Motivational Interviewing Flashcards
What is the rationale for motivational interviewing?
Many health related problems are linked to what we decide to do or not do (e.g exercise, drinking, smoking, eating healthy).
To improve our health, the key is changing our behaviour.
Motivational interviewing was based initially on the strategies used to deal with addictions by therapists who had good outcomes and attendance rates (techniques were then found to be useful in other spheres of health where behaviour change was key).
What is Change Talk and what is Sustain Talk?
Change Talk is anything that points towards the person being unsatisfied with the behaviour they are engaging in, showing hope, aspiration, wish for change.
Sustain Talk is arguments for staying the same and maintaining the status quo.
In motivational interviewing, acknowledge Sustain Talk but focus on Change Talk.
What does it mean when addicts experience Ambivalence?
They recognise the problem, but put up barriers/reasons they shouldn’t change their behaviour.
Often manifested by repeatedly using the word “but”.
What are the ingredients for change?
DARN CAT
Preparation:
DESIRE - needs to come from patient
ABILITY - know how to make change, effective support
REASON - may not be health related e.g financial
NEED - recognised need to change e.g after COPD diagnosis
Action:
COMMITMENT - e.g making a contract, setting a date to quit
ACTIVATION - saying today’s the day
TAKING STEPS - really important that the patient takes incremental steps towards the goal (avoid unrealistic over ambitious steps that will lead to failure)
What are the three essential elements of MI?
1) MI is a particular kind of consultation about change
2) MI must be collaborative (person-centred, partnership, honours autonomy, not expert to recipient)
3) MI is evocative - it seeks to call forth the person’s own motivation and commitment (draw from the person’s own ideas, ambitions, thinking)
What idea did Carl Rogers (psychotherapist in the 1950s) introduce, which formed the basis of motivational interviewing?
The patient is the solution to their own problems (rather than the clinician/therapist).
Name 5 components of the spirit of the therapist, needed in MI.
1) openness
2) collaboration
3) respect for autonomy
4) resisting the “righting reflex”
5) compassion
So the therapist should be talking less than the patient, use basic communication skills, invite the person to elaborate, listen carefully, be non-judgmental, give lots of meaningful affirmation and encouragement.
What is the Righting Reflex?
When a clinician has seem a case similar to the patient’s before, and gets into a mode of immediately offering solutions. It comes from good intentions but is a form f taking control.
It is verbal leafleting, and is the least effective way of getting someone to make a change.
The patient needs to discover the solution for themselves.
This form of impersonal advice giving leads to non-attendance as people become worn down and frustrated.
Name the four fundamental processes of MI.
1) engaging - form a relationship and rapport
2) focusing - provide a strategic direction, agenda, advice, information and clarify goals
3) evoking - selective eliciting, reflection, summary
4) planning - the bridge to change, goal setting, strengthening achievement
What is involved in the Engaging step of MI?
A person-centred style
Listening
20% of consultation focused on reengaging the patient
Use OARS core skills
Open ended questions
Affirming - focus on a person’s strength and effort to increase self efficacy
Reflecting - emphasise the Change Talk
Summarising - clarify statements and provide structure
What is involved in the Focusing step of MI?
Start with unlimited optimism and the belief that everyone has aspiration.
Find out what the Change Goal is
Don’t impose your own goals if the patient does not share them
Avoid the righting reflex
What stage of the transtheoretical model are people shown to be in by Change Talk, and by Sustain Talk?
Change talk = Contemplative
Sustain Talk = Precontemplative
What is involved in the Evoking step of MI?
Ask open ended questions to elicit more Change Talk
Keep questions focused on the change
Get people to be in the contemplative stage and start thinking what they might do to change their behaviour
Respond to Change Talk with “all EARS”
How do you respond to Change Talk? (all EARS)
E - elaborating (ask for more detail, an example)
A - affirming (comment positively on person’s statement)
R - reflecting (reflect back examples)
S - summarising (present the person’s own change talk back to them)
What is involved in the Planning step of MI?
Known as the “bridge to change”
Patient needs to be ready for change, or talk of action will cause resistance
The change needs to be in incremental steps, not big leaps
Recapitulate - summarise and state the key points again
Develop a plan
Troubleshoot potential obstacles
Be flexible, be prepared for slips and support this
Refocus, re-engage, identify learning
Acceptance
