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PTS - Final > Matulich - MI > Flashcards

Matulich - MI Flashcards

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1
Q

What is the “Spirit” of MI summarized as (4)?

A
  • Partnership
  • Acceptance
  • Compassion
  • Evocation
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2
Q

What four “rules” or principles are there in MI for the clinician?

A
  • Resist (telling the client what to do/fix their problems)
  • Understand (client’s own motivations and solutions- perspective)
  • Listen
  • Empower (& encourage hope/optimism)
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3
Q

What is the first “process” of MI and what does it mean?

first thing to do in act 1

A

Engage:
- The process of establishing a mutually trusting and respectful helping relationship

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4
Q

What four processes are there in MI?

A
  • Engage
  • Focus
  • Evoke
  • Plan
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5
Q

What counselor behaviours are counterproductive to engagement? (5)

A
  • Asking too many questions
  • Being the “expert”
  • Labeling your client (e.g., “addict)
  • Assigning blame for the problem to the client
  • Not getting down to business (just chatting)
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6
Q

What second process, happens in the first act and what does it mean?

A

Focus:
- Ongoing process of seeking and maintaining direction (note that agenda setting in MI is supposed to be collaborative)

Generally, the client’s agenda is followed

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7
Q

What is the advice from Matulich if one has a mandated agenda?

A

Present multiple options (e.g., we can first do this and then that or vice versa, or if you need to discuss a broad topic, offer multiple options- etc.)

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8
Q

Name the OARS skills

A
  • Open questions
  • Affirmations
  • Reflections
  • Summaries
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9
Q

What are querying commands? How are they categorized in MI?

A
  • Statements that have the same effect as an open question (e.g., “tell me about yourself”)
  • Counted as open questions
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10
Q

What is the “question-answer trap” and when does this typically occur?

A
  • Situation in which you are asking one question after another- client is passive and just waiting to answer the next question
  • Typically occurs when you over-rely on questions (especially closed ones)
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11
Q

What is the purpose of using reflections in the early part of MI

A

Convey that you are hearing/understanding what your client is telling you, gathering info and building rapport

Not that different of the purpose later on tbh

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12
Q

What are the uses for summaries? (5)

A
  • Transtition to new topic
  • Highlight/reinforce significant (motivational) statement
  • Connect different things you’ve heard
  • Understanding
  • When you feel stuck/unsure about direction
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13
Q

What are affirmations? Their use?

A
  • Statements that make your client recognize their strengths, accomplisments and positive behaviour
  • Build self-efficacy & help with engagement (act 1)
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14
Q

What is the main goal of focusing in MI?

A

Identify a target behaviour or a direction in which to proceed
- Even when identified, proper exploration is still worth it

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15
Q

What does one do in MI after engaging, establishing rapport, expressing empathy and focusing?

A

Assessing motivation

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16
Q

How does one assess motivation in MI?

A

Scaling questions
- E.g., “on a scale from 1-10, how important is changing X behaviour as of this moment?”
- Confidence questions are a part of this

Note that doing this in the PTS video session is not allowed

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17
Q

What does high importance, but low confidence on scaling questions indicate? What is needed to proceed with this type of client?

A

Motivation to change behaviour, not confident in being able to change (e.g., because of a past of failures trying to do so)
- Confidence needs to be increased to facillitate behavioural change

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18
Q

What does low importance, but high confidence on scaling questions indicate? How to proceed?

A

Low motivation (e.g., other priorities) or doesn’t see the behaviour as problematic
- Explore priorities, values and beliefs

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19
Q

What is something to avoid with follow up questions when it comes to scaling questions? Why?

A

Asking why the number isn’t higher (likely to give sustain talk)

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20
Q

What are “counselor advocacy responses” and when should you respond in this way? (6, 8 if you count repeats)

A

Trick questions, avoid these responses
- Arguing for change
- Criticizing
- Shaming
- Blaming
- Being in a hurry
- claiming preeminence (superiority)
- Expert role, labeling

Repeats are at the end

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21
Q

Which types of responses are considered “roadblocks” in MI? (8)

A
  • Ordering & Commanding
  • Threatening (well no shit)
  • Persuading with logic
  • Moralizing
  • Judging
  • Agreeing (?)
  • Interpreting & Analyzing
  • Humoring
  • Advocacy responses

Some of these are a bit weird, but context isn’t given

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22
Q

What is the focus of the act 2 of MI?

A

Listening for change talk and abivalence + eliciting/reinforcing change talk

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23
Q

Which skills are moreso relied on in act 2?

A

Reflective, empathetic listening (as opposed to questioning of act 1)

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24
Q

What is ambivalence?

