MI & model of change

Question 1

what is the transtheoretical model of change

Answer 1

six specific steps necessary for any type of radical change to occur:

• precontemplation
• contemplation
• preparation
• action
• adaptation/maintenance
  -evaluation

Question 2

explain the pre contemplation stage

Answer 2

• no insight into SUD
• Individual will resist change and typically has no intention of altering behaviour
• Unaware of the impact of behaviour on those around them

Question 3

role of RPN in pre-contemplation stage

Answer 3

use MI - keep pt engaged
- Build rapport and trust; increase problem awareness; raise the sense of the importance of the change.

Question 4

explain the contemplation stage

Answer 4

• pts get ready for change
• they become aware that they are stuck in a situation and must decide whether they wish to change or remain where they are

Question 5

role of RPN in contemplation stage

Answer 5

• the focus is on pros and cons
• Acknowledge ambivalence regarding the difficulties associated with change
• explore the discrepancy between present behaviour and the service user’s personal values and goals
• assist in weighing pros and cons of change, while working to tip the scales towards change
• Discussing reasons for change and risks of not changing important, as is increasing confidence in ability to change

Question 6

explain preparation stage

Answer 6

• pt considers changing drug-using behaviour and anticipates what this future action will entail
• pt adherent to OATs
• pts more involved, show up for apts

Question 7

role of RPN in preparation stage

Answer 7

• build pt confidence
• talk about timing of change
• provide information, options
• help pt identify and resolve barriers to success, including friends and family who may still benefit from user’s drug-using behaviour, along with activities associated with drug use
• help pt develop realistic plans that can be easily implemented with minimal risk of failure
• • dont rush; work at pt’s pace

Question 8

describe the action phase

Answer 8

• the work and behavioural change begins; heavy emphasis on problem solving and problem-solving skills
• Entails changing awareness, emotions, self-image, and thinking
• pt is actively involved in the change process
• pt will be abstinent or on OAT
• they may still be using drugs but are involved with tx with harm reduction awareness

Question 9

role of RPN in action phase

Answer 9

• Support of positive decisions and positive reinforcement
• help develop attainable goals
• monitor progress and assist pt in self-monitoring
• relapse prevention teaching
• helping pt identify and explore times that may lead to use (emotions, urges, cravings, social situations, etc.)

Question 10

describe maintenance/adaption phase

Answer 10

• pt has made changes and is sticking with it
• e.g., pt on OAT, only seen once every 3 months, taking antidepressants

Question 11

role of RPN in maintenance phase

Answer 11

• focus on skills training
• focus on supporting and encouraging new behaviour
• provide different counselling approaches to support pt in adapting to not using drugs
• help develop plans to address triggers that can lead to lapse or relapse

Question 12

describe the evaluation/termination phase

Answer 12

• Sees service user move beyond problem solving, with a focus on preventing reoccurrence and dealing with the reality of sobriety
• Service users assess their strengths and areas that may be problematic in the future as they develop a reoccurrence-prevention plan

Question 13

role of RPN in evaluation/termination phase

Answer 13

• Reinforce new skills, new knowledge, and the positive changes produced
• review triggers that can lead to lapse
• develop strategies on how to return to the new behaviour if a lapse occurs rather than returning to previous behaviours that led to drug use

Question 14

consciousness raising

Answer 14

increasing information to service users about themselves and their problem

Question 15

dramatic relief

Answer 15

experiencing and expressing feelings about one’s problems and solutions grieving losses, partaking in role play to appreciate impact of changed behaviour

Question 16

Environmental Re-evaluation

Answer 16

assesses habits that affect one’s social and physical environment; increase awareness that one can be a positive or negative role model for others

Question 17

Self Re-evaluation

Answer 17

users assess how they think and feel about themselves with respect to their substance use; value clarification, healthy role models, imagery used

Question 18

Self-liberation

Answer 18

choose and commit to change beliefs and actions

Question 19

Reinforcement Management

Answer 19

providing consequences: punishments or rewards

Question 20

helping relationships

Answer 20

combining caring, trust, openness, and acceptance and support for healthy behaviour

Question 21

counter-conditioning

Answer 21

substituting healthier alternatives for problem drug-using behaviours; focus on substituting alternatives for problem behaviours with an emphasis on self-care

Question 22

stimulus control

Answer 22

removing cues for drug use and replacing them with prompts for healthier alternatives

Question 23

SOCIAL LIBERATION

Answer 23

increasing engagement in non-drug-related behaviours, considering the needs of others, becoming involved in broader issues; increase is social opportunities or alternatives

Question 24

what is MI as defined by William miller

Answer 24

An interpersonal and interactional process wherein which there exists the probability of behaviours occurring that are intended to lead to positive outcomes

Question 25

reasons people resist change

Answer 25

- Nature of necessary change is misunderstood - Change is forced or mandated - Hard work required to change what you have been doing for a long time - New skills and knowledge often required - Changing threatens one’s competence - Too many changes are asked for all at once - Goal is not seen as achievable

Question 26

Change talk vs Sustain Talk

Answer 26

Change talk is talking about the possibility of changing and sustain talk is talking about remaining in the same situation.

