interviewing test for the 8 hour tour: pre post
TRANSCRIPT
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MotivationalInterviewingTestforthe8HourTour:
PrePost
Name: Agency:
Date: Score:
Instructions: Read each question carefully and circle the letter corresponding to the response you believe to be correct. Each item has only one correct response. Do NOT circle more than one response to any test item. Multiple marks or indiscernible responses will be marked as incorrect. This is a closed book test. Motivational Core Skills 1. Motivational Interviewing is only used with clients.
a. True
b. False
2. Motivational Interviewing uses active listening as a beginning point.
a. True
b. False
3. Developing discrepancies are keys to change.
a. True
b. False
4. Reflections help with the discord of clients.
a. True
b. False
5. Affirmations evoke sustain talk.
a. True
b. False
6. Which of the following statements correctly identifies the “C” in the acronym C.O.A.R.S.?
a. Collect information.
b. Communicate clearly.
c. Closed‐ended question.
7. Which of the following statements correctly identifies the “O” in the acronym C.O.A.R.S.?
a. Oral communication.
b. Open‐ended question.
c. Offer advice.
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8. Which of the following statements correctly identifies the “A” in the acronym C.O.A.R.S.?
a. Affirmations.
b. Ask permission.
c. Amplified ambivalence.
9. Which of the following statements correctly identifies the “R” in the acronym C.O.A.R.S.?
a. Remorse.
b. Reflections.
c. Recorded response.
10. Which of the following statements correctly identifies the “S” in the acronym C.O.A.R.S.?
a. Supports self‐efficacy.
b. Simple question.
c. Summarizations.
11. Which of the following statements correctly identifies the acronym D.E.A.R.S.?
a. Discord, empowerment, ability, roll with resistance, support self‐efficacy.
b. Develop discrepancy, express empathy, amplify ambivalence, roll with resistance, support self‐efficacy.
c. Develop diplomacy, even the score, ask a question, reflection, support sustained ambivalence.
Core MI Knowledge Scale
Mark the correct MI mechanics (A ‐ E) for each response below.
A. Closed‐end question
B. Open‐end question
C. Affirmation
D. Reflection
E. Summarizations
12. “How many times have you been here to talk with someone?” ☐ A ☐ B ☐ C ☐ D ☐ E
13. “Thank you for being here on time today, Brenda.” ☐ A ☐ B ☐ C ☐ D ☐ E
14. “Describe for me what happened next?” ☐ A ☐ B ☐ C ☐ D ☐ E
15. “So, if I have this right, you didn’t feel you were at fault.” ☐ A ☐ B ☐ C ☐ D ☐ E
16. “Were you there at the time?" ☐ A ☐ B ☐ C ☐ D ☐ E
17. “You got in the car, said hello to a friend, and jumped back out.” ☐ A ☐ B ☐ C ☐ D ☐ E
18. “Tell me about the situation you were in?” ☐ A ☐ B ☐ C ☐ D ☐ E
19. “That must have been hard for you staying away from those addictive friends.” ☐ A ☐ B ☐ C ☐ D ☐ E
20. “So you’re stressed out and you’re running out of patience about that.” ☐ A ☐ B ☐ C ☐ D ☐ E
21. “You felt nervous, so you just didn't pay.” ☐ A ☐ B ☐ C ☐ D ☐ E
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Stages of Change Model
22. Pre‐Contemplation is denial.
a. True
b. False
23. Active listening is a part of stages of change.
a. True
b. False
24. Contemplation without ambivalence will not work.
a. True
b. False
25. Maintenance is 0‐6 months.
a. True
b. False
26. Action and maintenance are the goals.
a. True
b. False
27. Ready, willing, and ability are major catalysts for change.
a. True
b. False
28. Preparation is a stage when the client is taking care of bussiness.
a. True
b. False
29. There are four types of pre‐contemplation.
a. True
b. False
30. Relapse is normal for most people.
a. True
b. False
31. Some people stay stuck in different stages of change.
a. True
b. False
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Application of Skills Knowledge
Word Bank for questions 32 ‐ 35
Engagement
Courage
Partnership
Compassion
Evocation
Reflection
Acceptance
Responsivity
Pre‐Contemplation
Using the word bank above, what are the 4 items used with the new SPIRIT of MI?
32.
33.
34.
35.
