Motivational Interview

Question 1

3 central MI concepts

Answer 1

1. Readiness
2. Ambivalence
3. Resistance

Question 2

Readiness and its role in MI

Answer 2

1. How ready is a person for a change
   - on what stage of change is a person
2. Impacts the action that follows the MI-Intervention
   - Counselor must be sure about the stage of the client
   - influences which methods are used

Question 3

Readiness measurements in MI

Answer 3

6 Stages of change
1. Pre-contemplation
2. contemplation
3. Preparation
4. Action
5. Maintenance
6. Relapse

Readiness Ruler

Question 4

Readiness importance in MI

Answer 4

• Readiness is in the client
• The methods must be related to the level of readiness
• Wrong assumed readiness by counselor can create resistance

Question 5

Ambivalence

Answer 5

• Feeling different ways about one’s own behavior
• often contains discomfort

Question 6

Ambivalence importance in MI

Answer 6

1. Counselor helps the client discover ambivalence
2. Main driver for the behavior change when discovered

Question 7

Resistance in MI

Answer 7

• Often the result of counselors’ behavior or previous experience of the client
  A client can be:
  1. reluctant to change
  2. suspicious of the counselor’s intentions and prejudice

Question 8

Forms how a client shows resistance in a Motivational Interview

Answer 8

1. Arguing
   - against expertise, the accuracy of the counselor
2. Interrupting
   - the counselor in a defensive manner
3. Denying
   - the own problems, responsibility, and cooperation
4. Ignoring
   - the counselor advises

Question 9

principles of MI

Answer 9

1. Express empathy (EE)
2. roll with resistance (RR)
3. develop discrepancies (DD)
4. support self-efficacy (SS)

Question 10

Express Empathy

Answer 10

The first phase of building a trust
Techniques:
1. Reflective listening (rephrase to show understanding and interest)

Question 11

How to Roll with resistance

Answer 11

1. Avoid confrontations
2. shift attention

Question 12

Develop discrepancies

Answer 12

1. Let the client set goals
2. Ask the client about the perceived consequences of their own current behavior
3. Cost and Benefits of change and no change

Question 13

Support self-efficacy

Answer 13

1. Support the confidence of the client in their own abilities to change
2. Self-affirmation can be used to rise confidence

Question 14

OARS

Answer 14

To advance in the stages of change
1. Open ended question
- elicits change talk in the client
2. Affirmation
- reduce resistance against topic
3. reflective listening
- build trust and reduce resistance against counselor
- highlighting ambivalence
4. Summarising
- strengthen autonomy, highlights clients change talk

Question 15

Normalizing

Answer 15

• difficulties with changing are not uncommon
• lowers pressure to change

Question 16

Levels of reflection

Answer 16

1. Simple = repeating
2. Complex = rephrasing
   
   • Affective - emphasised the emotional dimension
   • Values - emphasized beliefs & principles
   • Continuing the the clients argumentation

Question 17

Advice Giving

Answer 17

Only with permission
On goals or informations
Can also be hidden in reflective listening and summarizing

Question 18

Change Talk

Answer 18

Is about eliciting change talk by the client
The client makes statements like
- disadvantage of staying the same
- the advantages of change
- optimism about change
- the intention to change

Question 19

How to elicit change talk in the client

Answer 19

1. asking evocative questions
   
   • disadvantage of status quo
   • advantage of change
   • optimism
   • change intention
2. Using the “importance ruler”
3. Exploring the decisional balance (4-field matrix)
   
   • consequences of changing and not changing
4. Querying extremes
   
   • what would be the worst outcome if you continue
5. Looking back
   
   • have there been successes in the past?
6. Looking forward
   
   • where do you want to be?

Question 20

Limitations of MI

Answer 20

1. Most useful for clients with low motivation
2. Should not be used as a method alone

Question 21

Self-Determination Theory in MI

Answer 21

1. Integrating SDT to differentiate between motivation types and their impact on behavior change

Question 22

SDT Autonomy and MI

Answer 22

The change in the hand has to come from the client
Own goals, own way, own answers to open questions
Develop discrepancies (let the client develop them)
Roll with resistance

Question 23

SDT Relatedness and MI

Answer 23

Counselor & client relationship
Express Empathy without blaming

Question 24

SDT Competence and MI

Answer 24

Support self-efficacy
giving professional feedback if client agrees

Question 25

Stage 1: Pre-contemplation

Answer 25

1. are unaware of any problem related to their behavior 2. are unconcerned about their behavior or even enjoy it 3. unconcerned about consequences help could provide: - reducing resistance - help recognize, motivate

Question 26

Stage 2: Contemplation

Answer 26

1. are sometimes worried about the difficulties the behavior is causing 2. debating with themselves whether to not they have a problem 3. consider changing help could provide: - reducing resistance - support the thoughts

Question 27

Stage 3: Determination/Preparation

Answer 27

1. getting ready to make a change help could provide: - support self-efficacy, feedback on clients ideas on how to change

Question 28

Stage 4: Action

Answer 28

1. changing process help could provide: - goal setting, support self-efficacy (competence), feedback on process

Question 29

Step 5: Maintenance

Answer 29

1. change is made and maintained help could provide: - building resistance against temptations

Question 30

Relapse in the stages of change

Answer 30

1. normalized process 2. client learns from trying and relapsing 3. the client usually does not go back to pre-contemplation

Question 31

What to avoid in MI

Answer 31

Question-answer trap Confrontation-denial trap Expert trap Labeling trap Premature focus trap Blaming trap Lack of time trap

Question 32

Traditional Approach in relation MI

Answer 32

Giving the client a solution that does not fit the client Trying change by increasing bad feelings

Question 33

What can change the impact of MI (Behavior change methods) from person to person?

Answer 33

1. Difficulty to build a Counselor-client relationship - same age vs. different age, cultural differences, sometimes better when the counselor is not a clinical expert 2. social influences (social environment) either supportive or not - connected to role models, social determinants 3. Experience of Counselors 4. Anticipations of the person - e.g. self-efficacy = overestimation of MI as behavior change - Intervention effect = something was done so it has to have an effect 5. Goal - what MI is supposed to affect is too strict and leaves no room for own goals

Question 34

What methods can be used to support MI?

Answer 34

1. CBT and group therapy for maintaining the motivation and changing the behavior long term