MI... OARS else
Open Ended Questions
Affirmations
Reflection
Summaries
Name 4 of the 6 Interview Traps discussed yesterday.
Expert Trap
Premature Focus Trap
Chat Trap
Labeling Trap
Blaming Trap
Question - Answer Trap
When can you use MI?
when building rapport with a patient, when a patient is escalated, when discussing patient's future goals, etc.
True/False:
You are working with a patient about behavior change and they state they have no idea how to make changes. As an MI interviewer, it would be best to give your patient detailed steps interviewer created to show patient how to make improvements.
False
MI interviewers encourage patients to brainstorm ways to make changes
Respond to the following with a reflection:
"My parents are so stupid!"
You wish your parents would respond differently
Rephrase the following question to make it an open-ended question.
What school do you go to?
Tell me about your school.
What do you like about your school?
Identify the interview trap:
I see you got into a fight at school after a peer knocked your books on the floor. Sounds like a classic case of "acting on your impulses." You should really work on distress tolerance skills to enhance your impulse control skills. Have you tried the STOP Skill, or the TIPP skill? Many kids have had great success with the STOP skill. I want you to practice using the STOP skill at least once until our next session and we will talk about it next week.
Expert Trap - telling patient what they need to work on; how to work on it; not allowing patient to think for themselves
True/False:
MI will be an effective treatment strategy with every patient.
False
When a patient discusses reasons for maintaining the status quo, or not making any changes, they are displaying ____________ talk.
sustain or discord
Respond with a reflection.
"You aren't listening!"
I didn't give you the response you were looking for
You don't think I am understanding what you are trying to tell me
You're frustrated with me right now because you are trying to explain something to me and I am just not getting it
George and Bruce notice Billy sitting alone during Rec. They recognize this is unusual behavior for Billy. Bruce approaches Billy and says, "are you okay? Would you like to talk?" Billy does not respond and walks away from Bruce. George decides he is going to give it a try and walks up to Billy and states, "it's kind of noisy by all of those other kids."
What OARS skill is George using to encourage Billy to talk?
R - Reflections
George is recognizing the other kids are loud, and showing Billy he understands how that may cause someone to want to avoid the group
What's wrong with falling into the "Labeling Trap?"
interviewer does not look at the patient for who they are, and instead looks at patient as a diagnosis - while two people may have the same diagnoses, one may benefit much more from a different treatment intervention than the other
labeling can create discord in relationship between interviewer and patient
True/False:
The more you practice MI, the better your skills will improve.
True
Which of the following patients would be most likely to benefit from MI?
a. Marsha, a 13-year-old female who has a history of acting out at school. According to Marsha, she "just has terrible timing and is always in the wrong spot at the wrong time."
b. Mark, a 25-year-old male who has recently began to question if his drinking is the reason he cannot keep a steady job.
c. Molly, a 54-year-old mom who has just moved her youngest child into college and now feels lost with all of her free time.
d. Mike, a 15-year-old male who thinks everyone is over-reacting about his lack of anger control, "if people would just leave me alone, there wouldn't be any issues!"
B and C - a patient must have some sort of interest in changing in order for MI to be effective
Identify the change talk.
"I thought about not fighting, but what if someone disrespects me? I don't want people to think I'm weak."
thought about not fighting
Respond with a reflection:
"Why do I always have to be the bigger person? I am not the problem, why can't my mom change? Why do I have to be the one stuck in treatment? This isn't fair!"
You recognize you're not the only making mistakes, yet you seem to have larger consequences than your mom.
You don't feel you should be the only one trying to make changes.
You wish your mom had some consequences for her actions as well.
You feel people are looking at you as the problem, and no one recognizes the progress you have made.
What would be an example of the Chat Trap?
interviewer focusing on the football game last night, rather than discussing patient's treatment work
What is change talk?
any speech from the patient which suggests change may be possible and/or reasons to change
What is ambivalence, in regards to Motivational Interviewing?
uncertainty of change; patient questions if they would like to change or not ('on the fence' about change)
Respond with an affirmation.
"I am so frustrated with myself right now. I went all weekend without having any anger outbursts, even when Sally spent all afternoon on Saturday slamming her door during my family visit. Then Ruth hits me in the face with a basketball at Rec, and I lose it! What is wrong with me?"
You're right, that would be very frustrating about getting hit in the face, but I'm curious, how did you manage to control yourself during that family visit. You don't get to see your family often, so I know these visits are very important to you. Then you had a peer that was not being considerate and could have interrupting your family visit, yet you managed your urges. Tell me your secret!
When might one use a 'Summary' when interacting with a patient?
At the end of a session/conversation - wrap things up
When you get stuck and don't know where a patient wants to go next in the conversation
How can we avoid Interview Traps?
reflective/active listening; supporting patient rather than seeking a solution right away; encouraging patient to brainstorm their own goals and steps to attain them
What is the recommended reflection-to-question ratio in MI?
2 Reflections per 1 Question
Identify the change talk below.
"I really hate my anger! I wish I could make it just go away, but I don't know how to? I feel like I start making progress, and then someone goes and disrespects me; and you know how I get when someone disrespects me."
I really hate my anger! I wish I could make it just go away...
Respond with an affirmation.
"I have tried everything, and nothing seems to work as well as I had hoped. I don't know how much more disappointment I can endure."
You allude that you are ready to give up, yet you trusted me enough to express the frustration you are experiencing. I am taking this as you are seeking support or more assistance, which tells me, you are not ready to give up. That is not easy, and I appreciate you coming to me about this.