Question 27

MI tactics

Answer 27

- Encourage the change talk, and acknowledge sustain talk but do not dwell on it. - Acknowledge difficulties in the process, do not dwell on them. - Summarize progress and encourage their growth through observations. - COGNITVE DISSONANCE

Question 28

what is MI

Answer 28

- Influenced by Carl Rogers; developed by William Miller in 1983 - Brief, person-centred method; uses intrinsic motivation to change - Explores and resolves client ambivalence - Uses the ideas of attribution, cognitive dissonance, self-efficacy and empathy - Interpersonal process that de-emphasizes labelling - Emphasizes internal attribution for change and individual responsibility - Strength-based counselling style; counsellor works with user, rather than doing things for or to them - Focus on locating natural motivating issues within a person’s life - Non-confrontational in nature; acknowledges that creating conflict is counterproductive - Seeks to increase user’s awareness of their behaviour as well as unrecognized strengths and opportunities for change

Question 29

Cognitive Dissonance

Answer 29

- Cognitions include our thoughts and beliefs; our opinions about the environment, ourselves, our actions and behaviours - Consistency occurs when these cognitions align - If balance not obtained, individual will experience state of tension or inconsistency between their opinions, attitudes, beliefs, and actions - Dissonance occurs when this tension motivates individuals to alter their thoughts, bringing their beliefs and perceptions closer

Question 30

Principles of MI: RULE

Answer 30

- Resist providing suggestions - Understand the person’s motivation to change - Listen intently, provide feedback - Empowerment through encouragement and support

Question 31

Components of MI: PACE

Answer 31

- Partnership: MI is collaborative work - Acceptance: Absolute worth; Autonomy and support; Affirmation; Accurate empathy - Compassion: non-judgemental, non-blaming, non-shaming - Evocation: draw knowledge and options from service users rather than imparting information or opinions

Question 32

Attributes of MI

Answer 32

- Express Empathy: sets the stage for acceptance of efforts to facilitate change - Develop Discrepancies: perceived values versus actual behaviours and outcomes. User must be able to perceive discrepancy between present behaviour and personal goals and values - Roll with Resistance: resist arguing against resistance; have service user voice arguments for change - Support Self-Efficacy: service users (and counsellors) must believe change can happen

Question 33

OARS

Answer 33

- Open-Ended Questions: allow service user to guide conversation - Affirmations – compliment user on behaviours, strengths, and efforts - Reflections – 2- 3 reflections after open ended questions - Summarizing – ensure mutual understanding of discussion

Question 34

change talk

Answer 34

- Verbalizing arguments for change - Allows service users to openly discuss new idea - Think in ways different from when misusing drugs - Contrasted with “sustain talk”: conversations that favour the status quo and resisting change and “disengagement traps”: approaches that negate value of MI - Proficient use of MI techniques will increase change talk and decrease sustain talk

Question 35

disengagement trap: assessment trap

Answer 35

When you begin and focus only on information gathering rather than exploring the service user’s motivation for change.

Question 36

disengagement trap: question and answer trap

Answer 36

Asking too many questions and not letting the service user lead the discussion.

Question 37

disengagement trap: expert trap

Answer 37

Assuming and communicating that you have the best answers to resolve the service user’s challenges.

Question 38

disengagement trap: premature focus trap

Answer 38

Focusing the discussion before fully engaging with the service user.

Question 39

disengagement trap: labelling trap

Answer 39

Defining the service user through a label.

Question 40

disengagement trap: blaming trap

Answer 40

When the discussion shifts to blaming or finding faults with others rather than on the change process.

Question 41

disengagement trap: chat trap

Answer 41

Engaging in access small talk that is not action orientated.

Question 42

MI PROCESSES

Answer 42

- Engaging: establish a mutually trusting and respectful helping relationship - Focusing: “what” stage; entails clarifying particular goal or direction for change and exploring ambivalence to change - Evoking: “why” stage; counsellor assists service users to find, nurture, and implement their own reasons to change - Planning: “how” stage; counsellor helps the service user develop specific change plan that service user is willing to implement