36. What is the correct MI code for this statement? “Tell me about your day today?”
a. Reflection.
b. Open‐ended question.
c. Closed‐ended question
37. Which of the following would be the first thing to do when a client is in pre‐contemplation?
a. Tell them about it.
b. Call it a day.
c. Develop discrepancies.
38. Which of the following are the most important when using MI?
a. Facial expressions and active listening
b. MI mechanics and stages of change wheel
c. a and b
39. When relapse occurs, the correct approach is to:
a. Talk about what happened.
b. Increase consequences.
c. Give the client a hug and tell them it is okay.
40. S.M.A.R.T. goals are used for what reason?
a. To increase sanctions.
b. As a guide to deal with issues.
c. As a way to show you care about the client.
MI Matrix Handout
Fazzio Consulting Professional Development February, 2019 Motivational Interviewing Training Page 1
MI Master Matrix
1. The "SPIRIT" of MI: 2. "Active Listening" 6. The "Stages of Change" Model: 18. The 4 Processes:
‐‐Collaboration ‐‐Partnership Relapse ‐‐2 to 6 times, average ‐‐Engaging
‐‐Evocation ‐‐Acceptance 3. ‐‐R Resist the Righting Reflex ‐‐Focusing
‐‐Autonomy ‐‐Compassion ‐‐U Understand your client Maintenance Precontemplation ‐‐Evoking
‐‐Evocation ‐‐L Listen to your client ‐‐6 months to ‐‐No problem recognition ‐‐Planning
4. Target Area/s ‐‐E Empower your client forever 17. The 4 R's of Precontemplation:
7. The 3 catalyst for Action: ‐‐Reluctant
5. Instant Assessments: ‐‐Ready Contemplation ‐‐Rationalizing
‐‐Facial Expressions = 55% communications ‐‐Willing ‐‐Problem Recognition ‐‐Resigned
‐‐Tone of Voice = 38% communications ‐‐Ability ‐‐Ambivalence ‐‐Rebellious
‐‐Words = 7% communications Action
‐‐Body = Testosterone and Cortisol ‐‐Problem Recognition 19. The "Objective": Preparation/Determination Backwards Talk VS. Forward Talk
Other Skills of Communications: ‐‐Procrastination "Sustain Talk" VS. "Change Talk"
8. Principles of Effective Interventions: 10. DERS: 11. MI Mechanics, COARS: 12. "70%‐‐30% Split"
‐‐Risk Principle ‐‐Develop Discrepancies ‐‐Closed Ended Questions 20. The "7 Dimensions of Change Talk":
‐‐Need Principle ‐‐Express Empathy ‐‐Open Ended Questions 13. The "10 Second Rule" ‐‐Desire to change
‐‐Responsivity Principle ‐‐Roll with Resistance ‐‐Affirmations 14. "Empathy": ‐‐Ability to change
‐‐Support Self‐Efficacies ‐‐Reflections "Lightweight" and "Heavyweight" ‐‐Reason to change
9. Evidence Based Practices: ‐‐Summarizations 15. 3 Types: ‐‐Need to change
‐‐Assessment tool to help identify target area/s 22. SMARTER Goals: ‐‐Simple sided ‐‐Commitment to change
‐‐Intrinsic motivation ‐‐Small/Specific 16. 3 or more Reflections ‐‐Amplified/Complex ‐‐Actions towards the change
‐‐Match needs to target area/s ‐‐Measurable ‐‐Double Sided ‐‐Taking steps for change
‐‐Skill train with direct practice ‐‐Attainable
‐‐Support the positive ‐‐Realistic 23. More tools for MI: 21. "5 Dimensions of Sustain Talk":
‐‐Always measure outcomes ‐‐Timely ‐‐Importance/Confidence Ruler ‐‐Desire for the status quo
‐‐Expectations ‐‐Querying Extremes ‐‐Inability to change
‐‐Roles ‐‐Looking Forward/Looking Back ‐‐Reason for the status quo
‐‐Evocative Questions ‐‐Need for the status quo
‐‐Decisional Balance ‐‐Commitment not to change
‐‐Goals and Values
‐‐Elaborating
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PROFESSIONALDEVELOPMENTMotivational Interviewing
An 8 Hour Presentation
April, 2019
Andy Fazzio
Fazzio Consulting
1503 Egger Ave
Round Rock, TX, 78664
541 990‐3011
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TABLEOFCONTENTS
SECTIONI:INTRODUCTIONTOMOTIVATIONALINTERVIEWING...............................................................3
SECTIONII:CHANGEANDWHATITMEANS..............................................................................................6
SECTIONIII:UNDERLININGSKILLSTHATSUPPORTMOTIVATIONALINTERVIEWING............................7
SECTIONIV:MIMECHANICS......................................................................................................................8
SECTIONV:TIMETOTRYITALLOUT.......................................................................................................11
GLOSSARY...................................................................................................................................................................12
INTRODUCTION
Motivational Interviewing (MI) is a client centered, evidence based program that allows effective pro‐social
communications between people. This training provides an introduction to the techniques that help to
enhance communications between everyone.
