Week 2 Introduction to Motivational Interviewing Flashcards
What is Motivational Interviewing?
Evidence based practice to help people explore and resolve ambivalence to change
- MI is a “spirit” rather than a set technique/specific intervention
What else do we need to know about using MI?
Recognising that clients have the capacity to change but is NOT about coercion or imposing change
Is a collaborative person-centered approach to elicit and strengthen motivation to change
It is a way of being with the client which requires respect for the client (and their right to choose to change or not) and good client-health professional rapport
What is not part of Motivational Interviewing?
If you behave as an “expert”, give information, ask closed questions, do most of the talking, are judgmental, show no empathy, and dictate solutions you are NOT engaged in MI
What is OARS?
O - Open Questions
A - Affirmations
R - Reflective Listening
S - Summaries
What are Open Questions?
You are inviting the client to ‘tell their story’ in their own words without leading them in a specific direction. Using What, When, How, What questions.
This helps to elicit useful information and help you to understand the client’s perspective
Examples:
- How would you like things to be different?
- What are the good things about ___ and what are the less good things about ___?
- When would you be most likely to___?
What are Affirmations?
Affirmations are statements and gestures that recognise clients’ strengths and acknowledge behaviours that lead in the direction of positive change, no matter how big or small.
They help to build clients confidence in their ability to change.
Examples:
- You handled yourself really well in that situation
- That’s a good suggestion
- If I were in your shoes, I don’t know if I could have managed nearly so well
- I’ve enjoyed talking with you today
What is Reflective Listening?
RL is listening careful to what the client is saying and responding to them in a way that emphasises the feelings behind their statements.
This helps to genuinely engage with the client, build trust and foster motivation to change.
Examples:
- It sounds like you…
- You’re wondering if…
- So you feel…..
Reflective Listening Techniques
- Repeating or rephrasing: Listener repeats or substitutes synonyms or phrases, and stays close to what the speaker has said
- Paraphrasing: Listener makes a restatement in which the speaker’s meaning is inferred
- Reflection of feeling: Listener emphasises emotional aspects of communication through feeling statements. This is the deepest form of listening
What are Summaries?
Summaries are a special application of reflective listening. They are a summation of numerous parts of what the client has been talking about and are used to help ensure that there is clear communication between the speaker and the listener.
Examples:
- Let me see if I understand…
- We’ve been talking about a lot of things and I just wanted to check I’ve got things right…
- Let me summarize…
When and how can Summaries be used?
- Can be used throughout a conversation but are particularly helpful at transition points:
- after the client has spoken about a particular topic
- after the client has shared a personal experience
- to change the direction of the conversation
- when the conversation is coming to an end
What is a ruler in MI and how are they useful?
Rulers are a scale used to assess where a client sees themselves in terms of a certain context, generally for importance of an issue or confidence of change, for example.
‘on a scale from one to ten’ how important/confident are you about this?
They can give you lots of information. People can have high importance for the issue but low confidence for change, this helps to find where they might benefit.
How does it help?
This gives the interviewer a change to argue why they should change, and an arguement for themselves about change. What can we work on together to help with this?
‘don’t ask on a scale of one to ten how ready are you to change?”
Biopsychosocial Model in MI
The biopsychosocial model is good for looking at aspects of a persons life to identify potential issues. Asking questions around the physical, psychological and social aspects will help get a broader picture of issues.
Tips for using MI
IF you are going to use double sided statement start with the good, and focus on the good.
Ask questions about what is good about the behaviour, what are they getting out of it?
Or when discussing the bad, use terms like “less good’ i.e. what is the less good things that come from this?
Also avoid the use of ‘but’ in double sided statements, it frames these behaviours that follow in a “bad” sense
Asking for permission before asking a question occasionally makes the client more comfortable about what they are sharing.
Can get away with the occasional closed question.
