Test 2

Question 1

background of existential psychotherapy

Answer 1

not a formal school but rather a disposition that can be integrated with other formalized approaches to therapy. represents a way of thinking about the human experience. They zoom out and ask what it means to be human.

Question 2

foundational philosophers of existential psychotherapy

Answer 2

kierkegaard and Nietzsche first think about what it means to be a person in the 19th century, then Sartre and marcel continue in the 20th

Question 3

timeline of existential psychotherapy

Answer 3

1940s and 1950s rollo may and erich fromm publish books that explore existential ideas. May is the first to bring existentialism to psychology
1958: rollo may, ernest angle, and henri ellenberger publish existence: a new dimension in psychiatry and psychology
1980: irvin yalom publishes the first textbook in existential psychotherapy
1988: society for existential analysis is formed in the uk and publishes a journal

Question 4

what did rollo may think about existentialism becoming a psychotherapy

Answer 4

Once a person describes himself as an existential psychologist he is no longer existential. Classifying people is totally existential. The existentialists are most of all against the objectification of human beings. Result of industrialism. That is why Sartre rejected the Nobel prize. Talking about it is completely unexistential.

Question 5

current disposition regarding existential psychotherapy

Answer 5

Understanding psychological distress, in part, arises from “a confrontation with our existence” that confronting the reality that we are responsible for who we are and what we become can be uncomfortable. Only reflecting on mortality can we learn to live.

Question 6

broad theory of personality

Answer 6

We are meaning making beings who are subjects of experience and objects of self reflection. Meaninglessness makes us uncomfortable. We become trapped by some meanings that we didn’t make.

emotions and behaviors that constitute personality can be in or out of awareness and thus may conflict with our actions - we can live in authentic or inauthentic ways with our emotions and behaviors.

central conflict that leads to the theory of personality is between the individual the ultimate concerns of existence. Existential psychology attends to how each individual deals with these ultimate concerns

Question 7

psychoanalytic theory of defenses vs existential theory of defenses

Answer 7

psychoanalytic theory poses that there is a drive which leads to conflict between the drive and society or superego which leads to anxiety then defense.

existential theory poses something very different: that there are four ultimate concerns that lead to anxiety which lead to defenses.

both say that anxiety precedes defenses but existential says that the cause of anxiety is different. they agree when confronting anxiety people respond with defenses, but there is no innate drives - there is no supposed to be, rather you are born to confront these ultimate concerns.

Question 8

what are the four ultimate concerns

Answer 8

freedom, isolation, meaning, death

we are born with total freedom, completely isolated, left to make our own meaning before we die.

it is the reality that these four things are inevitable responsibility for all humans to confront. doing so determines our psychological health.

Question 9

freedom

Answer 9

we live in a world with no inherent design. we have come into the world and now we will decide what the design of the world is.

Issues arises when we think the culture is the inherent design.

there are some givens like the actions of others or where we are and whom we came from, we can’t choose the givens but we can choose how we respond to them, we can choose what we learn or where we grow and how we can live our givens.

freedom requires taking responsibility and living with intentionality. living without taking responsibility is living with bad faith, we often do so and give up responsibility.

this leads to failure of will

Question 10

failure of will

Answer 10

failures of will give rise to pathology

impulsivity: acting without intention or conscious will. often people act so impulsively they don’t realize how much agency they have

compulsivity: occurs when we get so stuck in willing that we start to do things that are not helpful, ocd has a real will behind it, a real intention to achieve something, but it has gone too far

decisional panic: choice paralysis

Question 11

isolation

Answer 11

requires balancing the knowledge of ultimate loneliness that is human being but also the wish for contact

Question 12

what are the three kinds of loneliness

Answer 12

interpersonal: we are separate from other people. No matter how hard we try to be empathic, we will never full embody the consciousness of someone else

intrapersonal: we are isolated from ourselves, there will always be parts of ourselves that we don’t fully know, it is our job to minimize these parts and know ourselves

existential loneliness: there is a piece of our loneliness that occurs completely alone: recognizing there is a piece of our existence that is separate from all else. I am born alone and I die alone, I am estranged from the world

Question 13

defenses people use against isolation which are maladaptive

Answer 13

craving witness: relying on the witness of others, while you can to some extent want to be with others you must examine the why

fusion: losing sense of self in someone else. think it is a fear from isolation.

psychoanalysts would say it comes from early caregiving experiences

one can empathize without agreeing or taking on the personal attributes of another person

Question 14

meaninglessness

Answer 14

root question, how does a being who requires meaning find meaning in a universe that has no meaning?

