FOB Exam 1: Motivational Interviewing Flashcards

motivational interviewing
Terms Definitions
A healthcare provider asking about quiting smoking more than once is the second best predictor in patients quitting smoking. First predictor is having a heart attack.
4 reasons why people change their behavior?
- disadvantages of status quo- advantages of change- optimism for change- intention to change
behavioral change is about ___ not ___.
- motivation not information
Motivational interviewing is a ___ centered, ___ method for enhancing ___ ___ to change by exploring and resolving ____.
- patient- directive- intrinsic motivation- ambivalence
___ ___ is primary reason people change.
intrinsic motivation
motivational interviewing is an ___, ___ , client centered way of being that manifests through specific techniques and strategies like ___ ___ and ___ ___ __.
egalitarian, empatheticreflective listeningshared agenda setting
Motivational Interviewing is focused on ___ to change. It has a ___ base and is good for the patient with ___ readiness that is ___, ___, ___, or ___.
- why- cognitive- low- resistant- angry- ambivalent- contemplative
Behavior Therapy/Interviewing is about __ to change. It has a ___ base and is good for the patient with ___ readiness that is ___ and wants ___.
- how- behavioral- high- convinced - action
Different Models for Motivational Interviewing:
- Medical Model- Roger's Client-Centered Therapy- Cognitive Behavioral Therapy- Transtheoretical Model
The ____ ____ is the most important model in terms of understanding change. It was founded by Prochaska and Diclemente and consists of what 4 main ideas?
- Transtheoretical Model1. Processes of Change2. Stages of Change (SOC)3. Decisional Balance4. Self EfficacyPlease Stay Don't Stay
According to the Transtheoretical Model, what are the Stages of Change: KNOW THESE STAGES
- Precontemplative- Contemplative- Preparation- Action- Maintenance
how to practice decisional balance with patient:
4 quadrants of pros and cons
define self efficacy:
- belief that one self can change- one's belief in his capabilities to organize and execute the course of action required to produce given attainments
Levels of self efficacy can be different for different behaviors and are not necessarily correlated.
Self efficacy is a ___ concept. It is not the same as ____.
- is a modifiable concept- is not the same as will power
Motivational Interviewing Key Principles:
- Motiviation is to be ilicited from the client, not imposed- persuasion/information is less effective and may cause resistance- clinician directs client to examine and resolve ambivalence- readiness is not a client trait but one that is a product of interaction- therapeutic relationship is a partnership, not a expert/recipient
Key Goals of the Clinician during Motivational Interviewing:
- Express Empathy- Develop Discrepancy: How does current behavior conflict with core values? - Roll with Resistance: client overcomes own obstacles, dance not wresting match- Support self efficacy: uncover and reinforce it
The provider should express ___. ___ facilitates changes. ___ ___ listenening is fundamental.
empathyacceptanceskillful reflective
expamples of how to develop discrepancy:
- the client, not the counselor, should present arguments for change- Change is motivated by a perceived discrepancy between present behavior and important personal goals/values
Tools of Motivational Interviewing:
- open ended questions to get the ball rolling- reflective listening- eliciting change talk- interest, confidence, dread, discrepancy
open ended questions:
Can’t be answered yes/no Cast a broad net Use respondent’s own words; Don’t label emotions Are not biased Have few assumptions Are non-judgmental or “preachy" Only ask about one thing at a time
boundaries for open ended questions:
- only use to initiate discussion- don't use more than 3 in a rowrely more on reflective listening than questioning
define reflective listening:
Statement, not a questionHypothesis testing (If I understand you correctly, it sounds like..)Affirms and validates (i.e., expresses empathy)Keeps the client thinking and talking Avoids arguingRolls with resistance
Reflective listening is more effective than questioning
Techniques for Reflective Listening:
- undershooting- short jumps- simple, short statements- acknowledge cons, emphasize pros- negative reverse/paradoxical overshoot
Negative reverese/paradoxical overshoot when to use:
- use when stuck at ambivalence- yes but syndrome high risk/fail safe
levels of reflective listening:
1. Restate- same words2. Rephrase- slightly different words3. Paraphrase- interpret, infer meaning4. Deduce- connect the dots5. Summative- review and synthesize
example of pre-reflective listening?
- Do you mean that? - must be yes/no question
example of restating and rephrasing:
what did you say
example of paraphrasing?
what are you saying, what did you mean
example of deducing:
what are you going to say/what are you feeling
summative example:
where are we/where are we going with this
Good starters for restating, rephrashing, and paraphrasing:
Responding to Content: "It sounds like..."Responding to Affect: "You feel...."
good starters for deducing:
Responding to meaning : You feel __ because ____
“I want to quit smoking because I don't want another heart attack; I want to see my kids grow up”
Content reflection “You see a connection between your smoking and the possibility of having another heart attack”Feeling reflection “You are scared that you might have another heart attack”Meaning reflection “Your children are important to you and you want to be there for them”
“It sucks that in Virginia you can’t buy a six pack after midnight…on nights like this, I really need to kick back and have a few”
Content reflection “You won’t be able to buy any beer tonight after you get off of work at midnight” “You wish you could buy some beer tonight”Feeling reflection “You are frustrated that you can’t buy beer whenever you want to” “You’ve had a tough day and you feel the need to wind down and relax”Meaning reflection “Drinking helps you cope with difficult days” “Drinking is an important part of your life”
self motivational statements:
We become more committed to that which we voiceClient takes the “positive” side of the argumentClient “discovers” discrepancy of current behavior with core values and goalsClient states their pros/reasons for changeClient solves own barriers
3 steps to eliciting change talk:
1. Recognizing change talk when you hear it. 2. Reinforcing change talk. 3. Eliciting change talk from your client.
Ways to ellicit change talk:
- pros and cons matrix- motivation scale- confidence scale
strategy 1 of ellciting change talk via "could have been lower" elicits ___outcome expecations. You said your confidence was a 7, why is it 7 instead of 1?
- positive
elliciting change talk strategy 2 "could have been higher" technique ellicits ___ outcome expectations/barrier. You said your confidence is a 5, what would it take to get it to 9 or 10.
how to develop value descrepancies:
give them list of values, traits, and characteristics snd have them point out 3-4 most importantgoal is to help patient find a link b/w their core values and health behavior
menu example:
give patient list of strategy options for change and ask which would work best for them and which they would be willing to try- or do a prioritizing list and ask which one they would like to work on first and which ones are most important to deal with
bringing it all together:
Get permissionAssess 1-10 interest/confidenceProbe higher/lowerReflect/SummarizeAssess core valuesLink behavior to valuesSummarizeWhere does that leave you? Where do we go from here?
issues to consider:
Resistance to new feeding approachChange not always feasible (low readiness)May not work with low verbal clientsMay not work with certain conditions Anorexia, DepressionWho should be the counselor?What to expect ?How much time can you give?When to referEthnic and cultural considerationsFollow-up
Markers of a productive Motivational Interviewing experience:
- client does most of the work- client accepts possibility of change- client accepts responsibility for change (intrinsic internal motivation)- upward slope of commitment language within or between sessions- dancing, not wrestling
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