PERFORMANCEOBJECTIVES:
1. Explain what is, "Motivational Interviewing”.
2. Have the ability to observe and understand basic human behavior.
3. Demonstrate “Active Listening”.
4. Identify "Readiness to Change” in a client.
5. Understand how to begin the process of using MI.
6. Practice using MI and giving MI adherent feedback.
SECTIONI:DEFINITIONSOFMOTIVATIONALINTERVIEWING:
Defining MI
2002 2009
A client‐centered, directive method for
enhancing intrinsic motivation to change by
exploring and resolving ambivalence.
Miller and Rollnick
A collaborative, person‐centered form of guiding
to elicit and strengthen motivation for change.
Miller and Rollnick
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The Spirit of MI (2002)
• collaboration
• evocation
• autonomy
The Spirit of MI (2009)
• partnership
• acceptance
• compassion
• evocation
Active Listening
The RULE
• resist the righting reflex
• understand client motivation(s)
• listen
• empower your clients
ACTIVITY:ACTIVELISTENINGWARMUP#1
Instructions: With a partner, interview each other using the question listed below. Determine who will be the
initial speaker and listener. Interview your partner by asking: “Tell me how it was for you growing up”? The
listener is free to take notes during this interview.
After one minute, stop the speaker and allow the listener time to reflect and summarize back what the
speaker said.
Switch roles and repeat the activity.
ACTIVITY:ACTIVELISTENINGWARMUP#2
Instructions: With a partner, interview each other using the question listed below. Determine who will be the
initial speaker and listener. Interview your partner by asking: “Tell me who was the most influential person
for you growing up and why?”
The listener is free to take notes during this interview.
After two minutes, stop the speaker and allow the listener time to reflect and summarize back what the
speaker said.
Switch roles and repeat the activity.
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Targeted Area(s)
• cues to client’s attitude and behaviors
• clinical or interpersonal
• client‐centered
• usually more than one target area
Other Tools of Communication
• facial expressions
• tone of voice
• words
• body language
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SECTIONIII:UNDERLININGSKILLSTHATSUPPORTMOTIVATIONALINTERVIEWING_________Communication Skills
Non‐confrontational Promotes positive outcomes
Other Skills
Effective interventions
risk principle
need principle
responsivity principle
Evidence‐based Practices
Assess risk/needs of the client
Enhance intrinsic motivation
Target the issue specifically
Skill training with directed practice
Support positive reinforcement
Measure outcomes
DEARS Principles
Develop discrepancies
• client goals/values and current behavior
• Expressing empathy
• understand meaning through reflective listening
Amplifying ambivalence
• “to‐ing and fro‐ing”
Rolling with resistance
• client is defiant
• client views situation differently
EMPATHETIC STYLE
− Communicates respect and
acceptance
− Encourages non‐judgmental
relationship
− Supportive and knowledgeable
consultant
− Sincerely compliments
− Listens
− Gently persuades
− Provides support
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Supporting self‐efficacy
• Therapist
− recognize client’s strengths
− acknowledge client’s strengths
− believe in client’s capacity to
reach goals
• Client
− believe that change is their
responsibility
SECTIONIV:MOTIVATIONALINTERVIEWINGMECHANICS__________________________________________
Close‐ended Questions
Advantages
• use for specific situations only
• answers who, what, when, and where
Disadvantages
• therapist does most of the work
• too many questions
Open‐ended Questions
Advantages
• client‐centered
• client does most of the work
Disadvantages
• using too many stems
• may sound disingenuous
OPEN STEMS OPEN STEMS CLOSED STEMS CLOSED STEMS
How? Tell me? Is? When?
What? Explain? Are? Who?
How could? Say more? Do? Where
How would? For example… Did? How many?
How might? Why? (sometimes) Why?
