatively high priority

Question 7

What is willing?

Answer 7

Client perceives discrepancy between status quo and desired goals

Question 8

What is able?

Answer 8

Client perceives high self-efficacy (confidence to actualize one’s intentions)

Question 9

This is where we talked about self efficacy

Answer 9

Self efficacy is the confidence to actualize one’s intentsion

Question 10

What is involved in the general spirit of MI?

Answer 10

Collaboration
Evocation
Autonomy

Question 11

What is collaboration?

Answer 11

counselor should not enact an authoritarian, one-up stance

Question 12

What is evocation?

Answer 12

Counselor should work to draw wisdom out of the client, not impose it

Question 13

What is autonomy?

Answer 13

Counselor should openly respect the client’s freedom to accept or reject ideas

Question 14

What is “Change Talk”?

Answer 14

The client needs to voice the arguments for change (counselor works to bring this out):
Disadvantages of the status quo
Advantages of change
optimism about change
Intention to change

Question 15

What is involved in the counseling practices?

Answer 15

1. Express empathy
2. Develop discrepancy
3. Roll with resistance
4. Support of self-efficacy

Question 16

What is involved in expressing empathy?

Answer 16

• Being accepting of the client’s circumstances (acceptance is not agreement or approval)
• Treat the client’s choices as understandable
• “Ironic process” - acceptance encourages change; lack of acceptance limits change
• -Unraveling of tough love
• • acceptance encourages change, now the personal feels they could change
• • irony - oppositie of expectations

Question 17

MI asks you to check your own morality at the door. It’s the patients morality. You must set your own aside and focus on the patient. You will fail at this as much as you will succeed.

Answer 17

A quote

Question 18

Expressing Empathy employ reflective listening techniques which include:

Answer 18

1. Paraphrasing ( “It sounds like..”
   - Invites clarification
2. Summarizing ambivalence (“On one hand… and on the other hand…)
3. Moderate understatement (intentionally misunderstand)
   
   • • “It sounds like you’re a bit annoyed about that”
   • – “I get completely furious
4. Moderate overstatement
   
   • • you feel your drinking is totally under control
   • – well there are some times when i wonder…”

Question 19

Develop discrepancy

Answer 19

See where the status Quo is and the desired goal and how far they are from one another and how much motivation will be used.

Question 20

What is involved in developing discrepancy?

Answer 20

Open-ended questions:

1. Disadvantages of status quo
2. Advantages of change

Inclining to patient motivation and patient care. These are used to motivate patients and those people around you to influence you within your goals

Question 21

What is roll with resistance?

Answer 21

Resistance (“No change talk”) is a natural manifestation of ambivalence
Arguments for change invite client resistance
Boxing versus Aikido
– Aikido: MI takes this approach (the way of unifying)

Question 22

What are reactions to avoid as a counselor?

Answer 22

• — Arguing for change
• — Assuming the expert role
• — Criticizing, shaming or blaming
• — Labeling the client
• — Acting in a hurry

Question 23

What are reactions to rely on as a counselor?

Answer 23

• — Reflective listening
• — Discussing the positive of not changing
• — Shifting focus
• — agreeing with a twist
• — Emphasizing client choice and control

Question 24

What is Support Self efficacy?

Answer 24

Even when motivation is high, a client with low self-efficacy will struggle to change
Enhancing the patients self-efficacy

Question 25

What kind of questions to evoke change talk?

Answer 25

Open-ended questions

a) Optimism about change
b) Intention to change