Term
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Definition
| Both treatment adherence and positive outcomes are related to more than the dose or amount of treatment, but also to a third factor - the motivation to change. |
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Term
Chapter 1
Faith/Hope Effects |
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Definition
| A person's belief in their ability to change, often called self-efficacy. |
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Term
Chapter 1
Counselor Effects |
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Definition
| One factor that frequently makes a difference in clients success is the counselor he/she is assigned to, including: counselor empathy is a significant determinant in clients response to treatment, counseling style, and non-specifics. (pg. 5-6) |
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Term
Chapter 1
Change Talk Effects |
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Definition
| The more a person argues against change during counseling, the less likely change will occur. What people say about the possibility of change is related to whether if will actually occur. (pg. 8-9) |
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Term
Chapter 1
Ready, Willing, Able |
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Definition
Three critical components of motivation:
Ready - A Matter of Priorities
Willing - The Importance of Change
Able - Confidence for Change |
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Term
Chapter 1
What triggers change? |
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Definition
| Change is not motivated primarily by the avoidance of discomfort, but when a person connects it with something of intrinsic value, of importance or cherished. |
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Term
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Definition
Ambivalence is feeling two ways about something. Conflict and ambivalence seen in three ways:
Approach/Approach - chooses between two similarly attractive alternatives
Avoidance/Avoidance - having to choose between two evils
Double Approach Avoidance - torn between two choices, both with pro's and con's. |
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Term
Chapter 2
Decisional Balance |
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Definition
| Metaphor of a balance or seesaw: competing motivations because there are benefits and costs associated with both sides of the conflicts. Perceived as two weights on each side of the balance. |
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Term
Chapter 2
Paradox of Change |
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Definition
| Ambivalent people may not respond in what would seem to be a logical manner. Unless one understands the dynamics of ambivalence, a person's responses can seem either counterintuitive and puzzling. |
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Term
Chapter 3
A. Righting reflex |
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Definition
| Human beings seem to have a built in desire to set things right. Those who work in the helping professions are inclined to want to set things right. |
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Term
Chapter 3
B. Developing discrepancy |
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Definition
| Fundamental dynamic in the resolution of ambivalence. It is discrepancy that underlies the perceived importance of change: no discrepancy, no motivation. It is the client who should be voicing the arguments for change. |
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Term
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Definition
| Change talk is self-motivating speech. The challenge is to first intensify and then resolve ambivalence by developing discrepancy between the actual present and the desired future. Tends to fall into one of four categories: disadvantages of status quo, advantages of change, optimism for change and intention to change. |
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Term
Chapter 3
1. Disadvantage of the status quo |
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Definition
| Reason for concern or disconnect with how things are. |
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Term
Chapter 3
2. Advantages of change |
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Definition
| Recognition of the potential advantages of change. |
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Term
Chapter 3
3. Optimism for change |
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Definition
| That which expresses' ones confidence and hope about ones ability to change. |
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Term
Chapter 3
4. Intention to change |
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Definition
| As the balance tips, begins to express ones intention, desire, willingness and commitment to change. |
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Term
Chapter 3
D. Definition of MI |
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Definition
| A client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. |
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Term
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Definition
| Underlying spirit lies in understanding and experiencing the human nature, including COLLABORATION, EVOCATION and AUTONOMY. |
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Term
Chapter 4
1. Express empathy |
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Definition
| Acceptance. Seeking to understand the client's feelings and perspectives without judging, criticizing or blaming. This includes: acceptance facilitates change, skillful reflective listening is fundamental and ambivalence is normal. |
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Term
Chapter 4
2. Develop discrepancy |
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Definition
| Create and amplify, from the client's perspective, a discrepancy between present behavior and his or her broader goals and values. The client rather than the counselor presents the arguments for change from the perceived discrepancy between present and future. |
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Term
Chapter 4
3. Roll with resistance |
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Definition
| Resistance that a client offers can be turned ore reframed slightly to create a new movement for change. Avoid arguing for change. Resistance is not directly opposed. New perspectives are invited but not imposed. Client is primary source in finding answers and solutions. Resistance is a sign to respond differently. |
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Term
Chapter 4
4. Support self-efficacy |
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Definition
