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34 Cards in this Set
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1. Is a person-centered counseling style for addressing the common problem of ambivalence about change.
2. Ambivalence about substance use and change is normal and is an important motivational barrier to substance use behavior change.
3. Ambivalence can be resolved by exploring the clients intrinsic motivations and values. 4. Your alliance with the client is a collaborative partnership to which you each bring important expertise. 5. An empathic, supportive counseling style provides conditions under which change can occur.
1. You can use MI to effectively reduce or eliminate client substance use and other health risk behaviors. - The MI counseling style helps clients resolve ambivalence that keeps them from reaching personal goals. MI builds on Carl Rogers humanistic theories about people's capacity for exercising free choice and self- determination. 2. As a counselor, your main goals in MI are to express empathy and illicit clients' reasons for and commitment to changing substance use behaviors. MI this particularly helpful when clients are in the Precontemplation and Contemplation stages of the Stages of change (SOC) when readiness to change is low, but it can also be useful throughout the changes cycle.
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Motivational Interviewing |
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Use an MI counseling style to support partnership with clients. Collaborative counselor-client relationships are the essence of MI, without which MI counseling techniques are ineffective. Counselor MI spirit is associated with positive client engagement behaviors (i.e self- disclosure and cooperation) and positive client outcomes and health related behaviors( e.g. exercise, medication adherence) similar to those in addiction treatment.
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Spirit of MI |
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An active collaboration between you and the client. A client is more willing to express concerns when you are empathetic and show genuine curiosity about the client's perspective. In this partnership, you are influential, but the client drives the conversation. |
Partnership |
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Refers to your respect for an approval of the client. This doesn't mean agreeing with everything that client says but is a demonstration of your intention to understand the clients point of view and concerns. In the context of MI there are four components of acceptance: ABSOLUTE WORTH: Prizing the inherent worth and potential of the client.
ACCURATE EMPATHY: An active interest in, and an effort to understand, the client's internal perspective reflected by your genuine curiosity and reflective listening.
AUTONOMY SUPPORT: Honoring and respecting a clients right to and capacity for self- direction.
AFFIRMATION: acknowledging the client's values and strengths |
Acceptance |
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Refers to your active promotion of the clients welfare and prioritization of client needs |
Compassion |
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Elicits and explores motivations, values, strength, and resources the client already has |
Evocation |
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It is theoretically linked to his theory of the "critical conditions for change_ which states that clients change when they are engaged in a therapeutic relationship in which the counselor is genuine and warm, expresses unconditional positive regard, and displays accurate empathy critical criticization for. |
Principles of person-centered counseling |
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A key concept in MI is ________________. It is normal for people to feel two ways about making an important change in their lives. Frequently, client ___________________ is a roadblock to change, not a lack of knowledge or skills about how to change. Individuals with SUDS are often aware of the risk associated with their substance use but continue to use substances anyway. They may need to stop using substances, but they continue to use. The tension between these feelings is ________________. This tension may help people move towards change, but often the tension of ambivalence leads people to avoid thinking about the problem. They may tell themselves things aren't so bad. View ambivalence not as denial or resistance, but as a normal experience in the change process. If you interpret ambivalence as denial or resistance, you are likely to evoke discord between you and clients, which is counterproductive. Type of Statement: Desire to change: Change Talk: " I want to cut down on my drinking." Sustain Talk: " I love how cocaine makes me feel." Reasons to change: Change Talk: "Ill miss less time at work if I cut down." Sustain Talk:" Getting high helps me feel energized." |
Ambivalence |
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Recognize ___________________ talk and _____________ talk in clients will help you better explore and address their ambivalence. ________________ Talk Consists of client statements that support not changing a health-risk behavior, like substance misuse. Change talk consists of client statements that favor change. Sustained talk and change talk are expressions of both sides of ambivalence about change. Over time, MI has evolved in its understanding of what keeps clients stuck in ambivalence about change and what support clients to move in the direction of changing substance use behaviors. Client stuck in ambivalence will engage in a lot of sustain talk, whereas clients who are more ready to change will engage in more change talk with stronger statements supporting change. |