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Affirmations
Elicits information
• lightweight versus heavyweight
Reflections
Information gathered by active listening
Confirming for the client
Statement I hear the client say
Do not end in a “swoop”
Types of reflections
• simple‐sided
• complex
• double‐sided
Summarizations
3 or more reflections
You are listening and heard the client
Shows concern
Establishes responsivity
Lowers defensiveness
Promotes evocation
Collect information from client
Assures accuracy
Transition from topic to topic
Consolidate information
SWOOP
− Indicates an up tone at end
− May create a challenge
response
− May cause a reaction
− May cause defensiveness
− Turns a reflection into a
question.
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Roadblocks to Listening
1. Ordering, directing
2. Warning, threatening
3. Giving advice, making suggestions,
providing solutions
4. Persuading with logic, arguing, lecturing
5. Moralizing, preaching
6. Judging, criticizing, blaming
7. Agreeing, approving, praising
8. Shaming, ridiculing, name‐calling
9. Interpreting, analyzing
10. Reasoning, sympathizing
11. Questioning, probing
12. Withdrawing, distracting, humoring,
changing the subject
SMARTER Goals
Small and specific
Measurable
Attainable
Realistic
Timely
Expectations
Roles
4 TYPES OF CLIENT PROFILES:
Low importance with low confidence
Low importance with high confidence
High importance with low confidence
High importance with high confidence
2012
Motivational interviewing is a form of collaborative conversation for strengthening a person’s own
motivation and commitment to change. It is a person‐centered counseling style for addressing the
common problem of ambivalence about change by paying particular attention to the language of change.
It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting
and exploring the persons own reasons for change within an atmosphere of acceptance and compassion.
Miller and Rollnick, 2012
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SECTIONV:TIMETOTRYITALLOUT!
Practice makes perfect. You will only improve your skills if you practice.
ACTIVITY:MOTIVATIONALINTERVIEWING–YOURTURN
Instructions: In groups of three, choose who will be the practitioner, the client, and the coder. Participants will play each role
at least once in a series of rounds. Be prepared to debrief after each round.
Simple Coding Process
Close‐ended questions _______________________________________________
Open‐ended questions ______________________________________________________
Affirmations _______________________________________________________
Reflections _________________________________________________
Summarizations _________________________________________________
Practitioner Feedback
1. Positive first and always.
2. Ask how they feel they did?
3. Support and/or affirm.
4. Always open‐ended questions.
5. Reflective listening and affirmations to enhance discussions.
6. Help client win his (or her) own arguments.
7. Always end with something positive.
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GLOSSARYAbility – A form of clien preparatory chang talk that reflects perceived personal capability of making a change; typical words
include can, could, and able.
Acceptance – I accept you for who you are, I honor the decisions you make, I am non judgmental of you and what’s going on
with you. (2009)
Affirmation – One of four aspects of acceptance as a component of MI spirit, by which the counselor accentuates the positive,
seeking and acknowledging a person’s strengths and efforts.
Ambivalence – The simultaneous presence of competing motivations for and against change.
Ampified Reflection – A response in which the intervieer reflects back the client’s content with greater intensity than the
client had expressed; one form of response to client sustain talk or discord.
Autonomy – The independence of, the freedom of, having the right of self government, self‐governing as an individual,
empowerment of ones self. (2002)
Change Ruler – A rating scale, usually 0‐10, used to assess aclient’s motivation for a particular change; see Confidence Ruler
and Importance Ruler.
Change Talk – Any client speech that favors movemnet toward a particular change goal.
Client‐Centered Counseling – A therapeutic approach introduced by psychologist Carl Rogers in which people explore their
own experience within a supportive, empathic, and accepting relationship.
Closed Question – A question that asks for yes/no, a short answer, or specific imformation.
Coaching – The process of helping someone to acquire a skill.
Collaboration – To work with one another, cooperation to cooperate willing. (2002)
Compassion – I have empathy and will do my best to understand. (2009)
Complex Reflection – And interview reflection that adds additional or different meaning beyond what the client has just said;
a guess as to what the client may have meant.
Confidence Ruler – A scale (typically 0‐10) on which clients are asked to rate their level of confidence in their ability to make a
particular change.
DARN – An acronym for four subtypes of client preparatory change talk: Desire, Ability, Reason, and Need.
Decisional Balance – A choice‐focused technique that can be used when counseling with neutrality, devoting equal
exploration to the pros and cons of change or of a specific plan.
Desire – A form of client preparatory change talk that reflects a preference for change; typical verbs include want, wish, and
like.
