psychological assessment- motivational interviewing Flashcards
What makes a psychologically informed clinical practice?
create a balance between the psychological barriers and mental barriers
- incorporate patients’ beliefs, attitudes, and emotional responses into patients management bases on biopsychosocial models
What is the Transtheoretical model?
- behavior change is not a simple process, it is gradual and follows a series of steps
- psychological readiness for change
need to help athletes make the decision to change
What are the steps in the transtheoretical model?
- preconception
- contemplation
- preparation
- action
- maintenance
- Termination (maybe)
What is the pre-contemplation phase?
-Pre-contemplators aren’t even thinking about changing, either because they don’t realize there’s a problem or because they are in denial
- barriers outweigh the benefits or person may not be aware of the benefits
- Low or no self efficacy for change because the person isn’t even considering it
What is the contemplation phase?
- At this point people recognize a problem but aren’t committed to making any changes
characteristics: - individuals have a sense of awareness about their behavior
- individuals may have the intent to take action or are seriously thinking about it but have not committed to change
- barriers still outweighing benefits
- low self-efficacy for change
What is the preparation phase?
- ready to make a change in the next month
*making an effort but not fully committed to change (ex. reach out to trainer but haven’t made an appointment) - developing a plan for action
- benefits are now outweighing barriers
- self-efficacy increasing
what is the action phase?
- Individuals take overt action to change a behavior
- Individuals use strategies to resist temptation, cope with everyday challenges, and prevent relapse
- self-efficacy is a key element in this stage (if they do not have it they will not stay in action phase)
- need small attainable goals at this stage (able to see progress and be motivated)
- in action phase for 6 months
What is the maintenance phase?
individuals sustain changed behavior for at least 6 months
- new patterns become automatic
- long term change creates strong efficacy
- increased internal reward system
- may still relapse at this stage
What is the importance of communication in behavioral changes?
Effective communication strategies are needed to successfully implement cognitive behavioral intervention techniques
- ex. motivational interviewing techniques
What is motivational interviewing? (MI)
Collaborative, person-centered form of guiding to elicit and strengthen motivation for change
- resolving ambivalence about a behavior change
- builds trust and rapport with athletes and target motivation as a mediating factor for change (ADHERANCE TO REHAB)
What are the 4 principles of empathy in MI?
- expression of empathy
- conveys understanding in nonjudgmental/genuine way - recognition of discrepancies
- identify differences between current and future states of athlete
-enhances patients ability to become more familiar with desirable outcome - rolling with resistance
- respect autonomy and allow patient to verbalize resistance - supporting self-efficacy
- enhance and affirm self-confidence
-identify client’s strength
What are traps to avoid in MI?
- expert trap
- you know and have all answers over the patient taking away their autonomy
- goal is to be collaborative - advice without permission
- MI is not for advice
- liability
- want them to come on their own conclusion (facilitating long term change) - doing all the talking
- athletes’ own words have a greater impact on behavior change than your words
- listen and reflect back what they have said
What is the readiness ruler and how would you use it?
1-10 scale of how ready they are to change
- “on a scale of 1-10, how ready/motivated are you to change the behavior?”
How are importance and confidence related in changing behavior?
people do what they think is most important
- the more important a behavior is and the more confidence they have the more their readiness for change increases
What is O.A.R.S?
0 = open-ended questions
A = affirmation
R= reflection
S= summary
What words do you use for open-ended questions?
How, what, tell me about this
characteristics of Open-ended questions
- Open questions are ones that cannot be answered with a “yes” or “no”
- Open questions do not elicit specific answers like name or date
- Open questions get the client talking, hopefully about change
- Open questions can demonstrate empathy and acceptance, elicit management, etc.
How do you open the interaction with an open ended question?
- “What brings you in here today?” What is the most important thing that you would like to discuss?
How do you close an interaction with an open-ended question?
- what else do we need to deal with before we end?
DONT SAY “is there anything else?”
Why do we not use WHY questions?
- can often come off as judgmental and harsh
- makes people try to rationalize their behavior
Affirmations v. compliments?
- use affirmations to increase confidence
- compliment = judgment = what you like
- affirmation = inference = about them and what they can do well
- need to make sure they are genuine and make sure it is about healthy behaviors
Why do we not want to use compliments?
- they will rely on you for their confidence and not themselves and doesn’t create self-efficacy
- may blur lines between professional and patient relationship
What are affirmations?
Identifying and commenting on a positive behavior/comment made by the individual that speaks to the quality of their character and commitment to health
What do you need to highlight in an affirmation?
At least once in the encounter, comment on the individual’s positive behavior or strengths:
*I appreciate you being on time for the appointment
* Your knee injury is hard on you. You are doing a good job keeping yourself moving
What is reflecting/active listening?
- A reflection is your guess/hypothesis about what the other person means or might mean
- Reflective listening involves being interesting in, curious about, respectful of what the person has to say
What are the outcomes of reflection/active listening?
Reflective listening reduces resistance, conveys empathy, and reinforces engagement.
What should you avoid saying in a reflection?
- “I’m sorry you feel that way” because that is about the clinician and not the patient
What is the summary process?
- Brings together what the person has been saying
- Serves as a transition to a new topic, bringing an encounter to an end or as a call to action if the person is ready
- happens at the end of sessions as well
- can serve as a call to action if the athlete is ready
What should you do in a summary as a clinician?
- If possible, have the patient give the summary of any plan/home practice to be done
- If not, you give a summary of the plan and check their confidence level in following through
- If confidence level is low, simplify the plan
How to give advice?
- AVOID IT
if unavoidable: Ask for permission
- The patient asks for advice
- You ask for permission to give it
- You preface your advice with permission to disagree/disregard
- Offer several options, rather than suggesting only one