We are meaning making beings in ways that we are unaware of. (ie family, religion ect.) goal is to be conscious and willful in the meaning you make.

We create value systems, whether it be culture, family, religion, etc. The goal is to be conscious and willful in the meaning you make. Also construct meaning through awareness of death. Finding patterns in seaming random stimuli, creating causal relationships.

Question 15

death

Answer 15

ultimate existential concern, core inner conflict. May - as soon as we are aware of our existence we must be aware of the possibility of not existing. This creates an uncomfortable inner conflict. Most of the time confronted with a near death experience or seeing it in a loved one, someone close to you, exposure to death which makes it impossible to ignore. Most of the time we don’t do the hard work to confront the ultimate concerns but rather use maladaptive coping mechanisms.

Denial based defense:

specialness - I am confronted with information that tells me I need to confront my own mortality, here one claims I won’t die, I am special and it won’t happen for me,

ultimate rescuer - somebody is watching out for us, waiting for us, or taking care of us after death.

Question 16

broad disposition in the theory of psychotherapy:

Answer 16

the therapist and patient are fellow travelers: the therapies is doing this work too. they need to be further ahead than the patient, but the are doing the same work of confronting the ultimate concerns together. Empathy is very important.

Question 17

goals of existential psychotherapy

Answer 17

understand unconscious conflicts

identify defense mechanisms

discover their destructive influence

develop other ways of coping

find tolerable levels of anxiety and use them constructively

emphasize the here and now, care about the past to the extent that it helps us understand what is taking place now - here depth means what is the most pressing at this moment.

Question 18

methods of existential psychotherapy

Answer 18

it is a framework to understand suffering, not a comprehensive system of techniques, integration with other treatments works well by focusing on the ultimate concerns and managing anxiety in the face of those concerns.

addressing the four ultimate concerns and failure of willing

Question 19

addressing freedom as a method of psychotherapy

Answer 19

point out instances in the moment - stopping people in real time regarding instances of giving up responsibility,

correcting can’t to won’t

inquire about the patients role

encourage ownership over actions, thoughts, and feelings. This made me feel this way - did it make you or did you have a role and choice in reaction

Question 20

addressing freedom with failure of willing

Answer 20

correct the inability to wish by helping people identify what they wish for.

reduce impulsivity, help people distinguish between when it is time to act on a wish and when that action is coming too quickly, ask where the urge is coming from and the goals of the urge,

help patients decide, come to terms with the idea that alternatives exculde and uncertainty in decision outcome

Question 21

addressing meaning

Answer 21

help patients focus on value beyond themselves, develop concerns and curiosity for others, remove obstacles to whole-hearted engagement

Question 22

addressing death

Answer 22

awakening experience - occurs only in confronting death can we truly begin to live.

they will ask people to look back onto their lives and examine their regrets,

choose toward a lived life

Question 23

psychotherapy methods for addressing isolation

Answer 23

balance isolation and support, reciprocity and mutuality, bring a fellow traveler mindset, authenticity, we see the therapist acting authentically in front of the patient, alone together

Question 24

mechanisms of psychotherapy

Answer 24

focus on the here and now,

empathy,

fellow traveler

Question 25

evidence base in existential psychotherapy

Answer 25

challenging because it is often combined with other modalities, common factors like empathy and alliance are empirically supported

Question 26

cultural considerations in existential psychotherapy

Answer 26

ultimate concerns transcend culture, culture is important because it influences defense and helps export decisions and relationships, therapists must acknowledge and adapt. goal is to help the patient understand where culture is making the decision for them

Question 27

other names for rogers client centered therapy

Answer 27

Developed by carl rogers, also termed humanistic, phenomenological, person-centered third force in psychology - until now it was psychoanalysis then behaviorism

Question 28

carl rogers relationship with psychoanalysis

Answer 28

psychoanalytically trained - did not like how impersonal psychoanalysis was - did not like how the therapist had to be the expert and come into the room with a theory, did not like the idea of the therapist being a blank slate, followed client’s lead instead of assuming “expert” role,