| Hope and faith are important elements of change. Major goal in MI is to enhance clients confidence in ability to cope with obstacles and succeed in change. A client's belief in the possibility of change is an important motivator. The client, not the counselor, is responsible for choosing and carrying out change. The counselor's own belief in the client's ability to change becomes a self-fulfilling prophecy. |
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Term
Chapter 6
1. Importance and confidence |
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Definition
| Useful in understanding a person's ambivalence to know his or her perceptions of both importance and confidence to change. The idea is to end up knowing how important the client perceives change to be and how confident the person is that he or she can change. |
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Term
Chapter 6
2. Traps to avoid |
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Definition
Traps to avoid include:
Question/answer trap
Taking sides
Expert Trap
Labeling (diagnostic/you're an alcoholic)
Premature Focus Trap
Blaming Trap |
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Term
Chapter 6
3. Early treatment |
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Definition
Five early methods/treatments:
Open Ended Questions
Affirmation
Reflecting
Summarizing |
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Term
Chapter 6
d. Eliciting change talk (4 types) |
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Definition
Four types of change talk:
Recognizing Disadvantages of Status Quo
Recognizing Advantages of Change
Expressing Optimism for Change
Expressing Intention to Change |
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Term
Chapter 6
4. Exploring the Decisional balance |
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Definition
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Term
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Definition
| Before moving on too quickly, it helps to have client elaborate on a topic before moving on. |
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Term
Chapter 6
6. Querying extremes |
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Definition
| When little or no desire to change, helps to have client describe the extreme of their (or others') concerns, to imagine the extreme consequences that might ensure. |
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Term
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Definition
| Have the client remember times before the problem emerged and to compare these times with the present situation. |
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Term
Chapter 6
8. Looking forward |
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Definition
| Helping the client envision a changed future is another approach for eliciting change talk. |
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Term
Chapter 6
9. Exploring goals and values |
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Definition
| Ask the client to tell you what things are most important in his her own life. |
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Term
Chapter 7
1. When is motivational interviewing directive? |
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Definition
It is directive in that it consciously is directed towards resolving ambivalence in order to facilitate change. Includes:
Elaborate Change Talk
Reflecting Change Talk
Summarizing Change Talk
Affirming Change Talk |
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Term
Chapter 7
a. Elaborate change talk |
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Definition
| When a client voices a change statement, even tentatively, respond with a particular interest, both non-verbally and by asking for elaboration. |
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Term
Chapter 7
b. Reflecting change talk |
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Definition
| Reflective listening both clarifies the person's meaning and encourages continued exploration of the content that is reflected. |
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Term
Chapter 7
c. Summarizing talk |
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Definition
| Offer summaries that gather together bouquets of change statements that the person has offered. |
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Term
Chapter 7
d. Affirming change talk |
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Definition
| Simply by positively commenting on change talk. |
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Term
Chapter 7
2. When is it non directive? |
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Definition
When counseling is not directed toward any particular change outcome. Still goals for counseling. Common ones are:
Clarifying Ambivalence
Clarifying Values |
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Term
Chapter 7
a. Clarifying ambivalence |
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Definition
| To explore each side in some depth. Thoroughly explore each side of the ambivalent conflict. |
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Term
Chapter 7
b. Clarifying values |
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Definition
| Primary basis for resolving ambivalence is in relation to the person's values. what does the client hold dear? What goals and values are central to his or her life? What values particularly pertain to this choice point? |
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Term
Chapter 8
1. Reflections on resistance |
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Definition
| Resistance arises from the interpersonal interaction between counselor and client. Observable client behavior that occurs within the context of treatment. Represents an important signal of dissonance within the counseling process. A signal that the client is not keeping up with you. A way that the client is saying wait a minute. Resistance and change talk are like traffic signals that tell you to go ahead, proceed with caution, slow down or stop what you are doing all together. |
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Term
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Definition
| A simple acknowledgement of the person's disagreement, feeling or perception can permit further exploration rather than continued defensiveness thus avoiding the trap of taking sides. |
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Term
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Definition
| To reflect back what the person ahs said in an amplified or exaggerated form - to state it in even more extreme fashion. |
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Term
Chapter 8
c. Double-Sided Reflection |
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Definition
Capture both sides of ambivalence.
