Motivational Interviewing Flashcards
What was developed by William Miller and Steven Rollnick?
motivational interviewing (MI)
what was first found out in MI?
observed that shame and confrontation did not bring about change
when confronted w/ shame, get defensive and people tend to turn away/not trust you
“Motivational interviewing is a ______________ for eliciting from patients their own ___________ for making behavior change” - Miller and Rollnick
skillful clinical style; good motivations
interviewing consists of strategic _____ and ______
questioning; listening
what type of questions are asked in MI?
open-ended and directive
change vs. sustained talk
change: when someone is speaking about focusing on how they could possibly change
sustained: focused on not changing/why they can’t change
motivation is a _______ state
fluctuating
3 critical components of motivation
ready
- how change is prioritized
willing
- how importance of change is perceived
able
- confidence for change
change occurs ________, change in treatment mirrors this
naturally
______ about change influence change and how we _______ change influences change
beliefs; talk about
goal of motivational interviewing is to
create and amplify discrepancy between present behavior and broader goals
resolve ambivalence for change
transtheoretical model
can be applied to other theories, helps measure the change process in phases of:
pre-contemplation
contemplation
preparation
action
maintenance
what can you do in the transtheoretical model?
exit and re-enter at any stage
transtheoretical model: pre-contemplation
someone is not thinking about changing at all
arguing with someone at this stage will not work, have to find common ground
ex) smoker not willing to think about quitting
transtheoretical model: contemplation
height of ambivalence
where most people are
get people more ready, willing and able
ex) “I don’t think I can do this”
transtheoretical model: preparation
have made concrete actions towards change but change hasn’t fully been made just yet
ex) smokers maybe stopped smoking in certain places and time (i.e. stopped smoking in their car or with their morning coffee)
transtheoretical model: action
quit day!
where a lot of people can mess up, goal is to try to prevent them from going back too far in process
you can mess up in this stage and stay in action with a good mindset
ex) day a smoker stops smoking cigarettes in any scenario
transtheoretical model: maintenance
hard part has pasted while there is still work to be done in maintaining behavior change
complex process
ex) done with withdrawals
methods of psychotherapy: what MI actually looks like
focuses on patient concerns
combines directive and non-directive approaches
is delivered with a spirit of collaboration and patient autonomy
ambivalence/resistance in MI is _______, how do we think of patient and therapist interaction?
expected; “dance” not a “wrestle”
principles of MI
express empathy
- acceptance, reflection, destigmatize
- letting patient know we understand/want to know what they are going through/we are here for them
develop discrepancy
- identify patient goals and arguments for change
- see what is getting in the way of goals
roll with resistance
- avoid arguing, resistance is not directly opposed
- dance, not wrestle
support self-efficacy
- patient and therapist belief in capacity for change; build small successes
- part of preparation, as goals are achieved, confidence increases
self efficacy
belief you can accomplish thing you are attempting
______ is seen as a function of importance (willingness) and confidence (ability)
readiness
what assess importance and confidence
importance and confidence ruler
on a scale from 0 to 10 how important is it for you …
on a scale from 0 to 10 how confident are you that you can…
what questions are asked when assessing importance and confidence ruler results to elicit change talk?
“why isn’t it lower?”
“what can we do to get it higher?”
decisional balance in eliciting change talk
change and status quo x costs and benefits
disadvantages of the status quo =
statements acknowledge a problem
advantages of change =
statements emphasize reasons to change
optimism for change =
statements that acknowledge change is possible
intention to change =
statements that envision change happening
OARS acronym for MI
Open-ended
Affirmations
Reflections
Summaries
OARS help build …
self-efficacy
OARS: open-ended questions in MI
require patient to provide information
cannot be answered with yes/no (produces unproductive answer)
ex) how is smoking a problem for you > is smoking a problem for you
OARS: affirmations in MI
statements of understanding or appreciation
reframe failure as partial success or learning experience
notice patient’s strengths
statements of hope
OARS: reflections in MI
reflective listening = careful listening follows by statement of what was heard
may include content or inferred meaning
give opportunity for patients to confirm or correct
types of reflections in MI
simple
- direct statement/verbatim
paraphrase
- suggestion about meaning
reframe
- change perspective
- ex) “I can’t do it” to “you know what works vs. doesn’t”
amplified
- overstate what was heard
- have to jar someone, use at right time and not too often
- ex) doesn’t want to quit smoking for a surgery, say “Ok so you don’t want the surgery”
double-sided
- when stating both sides
- ex) saying one-hand: you were unsuccessful in quitting in the past but on the other hand: you kept trying
- help convert sustained to change talk
OARS: summaries in MI
highlight both sides of ambivalence
transition to a new topic
wrap up session
example of how talking about change influences change!
giving advice using elicit - provide - elicit
elicit patient’s buy in
- ask permission for conversation, topic, advice
provide
- provide advice or information
elicit patients reaction
- ask what they think about the information you provided
elicit- provide - elicit technique is key for _________ and ________
collaboration; autonomy
motivational enhancement
specific goal to educating patient
more goal-oriented
mechanisms for MI
client change talk
perceived discrepancy
decisional balance
cultural considerations for MI
requires
- creativity
- flexibility
- appreciation of cultural differences