Question 29

rogers and Otto rank

Answer 29

influenced by otto rank’s non-directive therapy. The idea that rather than coming into therapy with a specific plan, we can let the patient decide where the session is going to go. The therpaist facilitates discovery but does not direct the session. Rogers thinks that therapy is about devleoping a skillful way of relating to other people – not having specific skills for being a therapist

Question 30

timeline of client centered therapy

Answer 30

1902 carl rogers is born, 1940 rogers presents some newer concepts in psychotherapy” at the univ. Of minnesota, 1942 counseling and psychotherapy is published, 1957, reogres published classic paper on ‘necessary and sufficient conditions” for therapy, wins distinguished scientific contribution award from apa, 1987 dies

Question 31

Rogers early research

Answer 31

Early research: looks at predictors of change among people with schizophrenia, this leads him to accurate empathy - the therapist understanding the clients internal point of view the way the client experiences the world - and patients perception

Question 32

current status of client centered therapy

Answer 32

Current status: association for the development of the person-centered approach (1986) is interdisciplinary and meets annually. Person centered journal

Question 33

the basic assumption of client centered therapy

Answer 33

Basic assumptions: all humans have an actualizing tenacity - formative tendency, reacting as a whole

Question 34

rogers conception of the self

Answer 34

experience: the private life of the individual - we have varying levels of awareness of experience. they are all filtered through perception which is unique. symbolization is the process of becoming aware of one's experience internal frame of reference: each person has there own, and that is unique for everyone - the way everyone sees the world. everyone is in their own world and everything I bring to the table is in reference to that world, the only way to understand the self is take it in relation to its unique frame of reference organismic valuing process: the self is a collection of these experiences and the values we place on them, people often develop distress when they are not engaged in an organismic valuing process. I am not talking about values from the outside haves shoulds or musts, but rather to have a fully cohesive self we need experience and awareness of that experience,m understand how that is inflating our frame of reference, and what we do with that information and how we give it meaning. that should all come from each of us. a fully functioning person can do all these things

Question 35

what is symbolization

Answer 35

becoming aware of ones own experience

Question 36

the major themes of rogers 19 propositions

Answer 36

Client centered therapy 1951 rogers makes 19 propositions to lay out his theory of personality: Perception, self-concept, psychological adjustment are major themes perceptions: we react to the world based on our own perceptions, we see our perceptions are reality and accept them as true automatically. this becomes in line with the perception of ourslef and forms the key component of who we are, how we see and experience the world. Whatever people are doing, whatever we see someone engaged in is an attempt to satisfy their needs based on their perception of reality. While someone may be seeming to do self destructive behavior, in reality they were thinking through their own perception of reality that may look very different than yours and through their filter they are doing something to satisfy their need. people are always doing the best they can. When it looks like they are not it is because our reality is different from their reality. When there is disconnect we need to understand their internal frame of reference. self concept: we are the center of our own worlds, that is not a problem and is not narcissism, it is how we are built and a function of perception, experiences, and outlook. this is a process of taking in and putting out. this forms the personality (not as hierarchical as frued) and has some consistency. I take something in, interpret it, act on it. it is a pattern of perceptions and values and characteristics that I bring out into the world and in my own experience within myself. people develop distress if their behavior is consistent or inconsistent with their self concept and don't know why or are unaware of what we are doing or how it fits into our self concept

Question 37

carl rogers theory of psychotherapy

Answer 37

client centered therapy in common with other approaches aims to enhance the life functioning and self-experience of clients. unlike other therapies, however, client centered therapy does not use techniques, treatment planning, or goal setting to achieve these ends. rather there is an inborn capacity to heal ourselves if we are given the right conditions. the goal is not to identify the deficits you have or things going wrong and fix them, the goal is create a space where your own innate actualizing tendency can fully work, if we create that space you will heal yourself

Question 38

necessary and sufficient conditions for therapy

Answer 38

two people in psychological contact client is in a state of incongruence - they are not fully aware of their self concept, their behavior is not aligned with their self concept therapist is congruent or integrated in the relationship: this does not necessarily mean that the therapist is always congruent, but rather they are fully aware of their own experience, capable of symbolizing their experience, able to integrate with their self concept, and be genuine and behave in ways that are consistent therapist experiences an unconditional positive regard for the client therapist experiences an empathic understanding of the client client perceives the therapists empathic understanding and unconditional positive regard