Acknowledges what the client has said and adds to it the other side of his or her ambivalence (not yours). |
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Term
Chapter 8
2. Beyond reflection |
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Definition
| Other ways to respond to resistance, besides variations on reflective listening. Intent is to defuse the underlying dissonance and thereby diminish resistance. |
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Term
Chapter 8
a. Shifting focus |
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Definition
| Shift attention away from what seems to be a stumbling block in the way of progress. |
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Term
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Definition
| Reframe what the client is offering. Acknowledges the validity of the person's raw observations but offers new meaning or interpretations for them. |
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Term
Chapter 8
c. Agree with a twist |
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Definition
| Offer initial agreement, but with a slight twist or change of direction. Retains a sense of consonance while allowing you to continue influencing the direction and momentum of change. |
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Term
Chapter 8
d. Emphasizing personal choice and control |
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Definition
| Assure the client what is surely the truth: in the end, it is the client who determines what happens. |
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Term
Chapter 8
e. Coming alongside |
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Definition
| Recommends that the client continues on as before, without changing, or should even increase the behavior in question. |
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Term
Chapter 8
3. What's the "drama of change"? |
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Definition
| Resistance is a key to successful treatment if you recognize it for what it is: an opportunity. In expressing resistance the client is probably rehearsing a script that has been played out many times before. The clinician has an expected role to play. t need not be dry predictable lines. Resistance is often the life of the play. The true art of the counselor is tested in the recognition and handling of resistance. It is on this stage that the drama of change occurs. |
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Term
Chapter 9
1. Confidence traps |
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Definition
Just as there are traps to avoid when beginning MI to enhance the importance of change, there are also a few to avoid when building confidence, including:
I'll Take Over Now
There, there, you'll be fine
Gloom a deux |
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Term
Chapter 9
a. ’ll take over now, Thank you |
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Definition
| Once the client seems to perceive the importance of change a temptation is to abandon a motivational approach. |
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Term
Chapter 9
b. There, there, you’ll be fine. |
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Definition
| Not taking the confidence issue not seriously enough. Too bald assurance. |
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Term
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Definition
| Falling into the trap of sharing the client's perception of helplessness or hopelessness. |
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Term
Chapter 9
2. Ways of Eliciting and Strengthening Confidence Talk |
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Definition
Ways of eliciting and strengthening confidence talk include:
Evocative Questions
Confidence Ruler
Personal Strengths and Supports
Brainstorming
Reviewing Past Successes
Giving Information and Advice
Reframing
Hypothetical Change
Responding to Confidence Talk]
Radical Change |
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Term
Chapter 9
a. Evocative Questions |
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Definition
| Consistent with the style of motivational interviewing, one approach is to elicit the person’s own ideas, experiences, and perceptions that are consistent with ability to change. |
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Term
Chapter 9
b. Confidence Ruler |
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Definition
| The ruler introduced in Chapter 6 can be used in a similar manner to elicit confidence talk. |
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Term
Chapter 9
c. Personal Strengths and supports |
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Definition
| Another route to confidence talk is ask about more general personal strengths and resources that may be helpful in making the desired change. What you’re looking for here are positive personal characteristics that, from an attributional perspective, are stable, internal traits. |
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Term
Chapter 9
d. Brainstorming |
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Definition
| A classic approach for problem solving is brainstorming, which involves freely generating as many ideas as possible for how a change might be accomplished. The list is generated without critique—all ideas are acceptable, no matter how silly or unrealistic they might seem. The purpose is to stimulate creative, divergent thinking about how change could be achieved. |
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Term
Chapter 9
e. Giving information and Advice |
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Definition
| It is not necessary, of course, for the client to have all the ideas. It is perfectly appropriate to provide information and advice that could be helpful in bol- stering confidence. The danger is taking sides: you advocate for a change solution, and the client explains why it won’t work. |
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Term
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Definition
| Sometimes a person bogs down in attributions of failure, and a process of reframing or reattribution can be helpful. A common theme is “I’ve tried several times, and each time I failed.” The general method here is to reframe “failure” in a way that encourages rather than blocks further change attempts. |
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Term
Chapter 9
g. Hypothetical Change |
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Definition
| If the person is struggling with practicalities, it may be helpful to leap into hypo-space, to think in the hypothetical. Subjunctive syntax is useful here. |
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Term
Chapter 9
h. Responding to confidence talk |
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Definition
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Term
Chapter 9
i. RadicalChange |
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Definition
| In such situations, the only avenue in which a person can have confidence might be one involving radical change that simultaneously addresses multiple problems. Without underestimating complexity, it is possible to discuss how such radical change might occur. Rather than trying to modify a particular behavior, this requires thinking about the big picture of change. |
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Term
Chapter 10
A. Recognizing Readiness |