A

Feeling two ways about a decision/change (e.g., both wanting and not wanting or wanting two incompatible things)

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25
What feelings does ambivalence produce and how is avoidance of those feelings disadvantageous?
- Produces anxiety - Avoidance perpetuates ambivalence and keeps people stuck
26
What are the seven types of change talk (DARN-CAT)? | just name them
- Desire - Ability - Reason - Need - Commitment (to change) - Activation - Taking steps
27
What is desire change talk?
**Consisting of expressiong of "wanting", "whishing" and "hoping for"** - e.g., "I don't want to end up like me father" (oop-)
28
What is ability change talk?
**"I can", "I'm going to", "I'm able"** - "I know I can quit smoking with the right system"
29
What is reason change talk?
Benefits for change - "I'd have more energy if I'd exercise regularly"
30
What is need change talk?
**"need to", "got to", "have to" and problems with current situation** - "I have to learn to be more sensitive to their needs"
31
What is commitment change talk?
**Implies action** - "I'll attend the next AA meeting on thursday"
32
What are six ways to use open questions to elicit change talk? Name them. | not including the follow-ups to scale questions
- Asking for it - Asking for elaboration - Querying extremes - Looking back - Looking forward - Exploring values/goals
33
What is meant by "asking for it" or "evocative questions"?
**Directly asking for change talk** - "Why would you want to exercise?" (evokes desire talk)
34
What is meant by "asking for elaboration"?
**Clarify change talk you've already heard** - "Tell me more about how you did this in the past"
35
What is meant by querying extremes?
**Best/worst things that could happen if the client changes (or didn't)** - "What’s the best thing that could happen if you started to exercise regularly?"
36
What is meant by looking back/forward?
**Asking about a time in the past when things were different or an imagined time in the future if change occurs (or doesn't)** - "What was your life like before you started using drugs?" - "Describe what your life would look like in five years if you didn't make a change"
37
What is meant by exploring values/goals (in the context of open questions to elicit change talk)?
**How does the target behaviour fit with values/goals** - "What are some goals in your future? How does smoking fit with these goals?"
38
How can open questions be used to explore/resolve ambivalence?
Decisional balance worksheet
39
What does a decisional balance worksheet consist of? (4)
Four open questions: - Advantages of changing - Disadvantages of changing - Advantages of status quo (not changing) - Disadvantages of status quo | ask these as questions
40
How can complex reflections be used to elicit change talk?
**Reflect back change talk that you assume** - e.g., if a client is talking about a low mood, but doesn't (fully) agree with the GP saying it is depression you could say "You want to feel better than you've been feeling recently"
41
What is the use of double-sided reflections?
**Explore and resolve ambivalence + holding client in ambivalent state** - "You want to watch reality shows on TV and you want to write your book"
42
In MI, why is "holding" your client in the ambivalence useful?
By making the ambivalence obvious (pointing it out) and holding them in the anxiety-producing ambivalence state for a while is **seen as sufficient for beginning to resolve ambivalence on their own**
43
How are affirmations helpful for MI?
Helping to build client's confidence
44
What is something to be careful with when it comes to affirmations?
To not overdo them
45
How can summaries be used to elicit/reinforce change talk?
By summarizing only change talk
46
What is something to be careful with when using summaries to elicit change talk?
**To do it only when ambivalence becomes resolved** - If it hasn't been done so sufficiently, you might get more arguments for the status quo, "yes buts"
47
How is resistance seen in MI?
As the flip side of motivation (thus, motivation increasing = resistance decreasing)
48
What is the historical view of resistance?
As a client characteristic (reluctance to participate, oppositional behaviour, etc.)
49
What is the social interaction view of resistance?
Seen as a function/characteristic of the interaction styles between client and counselor
50
What has the concept of resistance been replaced with in MI?
Sustain talk and discord
51
What is sustain talk?
Statements that favour the status quo
52
What is discord (MI)? | included four possible variations of it
**What is generally seen as resistance;** includes **disagreement**, not being on the same **wavelength**, talking at **cross-purposes** or a disturbance in the **relationship.**
53
What is one of the biggest sources of discord in MI?
The righting reflex
54
What are two signs of discord?
- "yes butting" - feeling like you are arguing/wrestling or working harder then your clients
55
What are three techniques when discord comes up?
- Backing off and analyzing what's up - Acknoledgement of client autonomy - Shift focus
56
What does one do in MI when they are required to give certain information?
**Be upfront about it** "I have to tell you this" and **give options**
57
What two methods are there when entering act 3 of MI?
- Summarize all change talk you've heard up until now and ask a key question - Revisit questions and follow with a key question
58
What is the purpose of a key question in MI?
**Move the client into the planning phase of MI** - "What is your next step?", "Where does this all leave you?"
59
What is a change plan?
Constitutes setting/clarifying goals, arriving at a plan and eliciting commitment
60
What constitutes the SMART goals (+ expl)?
- **Specific** (specific goal that focuses on what exactly your client wants to do) - **Measurable** (clear methods to measure achievement) - **Attainable** (client should be able to accomplish it) - **Realistic** (goals that are doable based on current behaviour) - **Timely** (time frame present)
61
Difference between attainable and realistic SMART goals?
**Attainable seems more about time** (i.e., short-term goals are more attainable than long-term goals) and **realism about ability** (i.e., if someone is a heavy drinker, immediate and full abstinence are unlikely)
62
What is the last step of MI and what constitutes its completement?
Commitment statement to a change plan | note that commitment can be taken back

PTS - Final (3 decks)

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