Motivational Interviewing (M.I.) Flashcards
Areas to cover in suicide assessment
-are you suicidal?
-do you have a plan?
-do you have the means to carry out that plan?
-depression
-thoughts & plans
-intent to commit (mild/moderate/severe)
Continuum of Styles (3)
- Directing
- Guiding
- Following
Directing-Continuum of Styles (3)
-one-end: professional provides info., instruction, advice
-non-judgmental, unbiased
-not how we feel, but how we can professionally guide ppl. to their values/interests
-roles for recipient: obeying, adhering, complying
Guiding-Continuum of Styles (3)
-good listener, offers expertise where needed
-ask permission to share insight/judgement
-not too much/too little
Following-Continuum of Styles (3)
-active listeners, seek to understand
-no agendas; refrain from inserting own material (temporarily)
4 Interrelated Elements of the Spirit of M.I.
- Pace
- Acceptance
- Compassion
- Evocation
Why is documentation important working with suicidal clients?
-shows you obtained adequate historical info.
-shows you consulted w/1 or more professionals
-shows you gave resources to clients
O.A.R.S.
-core skills of M.I.
O- asking open questions
A- affirming
R- reflective listening
S- summarizing
-informing/advising
Open Que.’s
-invites ppl. to reflect before responding
Affirming
-recognize, support, & encourage strengths & efforts
Summarizing
-pulls together info. client’s offered
-can be collecting, linking, transitional
Reflective Listening
-fundamental skill in MI
-deepens understanding whether guess is accurate
-allow ppl to hear again thoughts/feelings they’re expressing in different words, ponder them
-keeps person talking, exploring, considering
D.A.R.N. C.A.T.
- increase change talk; heart of M.I.; we want to elicit:
D- desire
A- ability
R- reason
N- need
C- commitment
A- activation
T- taking steps
Desire (D.A.R.N. C.A.T.)
-I want to change
-contain verbs; want, wish, like
Ability (D.A.R.N. C.A.T.)
-I can change
-what a person can do, able to do, gently (hypothetically) what they could do
Reason (D.A.R.N. C.A.T.)
-it’s important to change
-ask for specific reasons why
-they explore the if…
-then reasons for considering or making a change
Need (D.A.R.N. C.A.T.)
-I should change
-expresses urgency for change w/out giving particular reasons
-need que’s may evoke reasons
Commitment (D.A.R.N. C.A.T.)
-how I will make changes
Activation (D.A.R.N. C.A.T.)
-I’m ready, prepared, willing to change
Taking Steps (D.A.R.N. C.A.T.)
-the client’s doing the work of treatment; taking active steps towards goal
A.B.C.’s of Documentation
Accurate
Brief
Clear
-no need for lengthy notes unless suicide discussion or serious occurrence
-include client, setting, clinician
The 4 Aspects of Acceptance (the A Team)
Absolute Worth
Accurate Empathy
Autonomy
Affirmation
Absolute Worth
(The 4 Aspects of Acceptance (the A Team)
-unconditional Pos. regard
-no judgement
Accurate Empathy (The 4 Aspects of Acceptance (the A Team)
-see the world thru their eyes
Autonomy (The 4 Aspects of Acceptance (the A Team)
-honouring their right/capacity of self-direction
-complete freedom to be & to choose (Rogers)
Affirmation (The 4 Aspects of Acceptance (the A Team)
to seek & acknowledge person’s strengths & efforts
Ambivalence
- normal step on the road to change
- pre-contemplation stage
-see both reason to change & reason not to
-want to change & don’t want to change
-either focusing on the pos. of the change or focusing on the neg. of the change
Change Talk
-self-motivational statements that favour change
-statements about desire, ability, reasons, & need for change
Sustain Talk
-reflects one side of ambivalence
-person’s own arguments for not changing
-desire to stay as they are
-worries & reasons not to change
-need to stay as they are (status quo)
4 M.I. Processes (E.F.E.P)
- Engaging
- Focusing
- Evoking
- Planning
Engaging (4 M.I. Processes (E.F.E.P)
-both parties establish helpful connection & working relationship
Focusing (4 M.I. Processes (E.F.E.P)
-focus on agenda: what person came to talk about
Evoking (4 M.I. Processes (E.F.E.P)
-eliciting client’s own motivations for change
-heart of M.I.
Planning (4 M.I. Processes (E.F.E.P)
-motivation reaches threshold of readiness
-balance tips to think & talk more about when & how to change
Thomas Gordon’s 12 Roadblocks
- ordering, directing, commanding
- warning, cautioning, threatening
- giving advice, making suggestions, providing solutions
- persuading w/logic, arguing, lecturing
- telling ppl. what they should do; moralizing
- disagreeing, judging, criticizing, blaming
- agreeing, approving, praising
- shaming, ridiculing, labeling
- interpreting, analyzing
- reassuring, sympathizing, consoling
- questioning, probing
- withdrawing, distracting, humouring, changing the subject
Agenda Mapping
is a meta-conversation
-I.D.’ing 1 step to focus on in process of change
-choosing & prioritizing
-assists w/changing direction, getting unstuck, raising difficult topic, clarifying roles
Meta-conversation
taking a few steps back to have a convo.about the convo.
Resistance
-characterized client movement away from change
-sustain talk & discord
2 Psychologists that Developed M.I.
William R. Miller & Stephen Rollnick (1983)
Transference
-when someone redirects their feelings about one person onto someone else
-person transferring their feelings about someone else onto their therapist
Countertransference
-when therapist projects their own unresolved conflicts onto the client
Positive Engagement
-being involved w/task or team in way that fosters wellbeing, productivity, & growth
-achieved by taking initiative, valuing & recognizing others, facilitating teamwork & trust, promoting complete immersion in activities
P.A.C.E.
-4 key interrelated elements of M.I.
-spirit of M.I.
Partnership
Acceptance
Compassion
Evocation
Partnership (P.A.C.E. - 4 key interrelated elements of M.I.)
-nature of relationship between client & clinician
-clinician brings expertise (education, training, experience)
-client knows themself better than anyone else
Acceptance (P.A.C.E. - 4 key interrelated elements of M.I.)
-clinicians deep appreciation for client & their worldview
-incl.’s 4 A’s: absolute worth, accurate empathy, autonomy support, affirmation
Compassion (P.A.C.E. - 4 key interrelated elements of M.I.)
-prioritize needs & welfare of client above that of clinician
-foundation of trusting relationship
Evocation (P.A.C.E. - 4 key interrelated elements of M.I.)
-client has strengths, resources, thoughts, ideas, solutions, motivation, expertise, wisdom, & experience that can be tapped
Discrepancy
-lack of compatibility/similarity between two or more facts
-between the way things are & the way client wants them to be
-helpful tool: decisional balance worksheet (pros & cons)