Sustain talk and change talk |
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Desire To Change: this is expressed in statements about wanting something different- I want to find an Alcoholics Anonymous (AA) meeting or "I hope to start going to AA" Ability to Change: this is expressed in statements about self perception of capability- In could start going to AA." Reasons to Change: this is expressed as arguments for change- I'd probably learn more about recovery if I went to AA" or "Going to AA would help me feel more supported." Need To Change: this is expressed in client statements about importance or urgency- I have to stop drinking" or "I need to find a way to get my drinking under control." Commitment: this is expressed as a promise to change- I swear I will go to an AA meeting this year" or "I guarantee that I will start AA by next month." Activation: this is expressed in statement showing movement toward action I'm ready to go to my first AA meeting Taking Steps: This is expressed in statements indicating that the client has already done something to change-- I went to an AAA meeting" or "I avoided a party where friends would be doing drugs." |
Acronym for Change Talk in MI is DARN-CAT |
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Asking Open questions Affirming Reflective Listening Summarizing |
Core Skills of MI: OARS |
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You use open question to invite clients to tell their story rather than close questions, which merely elicit brief information. Open questions or questions that invite clients to reflect before answering and encourage them to elaborate. Asking open questions helps you understand their point of view. Open questions facilitated dialogue and do not require any particular response from you. They encourage clients to do most of the talking and keep the conversation moving forward. Close questions evoke yes/no or short answers and sometimes make clients feel as if they have to come up with the right answer. One type of question is actually a statement that begins with "Tell me about or "Tell me more about. The "Tell me about" statement invites clients to tell a story and serves as an open question. |
Asking Open Questions |
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Is a way to express your genuine appreciation and positive regard for clients. Affirming client supports and promotes self-efficacy. By affirming, you are saying, "I see you, what you say matters, and I want to understand what you think and feel." A firming can boost clients confidence about taking action. Using affirmations and conversations with clients consistently predicts positive client outcomes
When affirming: 1. Emphasize clients strengths, past successes, and efforts to take steps, however small to accomplish change goals. 2. Do not confuse this type of feedback with praise, which can sometimes be a roadblock to effective listening. 3. Frame your affirming statements with "you" instead of "I" Use statements such as: - "You took a big step in coming here today." -"You got discouraged last week but kept going to your AA meetings. You are persistent." |
Affirming |
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Is the key component of expressing empathy. ________________ it's fundamental to person-centered counseling in general and MI in particular. Reflective listening: - Communicates respect for and acceptance of clients. - Establishes trust and invites clients to explore their own perceptions, values, and feelings. - Encourages a non-judgmental, and collaborative relationship. - Allows you to be a supportive without agreeing with specific client statements. Reflective listening requires you to make a mental hypothesis about the underlying meaning or feeling of client statement and then reflect that back to the client with your best guess about his or her meaning or feeling |
Reflective Listening |
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The counselor follows the principles of person-centered counseling but also guides a conversation towards a specific, client written change goal. MI it's more directive than purely a person-centered counseling; it is guided by the following broad person-centered counseling principles: - SUD treatment services exist to help recipients. The needs of the client take precedence over the counselors or organizations needs or goals. -The client engages in a process of self change. You facilitate the client's natural process of change. - The client is an expert in his or her own life and has knowledge of what works and what doesn't. - As the counselor, you do not make change happen. - People have their own motivation, strength, and resources. -Counselors help activate those resources. - You are not responsible for coming up with all the good ideas about change, and you probably don't have the best ideas for any particular client. - Change requires a partnership and "collaboration of expertise". - You must understand the client's perspective on his or her problems and need to change. - The counseling relationship is not a power struggle. Conversation about change should not become debates. Avoid parking with her trying to persuade the client that your position is correct. - Motivation for change is evoked from, not given to, the client. - People make their own decisions about taking action. It is not a change goal until the client says so. - The spirit of MI and client centered counseling principles Foster a sound therapeutic alliance.