Directing – A natural communication style that involves telling, leading, providing advice, information, or instruction.
Direction – The extent to which an interviewer maintains in‐session momentum toward a change goal.
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Discord – Interpersoanal behavior that reflects dissonance in the working relationship; sustain talk does not in itself constitute
discord; examples include arguing, interrupting, discounting, or ignoring.
Discrepancy – The distance between the status quo and one or more client change goals.
Double‐sided Reflection – And interviewer reflection that includes both client sustian talk and change talk, usually with
conjuction “and.”
Elaboration – An interviewer response to client change talk, asking for additional detail, clarification, or example.
Elicit‐provide‐elicit – An information exchange process that begins and ends with exploring the client’s own experience to
frame whatever information is being provided to the client.
Empathy – The extent to which an interviewer communicates accurate understanding of he client’s perspectives and
experience; most commonly manifested as reflection.
Evocation – One of four central components of the underlying spirit of MI by which the interviewer elicits the client’s own
perspectives and motivation.
Evocative Questions – Strategic open questions the natural answer to which is change talk.
Evoking – The third of four fundamental processes of MI, which involves eliciting the person’s own motivation for a particular
change.
Exploring Goals and Values – A strategy for evoking change talk by having people describe their most important life goals or
values.
Importance Ruler – A scale (typically 0‐10) on which clients are asked to rate the importance of making a particular change.
Integrity – To behave in a manner that is consistent with and fulfills one’s core values.
Intrinsic Motivation – The disposition and enactment of behavior for its consistency with personal goals and values.
Looking Back – A strategy for evoking client change talk, exploring a better time in the past.
Looking Forward – A strategy for evoking client change talk, exploring a possible better future that the client hopes for or
imagines. Or anticipating the furure consequences of not changing.
Motivational Interviewing – Lay definition: A collaborative conversation style for stengthening a person’s own motivation and
commintment to change.
Clinical definition: A person‐centered counseling style for addressing the common problem of ambivalence about change.
Technical definition: A collaborative, goal‐oriented style of communication with particular attention to the language of
change, designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the
person’s own reasons for change wihin an atmosphere of acceptance and compassion.
Need – A form of client preparatory change talk that expresses and imperative for change without specifying a particular
reason. Common verbs include need, have to, got to, must.
COARS – An acronym for five basic client‐centered communication skills: Closed question, Open question, Affirmation,
Reflection, and Summarization.
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Open Question – A question that offers the client broad latitude and choice in how to respond; compared to Closed Question.
Partnership – One of four central components of the underlying spirit of MI by which the interviewer functions as a partner or
companion, collaborating with the client’s own expertise.
Planning – The fourth fundamental process of MI, which involves developing a specific change plan that the client is willing to
implement.
Querying Extremes – A strategy for evoking change talk by asking clients to imagine best consequences of change or worst
consequences of status quo.
Reason – A form of client preparatory change talk that describes a specific if‐then motive for change.
Reflective Listening – The skill of “active” listening whereby the counselor seeks to understand the client’s subjective
experience. Offering reflections as guesses about the person’s meaning.
Reflection – An interviewer statement intended to mirror meaning (explicit or implicit) of preceding client speech.
Resistance – A term previously used in MI, now deconstructed into its components; sustain talk and discord.
Righting Reflex – The natural desire of helper to set things right, to prevent harm and promote client welfare.
Self‐Efficacy – A client’s percieved ability to successfully achieve a particular goal or perform a paricular task; term introduced
by Albert Bandura.
Self‐Esteem – A client’s general level of percieved worth.
Simple Reflection – A reflection that contains little or no additional content beyond what the client has said.
Spirit – The underlying set of mind and heart within which MI is practiced, including partnership, acceptance, compassion, and
evocation.
Stages of Change – Within the transtheoretical model of change, a sequence of steps through which people pass in the change
process: precontemplation, contemplation, preparation, action, maintenance, and relapse.
Status Quo – The current state of affairs without change.
Summary – A reflection that draws together content from three or more prior client statements.
Sustain Talk – Any client speech that favors status quo rather than movement toward a change goal.
Taking Steps – A form of client mobilizing change talk that describes an action or step already taken toward change.
Transtheoretical Model – a complex model of change develped by James Prochaska and Carlo DiClemente, one part of which
describes stages of change.
Values – A person’s vvore goals or standards that provide meaning and direction in life.