psychological assessment- motivational interviewing

Question 1

What makes a psychologically informed clinical practice?

Answer 1

create a balance between the psychological barriers and mental barriers
- incorporate patients’ beliefs, attitudes, and emotional responses into patients management bases on biopsychosocial models

Question 2

What is the Transtheoretical model?

Answer 2

• 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

Question 3

What are the steps in the transtheoretical model?

Answer 3

1. preconception
2. contemplation
3. preparation
4. action
5. maintenance
6. Termination (maybe)

Question 4

What is the pre-contemplation phase?

Answer 4

-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

Question 5

What is the contemplation phase?

Answer 5

• 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

Question 6

What is the preparation phase?

Answer 6

• 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

Question 7

what is the action phase?

Answer 7

• 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

Question 8

What is the maintenance phase?

Answer 8

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

Question 9

What is the importance of communication in behavioral changes?

Answer 9

Effective communication strategies are needed to successfully implement cognitive behavioral intervention techniques
- ex. motivational interviewing techniques

Question 10

What is motivational interviewing? (MI)

Answer 10

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)

Question 11

What are the 4 principles of empathy in MI?

Answer 11

1. expression of empathy
   - conveys understanding in nonjudgmental/genuine way
2. recognition of discrepancies
   - identify differences between current and future states of athlete
   -enhances patients ability to become more familiar with desirable outcome
3. rolling with resistance
   - respect autonomy and allow patient to verbalize resistance
4. supporting self-efficacy
   - enhance and affirm self-confidence
   -identify client’s strength

Question 12

What are traps to avoid in MI?

Answer 12

1. expert trap
   - you know and have all answers over the patient taking away their autonomy
   - goal is to be collaborative
2. advice without permission
   - MI is not for advice
   - liability
   - want them to come on their own conclusion (facilitating long term change)
3. 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

Question 13

What is the readiness ruler and how would you use it?

Answer 13

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?”

Question 14

How are importance and confidence related in changing behavior?

Answer 14

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

Question 15

What is O.A.R.S?

Answer 15

0 = open-ended questions
A = affirmation
R= reflection
S= summary

Question 16

What words do you use for open-ended questions?

Answer 16

How, what, tell me about this

Question 17

characteristics of Open-ended questions

Answer 17

• 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.

Question 18

How do you open the interaction with an open ended question?

Answer 18

• “What brings you in here today?” What is the most important thing that you would like to discuss?

Question 19

How do you close an interaction with an open-ended question?

Answer 19

• what else do we need to deal with before we end?
  DONT SAY “is there anything else?”

Question 20

Why do we not use WHY questions?

Answer 20

• can often come off as judgmental and harsh
• makes people try to rationalize their behavior

Question 21

Affirmations v. compliments?

Answer 21

• 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

Question 22

Why do we not want to use compliments?

Answer 22

• 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

Question 23

What are affirmations?

Answer 23

Identifying and commenting on a positive behavior/comment made by the individual that speaks to the quality of their character and commitment to health

Question 24

What do you need to highlight in an affirmation?

Answer 24

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

Question 25

What is reflecting/active listening?

Answer 25

• 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

Question 26

What are the outcomes of reflection/active listening?

Answer 26

Reflective listening reduces resistance, conveys empathy, and reinforces engagement.

Question 27

What should you avoid saying in a reflection?

Answer 27

• “I’m sorry you feel that way” because that is about the clinician and not the patient

Question 28

What is the summary process?

Answer 28

• 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

Question 29

What should you do in a summary as a clinician?

Answer 29

• 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

Question 30

How to give advice?

Answer 30

1. 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