Question 39

how do empathy, unconditional positive regard and congruence align

Answer 39

Empathy, unconditional positive regard, and congruence align to form trust, they are necessary for a therapist to bring It is possible to be congruent and bring unconditional positive regard. Even if congruence is in opposition to the client (telling them you don't like them) we can still hold them in positive regard, and genuinely care and attempt to understand the world through their eyes When therapy starts people often do not symbolize their experiences. When they do it is often rigid. It creates a little reality that is enclosed. Part of the therapeutic process is opening it up

Question 40

methods of client centered therapy

Answer 40

non directive: agenda is set by the client respect: unconditional postive regard will be set from the outset by showing respect for the clinet understanding: the goal is to understand their point of view: what is the reality for them. therapists of this in several ways. recognize the implicit occurrences - especially feelings, clarify, answer questions without reassurance - can contribute to external locus of evaluation (hard to balance positive regard without reassurance, you don't need to feel good to feel valued or cared for) and answer questions without advice

Question 41

what are some distinctive components of client centered therapy

Answer 41

necessary and sufficient conditions for change focusing on the clients internal frame of reference not focusing on changing structure of personality client centered therapy is universal

Question 42

mechanisms of client centered therapy: molecules of change

Answer 42

therapy is built of tiny molecules of change. moments of change - this is the direction client centered therapy generally takes these moments may be split up by lots of time with no change. the moments of movement from no change to change occur at instances in which suddenly the person is fully symbolizing and experiencing something that they were not before. this is a sense of insight or an aha moment seeing for the first time experience clearly. this can occur in therapy or in the memories of recollections outside of therapy. the moment of movement is the first time experience is fully symbolized

Question 43

zimring: how does a therapist take a clients internal frame of reference

Answer 43

often a patient comes in with a more objective external lens on the world and sees themselves as an object in a world of objects the work of therapy is to move from the objective into the subjective it is not enough for a patient to just become more capable of symbolizing their experiences that are fully internal - we are centers of our own universe and must become fully aware of what that is. the therapist can help this along by trying to tune into this subjective context, bring people back o their own internal world

Question 44

evidence base for client centered therapy

Answer 44

it is difficult to research because it is so non directive so it is hard to standardize. there are lots of research on what makes client centered therapy work, alliance, relationship, exratheraputic factors. the three necessary conditions, unconditional positive regard, accurate empathy, congruency. able to make a questionnaire

Question 45

cultural considerations for client centered therapy

Answer 45

within group differences can be bigger than between group differences, rogers says that every person is different, client centered therapists must be aware where culture is playing a role in external locus of evaluation, and how it is impacting the patient. be aware of biases to understand how it impacts understanding, challenge their own bias, and have openness and appreciation for all kinds of difference

Question 46

rebt og

Answer 46

rooted in greek and roman stoic philosophy, say we are disturbed by the view we take on things

Question 47

adler and sor

Answer 47

in the 1930s alder enters the scene and poses the s-o-are theory stimulus, organism, response, everything we do depends on opinion, we determine ourselves by the meaning we give to situations

Question 48

Ellis timeline

Answer 48

born in 1903, parents divorce in 1915, faces adversity and kidney disease, in 1959 he develops the alter ellis institute - the same time client centered therapy is coming up, in 2005 he separated from the ellis institute. as Rebt is coming up, so does cat, he goes to his grave saying they are not the same thing, yet for the most part modern psychotherapy would put rebt in the same boat, ellis argues that rational and emotion can exist at the same time, he thinks the past is not very important but is what we make of it

Question 49

rebt theory of personality

Answer 49

temperament: we all have our own physiologically/psychologcally we are in someway hardwired to respond negatively when demands are not met, we are born with instinctual demandingess, we often then interpret our desires as needs and not wants, socially it makes sense that we want to be connected to others, the need for connection must be hardwired into us for as infants we need it to survive, yet we often take this way too far we make interpretations relatie to our demandingness and our social needs emotional problems: disturbances according to ellis, because of their own interpretations, the reason this happens is because we are thinking irrationally, if we were thinking rationally we may not feel good all of the time, but we wouldn't have this level of disturbance and distress that interferes with our life. people needlessly upset themselves

Question 50

according to rebt what makes something irrational

Answer 50

extreme and absolute in its demandingness, and high in its intensity, when needs are not met, when we place these irrational beliefs we wet them ourselves, we cause them

Question 51

rebt abc model

Answer 51

acting event, belief, consequence. we reindoctrinate ourselves consistently into a cycle.

