Motivational Interviewing Flashcards
Define MI
A collaborative, person centered form of guiding to elicit and strengthen motivation for change
What are three concepts of MI?
- Conversation about change
- Collaborative, person centered
- Evocative
What is evocative?
Seeks to call forth the persons own motivation and commitment
What is motivation viewed as in MI?
- Not viewed as a personality trait or defence mechanism
- Originates from internal beliefs and values
- Considered a state of readiness to change that can alter and be influenced by other
What is the goal of MI?
help clients move through the stages of change, no matter where they are now
What are 5 assumptions of avoid in MI?
- The person ought to change
- The person wants to change
- This persons health is the prime motivation factor
- If he or she decides not to change, the consultation has failed
- Individuals are either motivated to change or they’re not
What is the spirit of MI? (PACE)
- Partnership of equals
- Acceptance (empathy, autonomy)
- Compassion (caring for them)
- Evocation (use of their wisdom)
What are the four processes of MI (EFEP)
- Engage: establish partnership
- Focus: Clarify their agenda
- Evoke: Elicit reasons for change
- Plan: Commit to a plan for action
Core skills for MI (OARS)
- Open-ended question
- Affirmations
- Reflective listening
- Summaries
How can change talk be evoked? (DARN-CAT)
- Desire
- Ability
- Reasons
- Need
- Commitment
- Action Taken
- Take Steps
What is partnership?
The counselor functions as a partner or companion, collaborating with the clients own expertise
What is acceptance?
The counselor brings an attitude of acceptance to the client/counselor relationship
What is compassion
The counsellor acts benevolently to promote the clients welfare, giving priority to the clients needs –> compassion is about seeking and valuing the well-being of others
What is evocation?
The counselor elicits the clients personal motivation for particular change –> done by interviewing the client and to to prompt the client to talk about behaviour change
What does eliciting thought and feelings about change (evoking) do?
Helps the counselor to accurately highlight what is important to the client and helps the client to hear his true belief
What are the 4 basic principles of MI (ESRD)
- Express empathy
- Support self-efficacy
- Roll with resistance
- Develop discrepancy
What is expressing empathy
What i feel as you, seeing with the eyes of another, listening with the ears of another, and feeling with the heart of another
What is supporting self efficacy
- Clients must believe in their capacity for change
- help clients identify their past success
- ask client to make an inventory of their strengths and resources
What is rolling with resistance?
-Resistance is what happens when we expect or push for change when the client is not ready –> required that the counselor does NOT engage in power struggles, therefore by rolling with resistance will inhibit any “Struggle” to occur
What value of MI results in less resistance?
Having the client define the problem and develop their own solution leaves little for the client to “resist”
What are two types of resistance? What do they promote?
- Sustain talk
- Discord
- -> both types are promoting the status quo
What is sustain talk? Example?
- Client talking about themselves, their perception
- “My blood sugar isn’t a problem”
What is discord? Example?
- Clients talking about us or our interactions
- “You don’t understand”
What is one goal of MI?
To help clients get unstuck
What is developing discrepancy
- The client has to be the one to present argument towards change
- Motivation for change occurs when people perceive a mismatch between “where they are and where they want to be”
How does MI develop discrepancy?
helps clients examine discrepancies between their current circumstances
What is ambivalence?
- Individuals in the contemplation and preparation stages of change
- They are experiencing mixed feelings about starting something new
- A part of them want to change, and the other part doesn’t doesn’t
Why are people ambivalent?
- Alternatives are equally appealing
- Neither course of action is appealing
- Both alternatives have features that are both appealing/unappealing
- Conflicted feelings, fear of loss, not knowing what is right
What is ambivalence rooted in?
In a discrepancy between an individuals values and actions (i.e. a client might value health and fitness, but think there is insufficient time to be more PA)
What does ambivalence result in?
A mismatch between where the client is, and where the client want’s to be
As a counselor, what is our role in ambivalence?
-Help client see that current patterns conflict with her or his values and health goals
When will motivation for change increase?
When the client recognizes that there is a discrepancy between a current choice and a personal goal
How can clients move through ambivalence?
By spending time with it –> People tend to avoid it because it can be frustrating and uncomfortable to focus on conflicting priorities without making a decision
What is change talk?
-When the client expresses the need to change, or the reasons why the change is necessary –> the balance of indecision begins to shift towards taking more action
Discriminate between change and sustain talk
Change: client statement favouring change
Sustain: client statements favouring the status quo
What are 6 signs of readiness to change?
- Increased change talk
- Decreased sustain talk
- Taking steps
- Resolving (reached some kind of resolution)
- Questions about change
- Envisioning (talking about how life might be after a change)
In OARS, what does open-ended questions do?
-Prompt clients to search their memory banks and tells you what’s on their mind, gives the client latitude to respond
In OARS, what does affirming mean?
