Task 4 Flashcards
Three central concepts of MI
- readiness
- ambivalence
- resistance
Readiness
Conceptualised in stages of change:
framework that indicated that people often have different needs, depending on their stage of change, & that simply moving stages during counselling might be beneficial
- stages if change model: gives contract “readiness to change” which proves proves useful for understanding & conduct of MI session
Conceptualised as a continuum
- highlights the need to maintain congruent with the client’s readiness on an ongoing basis in counselling
- oversimplifies, no reference being made to circular process
Motivation can be views as a state of readiness to change
- fluctuates & can be influenced by others
Readiness & MI
- counsellor awareness of shifting readiness is invaluable for the skilful use of MI
- in MI the counsellor always walks beside the client, in step with its readiness to change
Issue: not only is the client usually cautious, but the counsellor often with limited time for the journey, may run ahead of clients readiness
- sensitivity to readiness may enable resistance behaviours of client ti be kept to minimum & for rapport to be sustained through difficult passages
Readiness & Resistance
big mistake of counsellor to assume bigger readiness to change of client than there is
–> resistance
Ambivalence
- feeling two ways about something
- all changes contain an element of ambivalence
- discomfort as a result of change or choice situations if the consequences are uncertain
MI & ambivalence
- ML helps to reduce it
- resolving ambivalence in direction of change key element
- MI helps to explore clients ambivalence about change without experiencing the process as hostile & insensitive
- places at center of description if MI bc provided counsellors with a conceptual anchor for dealing with the uncertainty about behaviour change that pervades so many counselling sessions
- inter-relationship of ambivalence about change and clients goals ans core values is substance of MI
Ambivalence & behaviour change
- change may be effortful & enervating
demanding to reconfigure beliefs concerning the role of the behaviour
Resistance
- observable behaviour that arises when the counsellor loses demonstrable congruence with client
- often consequence of counsellor behaviour & amenable to change
may be:
- a general reluctance to make progress
- opposition to counsellor or what counsellor thinks is best
- the client’s expectation as to the posture of the agency the counsellor represents
denial
May defend:
- self-esteem
- personal values
- articulating of a particular important opinion (e.g. a core belief)
Responding constructively to rapport damaged by miscommunication & confusion is especially important in early stages of counselling
Principles of MI
- express empathy
- develop discrepancy
- roll with resistance
- Support self-efficacy
Express empathy
fundamental principle
- ensures counsellor remains in step with needs & aspirations of client
- client needs to know you g have cognitive & emotional understanding
- show acceptance towards client, so client feels accepted
reflective listening
- rephrase what they are saying (not in clinical terms)
- try to move gently to next level
- show understanding for clients ambivalence
- no labelling, stay neutral & open in the beginning
- use labels at later stages when
client ready & willing to self-label
Develop discrepancy
Why?
- so client can look at own situation & release that is not good & realise that this is where change is coming from
- in exploration of client’s personal values & aspirations fir future, a particular state of discomfort, termed discrepancy, can arise from contrast between what person wants from life & self-destructive nature of addition problem
Goal
- clarify important goals for the client
- explore if client is aware of he consequences or potential consequences of the client’s current behaviour
- create & amplify the client’s mind a discrepancy between current behaviour & life goals
> find a way to put those two things together
> this means working with ambivalence, not fighting it
Roll with Resistance
Why?
- if client is not following you, you need to make different move such that you are not blocking their behaviour but are gently showing an alternative direction
Goal
- avoid resistance
- if arises, stop & find another way to proceed (step back & look at situation again)
- avoid confrontations
- shift perceptions
- invite, but not impose new perspectives
- value the client as a resource for finding solutions to problems
Types of Resistance
Arguing
- client contests the accuracy, expertise, integrity of the clinician/expert
Interrupting
- client breaks in & interrupts clinician/expert in a defensive manner
Denying
- client expresses unwillingness to recognise problems, cooperate, accepts responsibility, take advice
Ignoring
- client shows evidence of ignoring or not following clinician/expert
Support Self-efficacy
Why?
- give them tools, vocabulary, behaviour to help them develop so they are able to do it
–> here STD comes in
- belief in ability to change (self-efficacy) is important motivator
- research supports importance of self-efficacy as a predictor of success in changing behaviour
- client is responsible for choosing and carrying out personal change (also furnish them with the understanding/the belief they can do it)
- there is hope in the range of alternative approaches available (show client there is not only one way, try out one if not helping next one)
OARS
are the skills that can be used by interviewers to help move clients through the process of change
- Open-ended questions (use 50-70% of time)
- Affirmation (use at least 1x)
- Reflective listening (ratio 2:1)
- Summarising (1-2x)
–> amount of usage is minimum but no clear rule
Ask:
- permission
- open-questions
- closed questions
Tell:
- inform
- give feedback
- advise
Listen:
- appreciate
- reflect
- summarise
Open-ended Questions
evokes client’s arguments for change
- avoid yes-no questions
- should use specific labelling (stay neutral)
- should invite them to give you info to work with
Guideline:
- need to spell these out in your guideline for counsellors so that they have ready made questions that they can use
Keep in mind:
- this is harder/more complex than it seems
open question: asking permission
- needed when dicing into sensitive topic
- communicates respect for client
- major value in MI with patients
- allows clients to feel human, helps maintain eye-level between client & you
- gives opportunity to discuss patient’s behaviour when not presenting problem
> giving opportunity to present problem but ask “do you want to talk about it” - allows conversation to continue even if patient not thinking of changing
- respectful
Affirmations
Goal: affirm patient
- often forgotten
- can be big, important thing for patient
- supports self-efficacy
- increases their confidence
Affirmations need to be done:
- respectfully
- genuiely
- need to be pitched at a level that fits with the patient themselves
- useful to make them situational or behaviourally specific
Reflective listening
- used to checkout whether you really understood client
- highlights their ambivalence of behaviour
- steers client towards greater recognition of problem
reinforce statements indicating that the client is thinking about change
–> helps to find out where client is on change trajectory
Simple reflective listening: can ensure that client feels understood in often confusing discussion (empathy)
- use reflective statements to help people to keep thinking about their perspective on change and their ambivalence, and moving towards change
- use a lot of conditionals & question techniques while at same time repeating a lot of info you got from client
Reflect on:
- what person says
- how they feel
- what things mean to them
reflective listening is difficult
- do not put words in their mouth
- the more thoughtful & understanding the practitioner, the more likely client hets contemplative & by that makes new connections
- paraphrasing after clients comment
Normalising
in reflective listening
- communicates to the patient that difficulty in changing not uncommon
- don’t use negative label
- takes pressure/focus away from individual