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Definition
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Term
Chapter 10
1. Signs of Readiness for Change |
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Definition
Signs of Readiness for Change include:
Decreased Resistance
Decreased Discussion of the Problem
Resolve
Change Talk |
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Term
Chapter 10
a. Decreased resistance |
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Definition
| The wind seems to have gone out of the sails of resistance. Dissonance in the counseling relationship diminishes, and resistance decreases. |
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Term
Chapter 10
b. Decreased discussion of the problem |
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Definition
| The client seems to have talked enough about the area of concern. If the client has been asking questions about the problem area, these stop. There is a feeling of at least partial completion, of waiting for the next step. |
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Term
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Definition
| The client appears to have reached some kind of resolution, and may seem more peaceful, relaxed, calm, unburdened, or settled. This can also have a tone of loss, tearfulness, or resignation. |
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Term
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Definition
| Whereas resistance diminishes, change talk increases. The client makes direct change statements (see Chapter 5), reflecting disadvantages of the status quo, advantages of change, optimism about change, and/or intention to change. |
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Term
Chapter 10
e. Questions about change |
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Definition
| The client may begin to ask what he or she could do about the problem, how people change once they decide to, or the like. |
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Term
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Definition
| The client talks about how life might be after a change. This can be mistaken for resistance, in that looking ahead to change often causes a person to anticipate difficulties if a change were made. Of course, the client may also envision positive outcomes of change. |
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Term
Chapter 10
g. Experimenting |
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Definition
| If the client has had time between sessions, he or she may have begun experimenting with possible change actions since the last session. |
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Term
Chapter 10
B. Phase 2 Hazards |
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Definition
Phase 2 Hazards, include:
Underestimating Ambivalence
Overprescription
Insufficient Direction |
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Term
Chapter 10
1. Underestimating Ambivalence |
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Definition
| It is quite tempting to assume that once the client is showing signs of readiness for change (see Box 10.1), the decision has been made and it’s all downhill from there on. This confuses the commitment-strengthening process with a Eureka! decision. Most decisions to change are not made suddenly, once and for all. |
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Term
Chapter 10
a. Overpersription |
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Definition
| Another danger in Phase 2 is to prescribe a plan that is unacceptable to the client. There can be a tendency to say, “Now that you’re ready to change, here’s what you need to do.” This violates the collaborative tone of motivational interviewing and runs the risk of undoing what progress has been made. |
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Term
Chapter 10
b. Insufficient Direction |
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Definition
| The opposite risk is to provide the client with too little help. The question “What can I do?” is better answered in Phase 2 by a menu of alternatives than by reflective listening. If a wholly nondirective approach is sustained in Phase 2, the person may flounder. |
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Term
Chapter 10
2. Initiating Phase 2 |
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Definition
Initiating Phase 2 includes:
Recapitulation
Key Questions
Giving Information/Advice |
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Term
Chapter 10
a. Recapitulation |
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Definition
| A good first step in making the transition to Phase 2 is to summarize once again the client’s current situation, as reflected in your conversations thus far. |
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Term
Chapter 10
b. Key Questions |
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Definition
| Consistent with the spirit of motivational interviewing, Phase 2 does not involve telling people what they must do but, rather, eliciting what they want and plan to do. That is the purpose of a key question, which ordinarily follows directly from a recapitulation of Phase 1. Key questions are always open questions. They cannot be answered with a simple “Yes” or “No,” and their purpose is to start a person thinking and talking about change. |
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Term
Chapter 10
c. Giving Information/Advice |
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Definition
| It is quite possible and appropriate, within the spirit and principles of motivational interviewing, to share one’s expertise with clients. It is the context within which such information and advice are given that determines consistency with the overall clinical method. |
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Term
Chapter 10
3. Negotiating Change Plan |
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Definition
Negotiating a Change Plan include:
Setting Goals
Considering Change Options
Change Plan Worksheet
Eliciting Commitment |
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Term
Chapter 10
a. Setting goals |
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Definition
| Motivation is driven by a discrepancy between a person’s goals and his or her perceived present state. A first step in instigating change, then, is to have clear goals toward which to move. |
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Term
Chapter 10
b. Considering change options |
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Definition
| Once a person’s relevant goals have been clarified, the next step is to consider possible methods for achieving the chosen goals. Involve the client directly in this process of brainstorming and evaluating possible change strategies, drawing on his or her own ideas. Remember that there are almost always multiple ways to achieve a behavior change goal. |
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Term
Chapter 10
c. Change Plan Worksheet |
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Definition
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Term
Chapter 10
d. Eliciting Commitment |
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Definition
| Ideally, this plan summary brings you to the point of commitment. You are looking for the client’s approval of and assent to the plan. The simplest way to get such commitment is to ask for it. |
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