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MI add another dimension in your efforts to provide person-centered counseling |
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The spirit of MI compromises the following elements: |
Partnership. PACE Acceptance Compassion Evocation |
Think of acronym of the four elements of MI |
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Closed Question: " So you are here because you are concerned about your use of alcohol, correct?" Open Question: "What is it that brings you here today?" Closed Question: "How many children do you have?" Open Question: "Tell me about your family." |
Closed and Open Ended Questions |
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There making ethnic, culture, even personal differences and how people are respond to affirming statements. Be aware of verbal and nonverbal cues about how the client is reacting and be open to checking out the clients reaction with an open question "How was that for you to hear?" Strategies for forming affirmations that account for cultural and personal differences include: 1. Focusing on specific behaviors to affirm 2. Avoid using "I" 3. Emphasizing descriptions instead of evaluations. 4. Emphasizing positive developments instead of continuing problems. 5. But for a main interesting qualities and strengths of clients. 6. Holding an awareness of clients strengths instead of deficits as you formulate affirmations |
Strategies for forming affirmations that account for cultural and personal differences |
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And am i, there are several kinds of reflective listening responses that range from simple (i.e. repeating or rephrasing ing a client statement) to complex (using different words to reflect the underlying meaning or feeling of a client statement). Simple reflections engaged clients and let them know that you are genuinely interested in understanding the perspective. Complex reflections in by plans to deepen their self-exporation |
Types of Reflective Listening |
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Client Statement: "My wife is nagging me about my drinking." Counselor Response: "Your wife is nagging you about your drinking." Purpose: Builds rapport. Expresses Empathy |
Type of Reflective Listening: Repeat |
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Client Statement: "My wife is nagging me about my drinking." Counselor Response: "Your wife is pressuring you about your drinking." Purpose: Expressive empathy. Highlights selected meaning or feeling |
Type of Reflective Listening: Rephrase |
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Client Statement: "I'd like to quit smoking marijuana so that the second-hand smoke won't worsen my daughter's asthma." Counselor Response: "You are afraid that your daughter's asthma will get worse if you continue smoking marijuana." Purpose: Highlight selected feeling. Highlight discrepancy between values and current behavior |
Type of Reflective Listening: Complex Feeling |
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Client Statement: "I'd like to quit smoking marijuana because I've read that second hand pot smoke can make asthma worse and I don't want that to happen to my daughter." Counselor Response: "You want to protect your daughter from the possibility that her asthma will get worse if you continue smoking marijuana." Purpose: highlights selected meaning. Highlight discrepancy between values and current behavior |
Meaning |
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Client Statement: "I know I should give up drinking, but I can't imagine life without it." Counselor Response: "Giving up drinking would be hard, AND you recognize that it's time to stop." Purpose: Resolves ambivalence. Acknowledges sustained talk and emphasizes change talk |
Double- Sided |
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Client Statement: "I think my cocaine use is just not a problem for me." Counselor Response: "There are absolutely no negative consequences of using cocaine." Purpose: intensifies sustained talk to evoke change talk |
Amplified |
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_________________ is the first step in all counseling approaches. Pacific counseling strategies or techniques will not be affected if you and the client haven't established a strong working relationship. MI "As the process of establishing a mutually trusting and respectful helping relationship." |
Engaging |
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Once you have engaged the client, the next step in MI is to find a direction for the conversation and the counseling process as a whole. With the client, you develop a mutually agreed on agenda that promotes change and then identify a specific Target behavior to discuss. Without a clear focus, conversations about change can be unwiedly and unproductive. |
Focusing |
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Once you and the client agree on a general direction, focus on a specific behavior the climate is ready to discuss. Change talk links to a specific behavior change Target who can't evolve change talk until you identify a Target behavior. For example of the client is ready to discuss drinking, guide the conversation for details specific to that concern. |
Identifying a Target behavior. |
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_______________ elicits client motivations for change. It shapes conversations in ways that encourages clients, not counselors, to argue for change. ________ is the core of MI and differentiates. it from other counseling methods |
Evoking |
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Engaging the client in the process of change is the fundamental task of _______. Rather than identifying the problem and promoting ways to solve it, your task is to help clients recognize that their use of substances may be contributing to their distress and that they have a choice about how to move forward in life in ways that enhance their health and well-being. One signal that clients' ambivalent about change is decreasing is when they start to express change talk. The first step to evoking change talk is to ask open questions |
Evoking change talk |
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Ask and open question that elicits "Need change talk." "How important is it for you to (name the change in the Target behavior, such as cutting back on drinking)?" |
Eliciting importance of change. |
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Asking the client to identify the extremes of the problem; this enhances his or her motivation. Example: "What concerns you the most about (Name the target behavior, like using cocaine)?" |
Exploring Extremes |
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To point out discrepancies evolve change talk, client about what it was like before experiencing substance is problems, and compare that response with what it is like now. Example: "What was it like before you started using heroin?" |
Looking Back |
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Ask the client to envision what he or she would like for the future. This can elicit change talk and identify goals to work toward. Example: " If you decide to ( describe the change and Target behavior, such as quit smoking), how do you think your life would be different a month, A year, or 5 years from now? |
Looking forward |
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