Question 52

the cycle of reindoctriantion

Answer 52

condemn self for poor performance feel guilty or depressed condemn self for guilt and depression condiment self for condemning self condiment self for missing distrubance and not changing it condemn self for needing help what sets off this chain does not matter, past is not so significant here and now and forward thinking, humans largely create their own distress

Question 53

rebt theory of psychotherapy: therapeutic relationship

Answer 53

the therapeutic relationship is active, directive, and confrontational. warmth is not necessary. a good working alliance is good, but possible without warmth, therapist must bring in an unconditional acceptance for themselves, others, and life in general. this enables rational active and directive confrontation - for within active confrontation there is still acceptance. self esteem is a judgement of earned worth, the point is the worth is present regardless of action

Question 54

theory of psychotherapy for rebt: demandingness

Answer 54

demandingness causes distress. temporary solutions and other therapies provide relief but do not fix demandiness. we must be careful to identify where people are using temporary solutions and make sure they are not being used in therapy. satisfying the demand is a short term solutions cautions to look out for distraction. magic and mysticism - people believe that there is some magical solution out there and they often look to therapists to be that solution

Question 55

rebt goal of therapy

Answer 55

correct demandingness: we need to get people to recognize when they are making demands, give up perfectionism, develop high frustration tolerance, accept reality when grim, examine the worst case scenario, distinguish between rational and irrational thinking

Question 56

rational vs irrational thinking

Answer 56

irrational thought: because something once strongly affected life, it should indefinitely affect it. it is horrible when things are not the way we like them to be. we should be completely competent in all ways vs we can learn from our past experiences but not be overly influenced by them. focus on trying to change bad situations or accept the situation. accept yourself as an imperfect creature

Question 57

healthy vs unhealthy emotions

Answer 57

jealousy vs disappointment, anxiety vs concern, rage vs annoyance, depression vs sadness, guilt vs regret, low frustration tolerance vs frustration. examine the intensity of the emotion, healthy emotions may motivate us to take action unhealthy negative emotions act as a hinderance productivity vs, distress causing

Question 58

optimal therapy characteristics for rebt

Answer 58

time and effort: it should be fast and it takes as little effort as possible symptom reduction: should produce rapid symptom reduction, must be careful with this because things like meeting immediate demands can make you feel better in the short term but not the long term lasting results: the only way to produce lasting results is to reduce demandingness, (irrational demands) and increase frustration tolerance generalizable: therapy should be generalizable to large ranges of people, what works for whom in what context

Question 59

methods of psychotherapy

Answer 59

rebt helps clients acquire a more realistic tolerant philosophy of life, rebt practitioners often employ rapid fire, active directive persuasive philosophical methodology realistic - bring rational preferences tolerate when preferences are not met this is really fast highly directive not necesalriy warm create our own internal reality by filtering the world through our own internal believe system. abc model of rbt, acting event belief consequence ellis claims that everything that happens to us (a) get filtered through our belief system (b). the goal of therapy is to use this approach to change that philosophy of life - want your to build your life around a new set of beliefs because in changing b you change the consequence

Question 60

addressing musts

Answer 60

musterbation - any time you hear words like must of have to or need you are probably in irrational territory the goal is to demonstrate the different between a us and a preference and dramatize it to make it clear

Question 61

ways to reduce musterbation

Answer 61

role play: this can look a few different ways, therapists and client role play resolutions to. distressing situation brought up by the client. if the client is struggling to do so the therapist can role play as the client to how them how to respond to the situation humor: rebt can be highly confrontational so humor can be a way to reduce tension like sarcasm or pointing out absurdity unconditional acceptance: both the therapist and client should have unconditional acceptance for ourself, others, life itself. the therapist is expected to model this and bring the unconditional acceptance into the room, have unconditional acceptance for their patients and not have irrational demands, be able to accept when our preferences are not met strong disputingL the point of strong disputing is to get people to give up their crazy thinking, he want people to see the absurdity of their thought process and understand that it is ridiculous to place these demands and need them to be met. he wants the therapist to actively dispute the client on this. we look for behavioral experiences to either prove or disprove the belief. ellis is pretty sure it won't be hard to set up experiential exercises to disprove your beliefs because he thinks they are irrational

