Why is motivation so important in OT
- it provides the foundation for understanding an individual’s participation in occupation
- > motivation is the drive behind what we choose to do
What are the three steps in starting to help patients in OT
1) directing
- >tell people what to do and how to go about it
2) Guiding
- >it involves listening and offering expertise where needed
3) Listening
- >interested in what the other person has to say
- >seek to understand and respectfully refrain
What does prepatory change talk consist of?
Think of the acronym DARN
D-desire
->”I want or I wish or would like to or I hope to”
A-ability
->”what we believe we can do”
R-reason
->”background for making the change, the why”
N-need
- > has an urgency component to it
- > “If i don’t make a change, my diabetes will worsen significantly”
What does motivating change talk consist of?
Think of the acronym Cats
- commitment
- > commitment language signals the likelihood of change
- > commitment language is what people use to make promises to each other
- > include phrases like, “I will”, “I swear”, “I guarantee”
- activation
- > this is the language that indicates movement towards an action
- > this is not like a binding contract but does suggest the person is moving in that direction of change
- > include phrases like, “I am willing to”m “I am ready”, “I am prepared”
- Taking steps
- > this is language that indicates a person is already taking steps towards change
- > “I called my friend to make a time to go walking”
- > “I went to my first group therapy session”
What are theories that explain motivation
- Maslow’s Hierarchy of Needs
- Approach/Avoidance Model
- Self Efficacy
- Self determination theory
- Flow Thery
- Transtheoretical Model
- Model of Human Occupation
What does the transtheoretical model do
- it helps to set up a plan that is appropriate for our client
- > helps identify why something may not be working
- can provide a point of reference for our clients
- > so they can identify where they are at in the process of change
-it is a cycle, relapse is expected and a natural part of the process
What are the steps of the transtheoretical model
Pre-contemplation
Contemplation
Planning
Action
Maintenance
RELAPSE
- then from relapse, it goes all the way back to precontemplation
- in pre-contemplation and action, you can move forwards and backwards
How does the volitional subsystem in MOHO relate to motivation
- volitional subsystem is linked more frequently to motivation
- volition provides:
- > motivation for occupation
- > choice of occupation
- > the way people engage in their chosen occupations
- the volition subsystem consists of:
- > values
- > interests
- > personal causation
What are common self perception concepts that appear in the OT literature
-they are self esteem, self efficacy, personal causation or a sense of agency, self awareness and self identity
- low self esteem and low self efficacy affect personal causation
- > people will feel like they have less control over their lives
What are beliefs
- the lenses through which we view the world
- beliefs are the bedrock of behavior and the essence of our affect
- they are shaped and shifted through our interactions with others and the environment we live in
- beliefs resides in what we think, what we feel and what we do
What are the three types of beliefs
Surface beliefs
->automatic thoughts
Intermediate beliefs
->values, attitudes and rule of living
Core beliefs or schemas
->beliefs about ourselves our world and the future
What is the difference between constraining beliefs and facilitative beliefs
- constraining beliefs decrease solutions and options to problems
- facilitative beliefs increase solution options
What is trauma
- refers to an experience or experiences that overwhelm an individuals ability to cope or integrate ideas and emotions involved in that experience
- > it is an experience that threatens or harms a person
- > has a serious negative effect on a person’s physical, emotional, social and spiritual wellbeing
What parts of the brain can trauma effect
- pre-frontal cortex
- > affect the planning and making decision aspect of our brain
- amygdala
- > after trauma, the amygdala can become overstimulated and as a result it looks for a threat everywhere
underactive hippocampus
- > killing of the cells in the hippocampus due to stress
- > this results in less memory consolidation
What is PTSD characterized by
- characterized by 4 main symptom clusters
- intrusion
- > the re-experiencing of a traumatic memory
- > there does not need to be a trigger for it
- persistent avoidance
- > avoidance is extreme
- > triggers lead to avoidance
- persistent negative thoughts and feelings
- marked alterations in arousal and activity
What are the four principles and practice of trauma informed care
1) Trauma awareness
- >how common trauma experiences can be
- >acknowledge various coping strategies
2) Emphasis on Safety and Trustworthiness
3) Opportunity for Choice, Collaboration and Connection
4) Strengths Based and Skill Building
What is motivational interviewing
-a collaborative conversations style used as a way of strengthening a persons own motivation for change
- it has its roots in addiction counselling
- > it has been well researched over the last 36+ years and continues to be a popular way of interacting with people
-it can be used fro short interactions, be an intervention on its own or paired with other treatment perspectives
Does motivational interviewing sit on the conversation continuum?
- yes
- >it starts off with directing then moves to guiding and ends with following
What is righting reflex
- it is the desire to fix what is wrong with people
- > and to quickly set them on a better course
- > it relies heavily on DIRECTLY
Does motivational interviewing try to resits righting reflex
- yes
- >it is a key concept to resist righting reflex
What are the 4 aspects of motivational interviewing spirit
- partnership
- acceptance
- compassion
- evocation
- > the act of bringing or recalling a feeling, memory, or image to the conscious mind
- > note that ideas about change are already in a person
What are the four components of acceptance within motivational interviewing
1) Absolute worth
- >unconditional positive regard
- >when people are accepted as they are, they are mobilized to change
2) Accurate empathy
- >an active interest and effort to understand a person’s internal perspective
- >to see the world through their eyes
- >it is about meeting the person where they are at
- >the opposite of empathy is imposing your own perspective
3) Autonomy
- >we do not have to agree with what clients choose to do
- >we have to respect that they are able to make that decision
4) Affirmation
- >to seek and acknowledge the person’s strengths and efforts
- >this is more than appreciating
What are the core skills of motivational interviewing
-use the acronym oars
O-open ended questions
A-affirmations
R- reflection
S-summary
What are the 4 processes of motivational interviewing
1) Engaging
- >resisting the righting reflex, explore motivation, being empathetic and empowering the patient
2) Focusing
- >collaboratively identifying the goal of the MI session or ongoing counselling
3) Evoking
- >thought of the as the heart of MI
- >change talk happens in this process
- >simplest method to evoking is to ask open ended questions
4) Planning
- >move from discussing importance to an actual change plan
- >moving from evoking to planning is a clinical judgement
