Clinical Final Motivational interviewing MI o Beginnings o A way to address ambivalence Drastic departure from 12 step programs like AA o Characteristics o collaboration between therapist client o therapist evokes not instills motivation o client is responsible for change autonomy o 5 general principles o Express empathy EX I can see how that would be very difficult Current behavior interferes w life goals o Develop discrepancy o Avoid argumentation o Roll with resistance o Support self efficacy Client is responsible for change Self efficacy belief that changing oneself is possible Confidence optimism that enables one to accomplish tasks Dynamic rather than static Related to probability of success o Types of clients o When it s helpful o People who want to change o People who don t want to change o People that are ambivalent unsure about changing o When people don t want to change are unsure about change o When people have motivational problems EX not attending therapy being late not doing homework o Two phases o Gathering motivation from w in the client Get client to acknowledge how the current behavior isn t as good as the changed behavior Disadvantages of the status quo Advantages of changed behavior Start therapy w 2 s How important is it for you to change on a scale of 1 10 How confident are you that you could change if you decided to o If 3 say that s a lot higher than a 0 or 1 why so high Use resistance against them Ask open ended s demanding silence ask the let them sit w it use active listening skills summarizing listen reflectively o take their thought to the next step elicit talk about change from the client EX what worries you about your current behavior Suppose you don t change where do you see yourself in 10 years What if you do change o Developing a change plan enacting change Questions to ask the client What are the most important reasons for change What are the main goals for change What are the specific things you re going to do to change when you ll Who can help What are going to be the obstacles of change how can they be do them addressed How will you know if you re succeeding What can you do to get back on track Describe in one sentence each of the two phases of MI 1 st get the client to talk think about what s wrong w their current behavior the possibility likelihood it will change 2 nd assessing planning how to go about changing the behavior o Responding to resistance Rolls with resistance against them use a client s resistance argumentative tendencies Acknowledge the person s perception disagreement o EX you don t think taking your medication every day is necessary o You think your gunna die anyways smoking won t make any difference how when it happens Simple reflection Amplified reflection C My PO is up my ass all the time T it must be frustrating to have someone always looking over your shoulder C My wife is going off the deep end about my gambling I don t have a problem T It seems to you that she really doesn t have any real reason to be concerned Double sided reflection C Yeah maybe I do have some gambling problems but it s not like I m some sort of gambling addict who lost my house or anything T So on one hand you see that gambling has caused some problems for you on the other hand it s important to you that others don t view you as an addict Reframing C I ve tried to quit smoking so many times I just can t do it T So you re pretty persistent Agreeing w a twist Emphasize personal control C My husband is always nagging me about taking my medicine it drives me nuts T It sounds like he really cares about you your health C You don t live in my house so how can you tell me how to raise my kids T the truth is you re in the best position to decide the best way to raise your kids to figure out what would work what wouldn t so you ll need to be a full partner in this process C Why are you giving me this pamphlet Are you saying I shouldn t drink anymore T This is just some info You can do whatever w it Naturally no one can make you stop drinking C This is hopeless Z isn t going to work T It s possible that after trying again you won t be better off than you are now you re starting to think that maybe it would be better not to try at all What do you think Coming alongside Therapeutic Paradox o How things can be fouled up Taking sides Ambivalent clients will tend to argue against whatever side the therapist takes Being an opinionated expert Remember allow the client to arrive at conclusions Here s how you do it o How MI differs from traditional therapies Therapist s role Client autonomy decision making Motivation MI Collaborator w client Client is responsible for change Comes from w in client Traditional THE authority Therapist determines what change must occur Must be instilled into the client Cognitive Behavioral Analysis System of Psychotherapy CBASP o Psychodynamic treatments o Explore patient s past experiences o Try to establish links to current problems o Gain insight into subconscious conflicts issues o Cognitive behavioral treatments o More focused on here now than on past o Less concerned w original source cause of problem more concerned w current identify change patterns of thoughts behaviors that perpetuate the problem maintaining causes o Goal o Depressive spiral o Depressed mood cognitions expectation of negative outcomes negative behaviors increased likelihood of negative outcome expectation confirmed accurate starts all over again o CBASP vs Other types of CBT o Classic CBT identifies problematic thoughts behaviors in an abstract general way EX expecting the future to be bleak thoughts Avoiding interpersonal contact behavior o CBASP takes a more concrete approach Focuses on the patient s thought behaviors w in one specific situation in their recent life o Steps o Step 1 describe the situation Pick one discrete slice of time about 15 mins No editorializing just describing what happened What would a surveillance camera have recorded Keep description short sweet just a couple of sentences Make sure the description has beginning middle end o Step 2 interpretation of the situation Patient s particular read on a situation opinions about what the events meant Thought during the situation Highlight 3 4 most dominant interpretations o Step 3 identify behaviors in the situation Words actions Body language Tone of voice o Step 4 identify the desired outcome DO How did the patient want the situation to turn out Must be realistic attainable Cant directly
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