Question 62

experiential exercises

Answer 62

1. take risks 2. seek pleasure 3. stay in poor circumstances 4. take on hard tasks

Question 63

experiential exercises 1. take risks

Answer 63

combat perfections, deliberate fail and ask if it it is as bas as you thought it would be. send memos in with typos instead of perfecting them and get them in late

Question 64

experiential exercise 2. seek pleasure

Answer 64

a rational view of life balance yes the fact that we will experience both pain and pleasure a common irrational belief is that I should never feel pain and if I do then I can't also feel positive things ellis says that you'd prefer not to feel pain but you can and while you do you can still feel pleasure if you seek out pleasure even when you're in pain, it'll help tolerate the pain

Question 65

experiential exercise 3 stay in poor circumstances

Answer 65

tell people to just stay in the situation they think is bad, get comfortable being uncomfortable help people learn to accept and tolerate there is agency in making the choice to sit and stew in it and interrupts people constantly making demands

Question 66

expanded abcd model

Answer 66

later on was expanded D stands for dispute: in therapy, it is the therapists hob to dispute, but over time you are teaching the client to do their own disputing

Question 66

experiential exercise 4 take on hard tasks

Answer 66

ask people to do things they don't feel ready for want people to see that it is okay to fail and that it is okay to have a hard time in the process this builds frustration tolerance

Question 67

identify, ask, dispute, admit and face

Answer 67

identify the activating event, belief, and consequences ask: does this serve me dispute: irrational beliefs, marriage between demandingess and frustration tolerance, dispute the irrational demand itself and the belief that if the demand isn't met its awful admit and face: own role in reindoctriantion - ellis says the big issue is that we reindocrtinate ourselves over and over agin, we filter the world through an irrational belief we take in. that is where the problem starts because then that emotional consequence becomes a new activating event.

Question 68

ellis theory of rationality

Answer 68

people largely create their own distress he wants us to take responsibility for that distress

Question 69

changing irrational beliefs

Answer 69

dispute: challenge patients to defend their belief, prove to me you are right demonstrate logical fallacies: point out where they have logical missteps show why irrational beliefs don't work reduce irrational beliefs to absurdity teach thinking in terms of realistic preferences (new belief system)

Question 70

treatment modality for rebt

Answer 70

individual therapy group therapy people have the opportunity to observe the disputing process in someone else, can be les threatening to learn this through another situation, also offers a lot of opportunities for role play workshops marriage and family therapy: often people put irrational demands on others self help - some variance in the transmission of rebt between these but they focus on the abcd model nd know what it means to be reindoctrinated with those new activating events, teach to be able to dispute on their own

Question 71

mechanisms of rebt

Answer 71

patients beliefs, therapist approach

Question 72

evicence base

Answer 72

cognition, emotion, and behavior occur simultaneously and interdependently active-directive therapeutic approach activity oriented homework modifying beliefs can propel behavior change acceptance based approaches, rooted in radical unconditional acceptance

Question 73

cultural considerations for rebt

Answer 73

belief systems are influence by culture ellis does not dispute that as a whole but asks if they need to be holding that belief as rigidly as they do unconditional acceptance of everyone beyond culutre members of minority cultures

Question 74

origins of mi

Answer 74

Developed by Miller and Rollnick working with people with alcohol use disorder. They observed the ways addiction was handled was with shame and a moral failing. Shaming and confronting did not help to bring about change in their patients. Shame is associated with withdrawal.

Question 75

timeline of mi

Answer 75

1991 publish first text, have been updating manual regularly since then. 2002 removed addictive behavior portions and became preparing people for change. Third addition went from preparing people for change to helping people change. The early days were developing motivation to begin the change process, then translated into maintaining the change throughout the change process. Fourth edition 2023 added helping people change and grow. Not necessarily a focus on the positive direction but rather moving away from the negative direction.

