MI Reflective listening
Reflections help the participant to:
~Know that we are hearing them, and that we are listening
~Know what it is that we are hearing
~Hear important things that they are saying
~Think about things that they are saying
~Steer the conversation
Reflective listening is only partly about what you say to the person. Mostly it’s about what they hear themselves saying to you!
“I know what I think when I hear myself speak”
-Daryl Bem (Self-Perception Theory)
________is a PROCESS (not an event!)
This is what we describe as the practitioner "drawing out" the person's own motivations and skills for change, not to tell them what to do or why they should do it.
Evocation
_____ statements are those that indicate the person is oriented toward making a possible change in a behaviour, thought, attitude, or situation.
What is Change talk?
_________ is client language that indicates change is unlikely to occur.
Sustain Talk
The MI spirit and core skills remain central to the planning process. SOARS is an acronym for the five elements to which we attend in the planning process.
1. Set Goals
2. Sort Options
3. Arrive at plan.
4.Reaffirm and Strengthen Commitment
5. Support Change.
________is entirely antithetical to enhancing intrinsic motivation for change. _______ (either direct and obvious, or indirect and subtle) automatically negates any value to an MI conversation
Persuasion is entirely antithetical to enhancing intrinsic motivation for change.
Persuasion (either direct and obvious, or indirect and subtle) automatically negates any value to an MI conversation
Evocative questions.
*What do you wish you would have done differently?
*What is one step you could take to get the ball rolling?
*What would happen if nothing happens?
*How important is such a change for you?
*What’s your plan for how you’re going to get this happening?
*What do you wish you would have done differently? (Evoke Desire)
*What is one step you could take to get the ball rolling? (Evoke Ability)
*What would happen if nothing happens? (Evoke Reason)
*How important is such a change for you? (Evoke Need)
*What’s your plan for how you’re going to get this happening? (Evoke Commitment)
There are three elements in a statement that tell us whether it is truly steps to change.
1. Change talk contains statements about change.
2. These statements are linked to specific change or set of changes.
3. Change talk is typically phrased in present tense.
How do we know if the client is expressing sustain talk?
2. An ability to function with the status quo 3. The benefits of the current status quo 4.A need for status quo, or problems with change.
Thumbs up or down - Bonus/other teams point to fix it (if its wrong)
Client: "They told me I have to have this surgery right away. But I don't trust them, so I haven't scheduled it yet.
Practitioner: "Why take the chance? They're experts, after all. Let's call from this phone right now - maybe you can get in this week".
Thumbs down
Missed opportunity for clients autonomy, by pushing hard for change, even for compelling reasons, you may get the "yes, but.." response.
Difference between: Information and Advice Giving
Definition of
Information Giving
•Neutral knowledge, such as resources or protocols
•Implies no preferred response, choice or action to be taken
Definition of Advice Giving
•Implies that there is a correct course of action
•Suggests the practitioner is endorsing something
•Interviewer behaviour that is not consistent with the spirit, principles, or skills of MI
This is that strong urge to tell them the solution to their problem, because we feel we know what would work.
Righting Reflex
Change talk cane be divided into two broad categories. 1. Preparatory language
2. Mobilizing language.
~Within preparatory language are four components,
( Desire, Ability, Reason and Need)
~ Mobilizing Language includes three components,
( Commitment, activation, and taking steps.)
Sustain talk and Discord are the same thing.
True or False
Please explain.
False.
MI experts now differentiate these two types of behaviour. Trainers (MI) recommend that practitioners use the term "Sustain Talk" to identify client statements that favor maintaining the status quo, and use "Discord" to describe client behaviour that signals dissonance in the clinical relationship itself.
Participant: "I need to come up with some sort of plan to help myself get back on track now. This health crisis has thrown me fore a loop. I can't think about anything else. What do you think I should do?"
You "Well, I have some ideas about what might help, but first let me hear what you've already considered."
1 - Yup!
2 - Avoids expert role, and seeks partnership.
When is the right time for information and advice?
•When the following are presented by the participant:
•Decreased resistance or discord
•Decreased discussion about the problem
•Displays some evidence of resolve
•Change talk increases
•Asking “what if” questions about change
•Envisioning
•Experimenting
In DARN-CATS, if a participant is using the language "If I don't do it, then..", "I'd be able to...", or "It would help me out because..", they are exhibiting..
What is Reason
“___________ is simultaneously wanting and not wanting something, or wanting both of two incompatible things. It has been human nature since the dawn of time.”
Ambivalence
Affirmations are not…
•Unsubstantiated compliments: “You are special”; I really think you’re great”; ”You are very gifted”, “You’re one of my best participants in so many ways”
•
•Cheerleading: “I know you can do it”; you can do anything you set your mind to do”
•Judgmental: “You don’t seem very motivated”
There are traps to avoid in consultations in order to support the development of an MI approach.
The following is description of one of them.
"The clinical error of focusing before engaging, trying to direct before you have established a working collaboration and negotiated common goals.”
What it is ?
Premature Focus Trap
Intentional Reflective listening Exercise. "I know I could do things differently, but if she would just back off, the situation would be a whole lot less tense. Then things wouldn't happen."
1. "If she would just back off..." You wish she would give you some space.
2. "The situation would be a whole lot less tense..." You'd like things to be less tense.
3."I know I could do things differently.." You could do something differently.
Evoking change talk exercise.
"Except that I have to do it. I cant pay my part of the rent. Being off work has eaten up my savings, so I have to do it; that is why I am here- I want to figure out some way to cope."
Change talk? Yes - No.
If yes, what type?
Desire - Ability - Reason - Need Commitment - Or - Taking Steps.
If no, writer an evocative question that might elicit change talk.
There is more need language and also desire in the last statement. Coming in for a session might be considered taking steps, but it seems most clearly to be in the area of wanting some skills and coming for help to find them. A reflection might go like this: "You are here to get some tools, because you know the situation requires you do something different."
True or False
If client are inaccurate in their perceptions, it is acceptable in MI to correct their misperceptions.
If True or False, Please explain why.
True
We should correct misperceptions, though it is important to be thoughtful in how we do it. There are times when providing contrary information will simply heighten discord in an argumentative client. In this situation, delaying might make sense or choosing not to address that issue, if it is a minor point. However, even in situations where it might temporarily increase disagreement ( and Hence Discord), it may be important to present alternative information.
Reflections alone may be enough to reduce client discord?
True or False?
Please explain.
True.
Skillful Reflections often have the effect of reducing discord. Remember it is tough to sustain discord without someone pushing against it. If the practitioner's reflections do not push against the discord, then the energy is likely to dissipate.
When clients who are ready to change, we need to be prepared to continue support motivation, encourage their recommitment to action and help them revise plans as conditions, needs or results dictate.
These are known as the "Four R's of supporting change. " What are they?
1. Replanning,
2.Reminding,
3.Refocusing
4. Reengaging