Motivational Interviewing & Goal Attainment Scaling

motivational interviewing (MI) is a _____, _______ counseling style for eliciting _______ by helping clients explore and resolve ______

directive, client-centered; behavior change; ambivalence

Strategies: OARS - What is its purpose?

• to ask clients to share their concerns

• listen to how they respond

• help them discover what will make their lives better

What does OARS stand for?

• Open ended questions

• Affirmations

• Reflections

• Summaries

• When client's functional abilities don't change, the lack of ____ may be due to a lack of _____

• BUT sometimes the px hasn't had time to _____________________ and _____________

• progress; motivation

• think about what they want to change and set goals for themselves

Very few clients are ________; our _______ can ______ their desire to change

not motivated; interactions can influence

What type of therapy is MI ?

- collaborative therapy! (not prescriptive)

- Clinician becomes their partner/coach

MI is shared decision-making but…

client is the expert and has the final decision regarding goals

collaboration: Acceptance

• client's autonomy is respected; they explore therapeutic options

• client's responsibility to select and implement strategies

• clinician guides in an empathetic, compassionate and non-judgemental manner on how to make changes that will translate to functional goals

• client will client will ultimately decide what to do

What is the compassion part of collaboration?

Place the best interests and welfare of the client before your own

collaboration: evocation

• Based on idea that client has the resources to achieve his or her goals and the clinician is there to help him or her "find" them

• Conversations during counseling evoke change talk from the client

• Change talk will ideally lead (slowly and delicately) to talk about engagement in actions that facilitate change

What is change-talk?

talking about change

What is the principle in MI of RULE?

R: Resist the righting reflex

U: Understand the clients motivations

L: Listen to your client

E: Empower the client

What is resisting the righting reflex?

• Therapy is a partnership and client/clinician communicate on a peer level

• RESIST the tendency to correct the client's self-selected approach to improving “erase the errors”

• With TBI, client may need to undergo the process of trial and error with strategies So they realize that they may not be functioning at their pre-injury level

With TBI, client may need to undergo the process of _________ with __________

trial and error with strategies

What is understanding the client's motivation?

• What motivates your specific client to change/not change?

• Understand their own concerns and values and what the keys to motivating change might be

  • ex: A special relationship or experience they might want to work towards

What 3 things do we want to find out in conversations when understanding their motivation?

1. what clients want to change

2. why they want to change

3. how they might best go about to effect that change

Good listening signals ______, _____, and a _______

respect, empathy and a caring attitude

Listening to what the client shares will help …

channel the client's desire for change into an effective therapy plan

How do we empower our client?

Clients must ALWAYS know they have the freedom to choose the course of therapy and that the clinician will not tell them what to do

If you need to educate the client, what do you first do?

first ask for permission to share the information rather than taking a directive approach

What are our tools for interview?

1. Asking

2. Listening

3. Evoke change

What would you like to be doing that you aren't doing right now?

broad vs specific

broad

How can I help you do you think?

broad vs specific

broad

What do you want to happen?

broad vs specific

broad

What are the advantages/benefits of not changing?

broad vs specific

broad

What are the advantages/benefits of not changing?

broad vs specific

broad

What are the disadvantages/costs of not changing or staying where you are?

broad vs specific

broad

What happens when you read?

specific vs broad

specific

What happens at work?

broad vs specific

specific

What could you do to ___________?

broad vs specific

specific

What have you done before to __________?

broad vs specific

specific

If you were able to _________ better, how would things be different for you?

broad vs specific

specific

Why would you want to ____________?

broad vs specific

specific

What are you doing right now to ________?

broad vs specific

specific

What are negative questions we shouldn't ask?

Why aren't you __________?

Why don't you do____?

what are not questions; they are statements relevant to what the client has said?

reflections

when reflecting…

• If the clinician's hypothesis is correct what happens?

• If the clinician's hypothesis is wrong what happens?

• it furthers the discussion in ways that reveal what most concerns the client.

• the client is free to say so and hopefully elaborate on why it's wrong, providing additional information

used to gather and connect related information within the interview.

summaries

convey to clients that the clinician has been listening and understanding what they have said.

summaries and reflections

More importantly, summaries can be used to _____ and ______ specific information that can set the stage for informing clients about available strategies and developing _______ associated with the strategies they select

highlight and focus ; specific goals

Once the client has expressed readiness and commitment to a specific change, then you will move to the _________ stage of treatment

planning/action

The goal setting and goal attainment literature suggests that outcomes are better when…

the client participates in goal planning.

A study found that those who participated in ______________ performed significantly better and had higher ______ than those who did not

formulating task strategies; self-efficacy (belief you can do something)

Goal Attainment Scaling

-2 most unfavorable

-1 less than expected

0 expected outcome

+1 more than expected

+2 most favorable

the primary advantage of GAS is being able to _____ and _______ on individualized goals that are ______ and ______ to the client

scale and measure progress; important and meaningful

What was GAS originally proposed for?

• to evaluate mental health programs

• a collaborative process that allows clinicians to develop and monitor progress on individualized goals, that are personally relevant to the client

What type of measure is GAS?

a criterion-referenced measure

GAS serves as an ____________, allowing clinicians to measure _____________ in an individual

evaluative assessment; longitudinal change

GAS allows clinicians and clients to clearly define a range of ____ to _____ ______ _______

most to least favored outcomes

Because GAS is client-centric, GAS allows clinicians to embrace the ______ in patient needs and ____________ in performance

as opposed to ________ of disability that serve as a "__________" measure and fail to reflect the __________ in patient characteristics

diversity; accommodate differences

global measures; "population-centric" ; heterogeneity

What is the validity and reliability of GAS?

high!

What are the components of GAS?

• Planning

• Monitoring

• Evaluation

What is the planning component of GAS?

• Goal setting and identification of levels of goal attainment

• Selecting treatment approach

What is the monitoring component of GAS?

• Evaluate progress

• Adjust intervention

What is the evaluation component of GAS?

• Documenting outcome

• Determining intervention effectiveness

How should the levels of GAS look?

• Measurable and quantifiable (timeframe for target behavior)

• Roughly equidistant

• Should be discrete

The GAS functional domain should be (2 things)

1. meaningful to the patient

2. directly related to the type of therapy approach and/or cognitive domain being provided