Question 76

mi definition

Answer 76

“Motivational interviewing is a skillful clinical style for eliciting from patients their own good motivations for making behavior change” Interviewing - strategic questioning and listening, both open ended and directive.

Question 77

mi theory of personality

Answer 77

motivation is a fluctuating state, critical components of motivation: ready - how change is prioritized, People need to be ready, prioritizing the change over other things in their life willing - how importance of change is perceived, Willing is how important it is to the person to change, you may feel really willing it is very important, I have to do this but not feel ready able - confidence for change, Ability is the confidence to change, courage to face trial when failure it possible ambivalence is to be expected changes occur naturally, change in treamtment mirror natural changes by increases likelihood of change and facilitating change, people come in with the ability to change, we just need to find a way to harness it beliefs about change influence change, sustain talk vs change talk

Question 78

goals of mi

Answer 78

goal 1: to create and amplify the discrepancy between present behavior and broader goals goal 2: resolve ambivalence for change people have their own reasons and their own goals, to get to those goals, is for people to change their behavior, in doing the first we resolve ambivalence

Question 79

theory of psychotherapy

Answer 79

transtheoretical model this came out of decades of research on smoking change, revolutionary when introduced for it used to be a dichotomy, either on or off drugs, people move through multiple phases when changing behavior focuses on patient combines directive and non directive approaches is delivered with a spirit of collaboration and patient autonomy ambivalence or resistance is expected, therapist and patient dance rather than wrestle

Question 80

stages of behavior change

Answer 80

precomntemplation: no thoughts or motive for change at all contemplation: where most people live most of the time, where ambivalence lives, considering change, can recognize that there are benefits to change and may want to change but also don't feel ready or willing or able preparation: taking steps towards feeling more able and more ready, like stop smoking in the car or throwing away ash trays action: actually undertaking change maintenance: long term follow up, continue the behavior, unclear when action ends and maintenance begins. categories like weight loss may have a clear threshold, while smoking may not exit and reentry are able at any stage

Question 81

four principals of motivational influencing that the therapist brings

Answer 81

express empathy, acceptance, reflecting, destigmatize develop discrepancy: identify patient goals and arguments for change roll with resistance: avoid arguing, resistance is not directly opposed support self-efficacy: patient and therapist belief in capacity for change, build small successes

Question 82

mi helping patients become ready, willing, and able for change

Answer 82

helping patients become ready, willing, and able for change. readiness is seen as a function of importance (willingness) and confidence (ability)

Question 83

assess importance and confidence

Answer 83

on a scale from 0-10 how important I it for you, why isn't it lower, what can we do to get it higher on a scale from 0 to 10 how confident are you that you can, what isn't it over, what can we do to get it higher

Question 84

illicit change talk by asking questions in specific ways

Answer 84

disadvantages of the status quo: statements acknowledge a problem advantages of change: statements emphasize reasons to change optimism for change: statements that acknowledge change is possible intention to change: statements that envision change happening

Question 85

oars style in mi

Answer 85

open ended: requires patient to provide information, cannot be answered with a yes/no, tell me about what happens when you X affirmations: statements of understanding or appreciation, reframe failure as partial success or learning experience, notice patients strengths, statements of hope reflections: reflective listening, careful listening follows statement of what was heard, often leads to deeper responses, non verbals, simple reflection - direct statement, paraphrase - suggestion about meaning, reframe: change perspective, amplified reflection, overstate what you heard gets people to argue the opposite, double sided reflection - state both sides of ambivalence summarize - always used, highlights both sides of ambivalence, wraps up a session, can also be used to transition to a new topic

Question 86

giving advice in mi

Answer 86

epe elicit patient buy in: ask permission for conversation, topic, advice provide: provide advice or information elicit pattern reaction: ask what they think about the information you provided

Question 87

mechanisms of change in mi

Answer 87

client change talk perceived discrepancy between action and desire decisional balance must tip in favor of the pros of change

Question 88

evidence base

Answer 88

strong support: addiction/substance use disorders, health concerns, treatment adherence and entrance interdisciplinary deliver, technology assisted delivery

Question 89

cultural considerations

Answer 89

developed in industrialized countries, expanded into developing nations, range of topics have been addressed like household water disinfection and storage, aids, substance use requires creativity, flexibility, and appreciation of cultural differences