Builds relationships, tends to put people at ease and to decrease defensiveness, it fosters engagements, it emphasizes the clients strengths
In OARS, what does reflecting mean
Active listening, serves as a mirror for clients to reflect their own situation. It also decreases miscommunication and strengthens the counselor-client relationship. it is the counselor making a guess about the meaning of what a client has to say.
In OARS, what does summarizing mean?
Draws together what the client has said, it offers back the counselors understanding of what the client has been saying, and bits together all important pieces
In DARN CAT, which change-talks build motivation?
-DARN
Desire, Ability, Reasons, Need
In DARN CAT, which change-talks strengthen the commitment to change?
- CAT
- Commitment, Taking steps, Change
What is DARN (motivation) and CAT (commitment to change) bridged by?
Summarizing, which should be done through the counselor
What is the objective of change talk?
To resolve ambivalence, by providing opportunities and the encouragement for the client rather than the counselor making arguments for change
What can desire look like?
“I want to, I would like to, I wish”
What does ability look like?
“I could, I cam, I might be able to”
What does reasoning look like?
“I would probably feel better if, I need to have more energy, quitting smoking would be good for my health”
What does need look like?
“I ought to, I have to, I really should”
What does commitment look like?
-Statements about likelihood to change.
“I promise, I will, I intend to”
How does change talk fit together?
People first talk about what they want to do (desire), why they would change (reasons), how they could do it (ability) and how important it is (need)
–> As DARN motivations are voiced, commitment gradually strengthens, and the person may take initial steps towards change
What are the 5/10 strategies for evoking change talk?
1) Ask evocative question
2) Explore decisional balance
3) Ask about the positive and negative of the target behaviour
4) Ask for elaboration/examples
5) Ask about a time before the change behaviour emerged - were things better or different?
How can we explore decisional balance?
By asking for pros and cons of both changing and staying the same
What are the 6/10 strategies for evoking change talk?
- Look forward - what may happen if things continue the way they are
- Query extremes
- Use scaling
- Explore goals and values
- Come alongside and “disarm”
How can we query extremes?
Ask what the worst things that might happen if you don’t make the change, and what the best things might happen if we do the change
How can we disarm?
By explicitly siding with the negative (status quo side of ambivalence
The overall goal of MI i to help client get unstuck, what is the method to initiate this? How is it done?
- Change talk
- Asking evocative questions
Give 5 examples of phrases which evoke change talk
1) What would be the good thinks about changing your behaviour?
2) What would your life be 3 year from now if you changed your behaviour?
3) Why do you think others are concerned with your behaviour?
4) If you were to decide to change, what would you have to do to make this happen?
5) How can I help you get past some of the difficulties that you are experiencing?
When planning for change, how should we proceed?
Using elicit-provide-elicit
How can we elicit?
- Ask the client what he already knows about the topic
- Ask the client what else he would like to know about the topic
- Ask permission to provide information
- -> At this time, can also assess client’s stage of behaviour
How can we provide?
- Share only relevant information
- Use the client’s experiences as a starting point, and assess what is already known
- Keep it short and sweet
- Avoid using imperatives such as “you should” or “all you need to do is”
During the provide stage, what should the counselor observe?
Client’s verbal and non-verbal cues to determine wether the line tis engaged, interested and understands the facts given
How can we elicit after providing?
- Check in with client
- Invite the client to respond to information such as “what are your thoughts on that”?
What is discouraged in MI?
Advice giving, as it makes the client feel as though you have all of the answers
–> Remember the counselors goal during an MI session is to support your client to develop his own action plan
What may giving advice result in?
Sustain talk, and possible discord within the counseling relationship, ultimately slowing the client’s process towards change
How can we empower clients with goals?
- Follow through on a goal that they have selected themselves, rather than giving them one
- Use open-ended questions, to assist client in the goal setting process
Examples of phrases to empower patients with goals?
-“What ideas do you have of specific changes you’d like to work on”?
___ of clients entering counseling are in Stages 1-3
80%
How can we counsel clients in pre-contemplation?
Help client to understand that behaviour change comes from them, inform themselves about the consequences of the behaviour and do NOT argue for change
How can we counsel patients in contemplation?
- raise awareness of benefits of change, normalize ambivalence, explore barriers and SE
- Elicit/evoke change talk, such as using decisional balance and scaling of importance
How can we help build an intervention plan for clients in the preparation stage?
- Propose suggestions, and reinforce clients propositions (i.e. what have you already considered doing?)
- help client identify social support, barriers, and make client define SMART goals
What are the four steps to assess readiness and confidence?
1) Ask to scale issue
2) Explore SE by “why didn’t you pick a lower number”?
3) Then explore barriers “what would have to be different to pick a higher number?”
4) Reflect by putting together both SE and barriers
During the maintenance stage, how can we intervene?
- Discuss about relapse prevention
- Affirm success, explore positive feelings/benefits and reaffirm coping skills
During a relapse stage, how can we intervene?
- Make sure that client is not only experiencing a lapse
- Identify causes of relapse
- -> Explore triggers, and reframe the whole situation as a leaning experience, establish a new plan
