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UNC / Psychology / PSNU 242 / desiree griffin unc

desiree griffin unc

desiree griffin unc

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MOTIVATIONAL INTERVIEWING • Ready: Matter of priorities • “Quitting smoking is important to me… But it’s not the  most important thing RIGHT now.” • Willing: Perceived importance • “I don’t really want to quit smoking.” • Able:  • “I wish I could quit smoking… but I think I’ll fail if I try” • All contribute to ambivalence • Ambivalence is not pathological; Everyone is ambivalent  sometimes • Because ambivalence is uncomfortable, it often leads to  procrastination • Tempting to label ambivalence “resistance” • Ambivalence has to be resolved for change to occur • MI: turns ambivalence into motivation,  STAGE OF CHANGE • Precontemplation: Not acknowledging there is a problem  behavior that needs change • Contemplation: Acknowledging there is a problem, but not yet  ready or sure of change (ambivalence) • Preparation: Getting ready to change (e.g., finding resources) • Action: Actually changing (practicing new behavior) • Maintenance: Sustaining behavior change • Relapse: Returning to old behaviors • MI can help with all stages Stage of Change Precontemplation Techniques Validate lack of readiness;  clarify that the decision is  theirs; gently encourage re evaluation of current  behavior; encourage self exploration (NOT action);  explain and personalize the  risk Contemplation Validate lack of readiness;  clarify that the decision is  theirs; encourage evaluation  of pros and cons of behavior  change; identify and promote  new, positive outcome


• What will happen if you don’t change?




• What makes you think you need to change?




• What would you like to see that’s different about your current situation?



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expectations Preparation Identify obstacles, help  problem solve, help client  identify supports, develop  necessary skills, encourage  small initial steps Action Focus on social support,  restructuring cues, self efficacy, combat feelings of  loss, reiterate long-term  benefits Maintenance Plan for follow-up support,  reinforce internal awards,  discuss coping with relapse Relapse Evaluate trigger for relapse,  reassess motivation and  barriers, plan stronger coping  strategies

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• Elicit change talk  • What would you like to see that’s different about your  current situation? • What makes you think you need to change? • What will happen if you don’t change? • Provoke extremes: Suppose you don’t change, what is the  WORST thing that could happen? How about the best? • Look forward: How would your life be different from what it is  today? • Explore importance, readiness, and confidence (use  numerical scales): How confident are you that you can change  this behavior? What would it take to move from # to #? [Same  with importance] • Open-ended questions to understand: What do you like  about your behavior? What makes you think it might be time for  a change? What’s different about quitting this time? • Reflective listening: “It sounds like…” “I hear you saying…” • Normalizing: “Many people have struggled with this…” “A lot of  people are concerned about gaining weight when quitting.” • Decisional Balancing: What are some good things? Bad things? • Columbo approach: On one hand, I hear you telling me that…  On the other, I hear… How do you reconcile these ideas?• Support self-efficacy (validation, encouragement): Last week  you didn’t smoke at all! How did you do that? • Advice: Factual information (e.g., benefits of quitting smoking)  “Do you mind if I provide feedback on…” • Summaries: selectively highlight change talk and ambivalence • Therapeutic paradox: “Maybe now is not the right time for you to make changes… Psychic Conflict  Instinctual drive leads us to want things that we cannot have  Why? What sorts of things keep us from following our  drives?  Social expectations, rules  Contradictory desires  Ambivalence and conflict  Two opposite feelings toward the same thing  Loving feelings and hateful feelings together  One foot on the brake, one foot on the gas  This is uncomfortable  Defenses  Unconscious techniques created by ego as an  attempt to handle conflict.  Healthy people use these too!  Defenses are challenged through psychoanalysis  Denial: This didn’t happen! Reject impulse  Rationalization (making excuses): Convincing oneself no wrong has been done, through  faulty reasoning – “convenient excuses”  Splitting – Polarizing beliefs, actions, people  into “good” or “bad”  Repression – keep impulse in unconscious  Reaction formation – do opposite of impulse  Displacement – redirect impulse  Sublimation – redirect impulse in a way  toward a productive goal (healthy)  Intellectualization – frame impulse in  intellectual terms devoid of emotion (healthy)  Humor: Impulses converted to jokes (healthy) Unique Themes in Psychodynamic Theory Content vs. Process  Focus on affect and expression  Exploration of attempts to avoid distressing thoughts and  feelings Identification of recurrent themes and patterns  Discussion of past experiences  Focus on interpersonal relations  Focus on the therapy relationship  Exploration of fantasy life Evidence base for Psychodynamic therapy  General symptom improvement  Somatic Disorders  Personality Disorders  Intrapsychic changes exceeded those seen in Dialectical  Behavior Therapy  Bateman & Fonagy (2008)  87% (treatment as usual) vs. 13% (psychodynamic)  retained BPD diagnosis at 5 yr follow-up Behavioral Observations Level of Consciousness • Vigilant • Alert • Drowsy • Lethargic • Stuporous • Asleep • Comatose • Confused • Fluctuating Speech and Language • Quantity: Talkative, spontaneous, expansive, paucity, poverty • Rate: Fast, slow, normal, pressured, halting • Volume (tone): Loud, soft, monotone, weak, strong • Fluency and rhythm: Slurred, clear, appropriate inflection,  hesitant Mood and affect • What is mood? (Gloria: 4:00; Andy: 5:45) • Sustained inner feeling, reported by client • How are you doing today? How are your spirits? Have you  been depressed lately? • What is affect (observed emotion)• Appropriate to situation, consistent with mood, congruent  with thought content • Euthymic, dysthymic, angry • Fluctuations: Labile, even • Range: Broad, restricted Thought Process • Logical, relevant, organized • Linear, goal-directed • Loose associations: • Circumstantial: Unnecessary details, but returns to original  question eventually • Tangential: Unnecessary details, does NOT return to  original question • Incoherent, evasive, racing, blocking, perseveration • Neologisms, clang speech, word salad, echolalia • "I'm going to the park to ride the wallywhoop.“ • "He walked the dog eggnog, frog, clog, soggy”  • “The sheep languished blue trains suffer” • How are you doing? Oing, oing, oing…
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