Motivational Interviewing

Question 1

define motivational interviewing

Answer 1

a collaborative conversation style for strengthening a person’s own motivation and commitment to change

Question 2

what is the goal of motivational interviewing?

Answer 2

work through (with) ambivalence to facilitate change (ambivalence to change is normal)

Question 3

list and describe the tasks of motivational interviewing

Answer 3

1. engage → having, sometimes sensitive, conversations with pts
2. focus → focusing on what is important to the pt regarding their behavior and health
3. evoke → help determine the pt’s personal motivation for change
4. negotiate → discuss and negotiate plans for change

Question 4

list the components of motivational interviewing to keep in mind

Answer 4

1. collaboration (therapeutic alliance)
   
   1. develop a partnership
   2. foster and encourage exchange of power and ideas
2. evocation (not just education)
   
   1. motivation is within the pt
   2. use open ended questions to help gather their perceptions experiences and goals
3. autonomy (not authority)
   
   1. respect pt’s right to make an informed decision
   2. emphasize the pt’s control and choice
4. compassion
   
   1. empathy for pt
   2. belief and commitment to act in best interest of the pt

Question 5

list the 4 principles of motivational interviewing

Answer 5

1. express empathy
2. develop discrepancy
3. roll with resistance
4. support self-efficacy

Question 6

what are some tips for expressing empathy?

Answer 6

1. good eye contact
2. responsive facial expressions
3. body orientation
4. verbal and nonverbal “encouragers”
5. reflective listening/asking clarifying questions
6. avoid expressing doubt or passing judgement

Question 7

what does develop discrepancy mean?

Answer 7

point out where their current behavior and future goals do not match

Question 8

list several effective responses that tend to defuse resistance and refocus on change

Answer 8

1. reflection: simply acknowledge it by reflecting it back
2. double-sided reflection: on the one hand. . . and on the other. . .
3. emphasize a person’s ability to choose, control, autonomy

Question 9

what is self-efficacy?

Answer 9

level of confidence individuals have in their ability to perform certain behaviors

Question 10

list and give an example for several strategies for developing self-efficacy

Answer 10

1. mastery experiences/performance accomplishments
   
   1. ex → incremental mastery - start w/low level difficulty activities and increase gradually
2. modeling/vicarious experiences
   
   1. ex → watching others like you perform the activity
3. social persuasion/credible sources
   
   1. ex → enlisting a credible spokesperson; trusted health pro influencing decision
4. internal feedback (psychological and physiological)
   
   1. ex → facing barriers head on and learning that they can be managed

Question 11

the 4 strategies of motivational interviewing are called ______

Answer 11

the OARS

1. Open-ended questions: avoid short answer yes/no or rhetorical questions
2. Affirmation: comment positively on strengths, effort, intention
3. Reflection (reflective listening): use what the person says “active listening”
4. Summaries: pull together the person’s perspectives

Question 12

list keys to affirmation

Answer 12

1. our responsibilities to always be on the lookout for patient’s strengths, good steps, and good intentions
2. pointing out pt’s strengths and resources can build confidence
3. be intentional and specific
4. be genuine in your affirmation
5. avoid cheerleading
6. reaffirm both big and small steps to change

Question 13

what are the 3 levels of reflective listenging?

Answer 13

1. repeat or rephrase
2. paraphrase/rephrase
3. reflect the feeling

Question 14

describe the structure of summaries

Answer 14

1. begin with statement indicating you are making a summary
2. give special attention to change statements made by the client
3. if pt expresses ambivalence it is helpful to use both sides of their feelings in the summary statement
4. can be helpful to include objective info in summary statements
5. be concise
6. end with an invitation

`

Question 15

how to respond to change talk

Answer 15

1. when you hear change talk, act on it
2. reflect it: restate it back to the person
3. ask for examples/elaboration: when was the last time? In what ways?
4. Ask for more: What else? What other reasons?
5. Affirm change talk: reinforce, encourage, support it
6. Summarize

Question 16

things to remember when giving advice

Answer 16

1. sometimes advice will need to be given
2. person is more likely to hear and heed your advice if you have permission to give it
3. It is often better to offer several options, versus one idea and then asking them for more ideas

Question 17

General recommendations for motivational interviewing

Answer 17

1. perform in private environment
2. position yourself so that your eye-to-eye with your pt
3. monitor your body language
4. perform after you have had success treating their primary complaint
5. maintain focus
6. try to show understanding and empathy by listening and letting them tell their story, solutions, and ideas
7. understand the health behavior that you are addressing
8. remember it is your responsibility to address the unhealthy behavior, but the pt’s responsibility to adopt a healthy behavior