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Questions:
1.
Rather than asking, “Do you want to go to detox?” what might be a more effective approach?
2.
There are four principles as the basis for the MI approach. The original version was Express empathy, Develop discrepancy, Roll with resistance, and Support self-efficacy. The new emphasis in MI is on evoking change talk and commitment to change. What are the updated principles?
3.
In MI, a goal is to evoke change talk and minimize evoking or reinforcing sustaining talk in counseling sessions. What are examples of different kinds of change talk?
4.
What is an example of constructing a complex listening response when your client/patient states, "I know I should give up drinking, but I can't imagine life without it."?
5.
What is the danger of the Premature Focus trap?
6.
What is an example of how to respond to client/patient sustaining talk that acknolwedges it, however does not encourage it?
7.
How can an investigative approach be used to develop discrepancy with patients/ clients?
8.
What is a technique to use to strengthen your client/patient's commitment to change?
9.
Many people with substance use problems seek treatment in response to external pressure from family, friends, employers, healthcare providers, or the legal system. What is a useful technique to use with a client/patient who blames the referring source and acuses them of an inaccurate perception of the situation?
10.
Actively involving a SO, such as a spouse, relative, or friend, in motivational counseling can affect a client’s commitment to change. What are things the therapist can say to help the significant other feel optimistic about the client’s ability to change?
11.
The therapist should be clear with clients about consequences they may experience from the referring agency if they do not participate in treatment as required. What motivational strategies can the therapist use to help maintain a collaborative working alliance with clients while presenting such consequences?
12.
Clients in the Contemplation Stage begin to recognize concerns about substance use but are ambivalent about change. One strategy to resolve ambivalence in the Contemplation Stage is shifting the focus from extrinsic to intrinsic motivation. What steps can the therapist take to help clients develop intrinsic motivation?
13.
Self-efficacy is a critical determinant of behavior change. It is the belief that the patient/client can act in a certain way or perform a particular task. What are categories of self-efficacy related to SUDs that a therapist should address with their patient/client during treatment?
14.
The therapist may need to help some clients sample or try out their goals before getting them to commit to long-term change. What approaches to goal sampling may be helpful for clients who are not committed to abstience as a change goal?
15.
Identifying barriers to action is an important part of the change plan. Clients can predict some barriers better than the therapist can. What strategies can be used by the therapist to allow the client/patiet to identify and discuss possible problems?
16.
To help clients move fully into Maintenance, the therapist must help them stabilize actual change in their substance use behavior. A coping plan lists strategies for managing thoughts, urges, and impulses to drink or use drugs. What should the planning process include?
17.
As the therapist explores triggers with the patient/client with SUD, how can the therapist reinforce the client’s commitment to engaging in coping strategies as an alternative to substance use?
18.
What are components of Relapse Prevention Counseling?
19.
Adaptations of motivational counseling approaches include Group Counseling, Technology adaptations, and Blended counseling. What strategies may be used by the therapist to blend MI and CBT in SUD treatment?
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Answers:
A. Engaging is the relational foundation; Focusing identifies agenda and change goals; Evoking uses MI core skills and strategies for moving toward a specific change goal; Planning is the bridge to behavior change.
B. The therapist can ask permission to discuss each individual’s substance use. Ask clients to help you understand what they enjoy about using substances and then what they enjoy less about it. Clients may often tell you they like to get high because it helps them relax and forget their problems and it’s a part of their social life. But they say they don’t like getting sick from drugs. They don’t like their family avoiding them or having car crashes. Listen attentively and refect back on what you understood each person to have said, summarize, and ask, “Where does this leave you?” Also inquire about how ready they are to change their substance use on a scale of 1 to 10. If someone is low on the scale, inquire about what it will take to move forward. If someone is high on the scale, indicating readiness to change, ask what this person thinks would work to change his or her substance use.
C. To resolve client/patient ambivalence by using the word "and." Join two reflections: "Giving up drinking would be hard, and you recognize that it's time to stop."
D. Desire to change: “I want to fnd an AA meeting”; Ability to change: “I could start going to AA.”; Reasons to change: "I’d probably learn more about recovery if I went to AA; Need to change: “I have to stop drinking” or “I need to fnd a way to get my drinking under control.”; Commitment to change: “I swear I will go to an AA meeting this year” or “I guarantee that I will start AA by next month.”; Activation: “I’m ready to go to my frst AA meeting.”; Taking steps: “I went to an AA meeting” or “I avoided a party where friends would be doing drugs.”
E. Use an amplified reflection to overstate the client's point of view and nudge them to take the other side: The client states "But I can't quit smoking pot. All my friends smoke pot."The therapist states, "So you really can't quit because you'd be too different from your friends."
F. When a therapist focuses on an agenda for change before the client/patient is ready- for example, jumping into solving problems before developing a strong working alliance- discord may occur. The therapist's approach should match where the client is with regard to his or her readiness to change.
G. Encourage clients/patients to monitor their thoughts and feelings in high-risk situations where they are more likely to return to substance use or misuse.
H. The counselor plays the role of a detective who is trying to solve a mystery but is having a diffcult time because the clues don’t add up. The counselor expresses confusion, which allows the client to take over and explain how these conficting desires fit together. The counselor engages the client in solving the mystery.
I. Have you noticed what efforts Jack has made to change his drinking?”; “What has been most helpful to you in helping Jack deal with the drinking?”; “What is different now that leads you to feel better about Jack’s ability to change?”
J. Start with these sources of motivation as a way to raise the client’s awareness about the impact of his or her substance use on others. For example, if the client’s wife has insisted he start treatment and the client denies any problem, you might ask, “What kind of things seem to bother her?” or “What do you think makes her believe there is a problem associated with your drinking?” This lets the client express the problem from the perspective of the referring party and can raise awareness.
K. Invite clients to explore their life goals and values; Encourage this exploration through asking open questions about client goals: “Where would you like to be in 5 years?” and “How does your substance use fit or not fit with your goals?”; Highlight clients’ recognition of discrepancies between the current situation and their hopes for the future through refective listening.
L. Acknowledge clients’ ambivalence about participating in counseling; Differentiate your role from the authority of the referring agency (e.g., “I am here to help you make some decisions about how you might want to change, not to pressure you to change”); Describe the consequences of not participating in treatment in a neutral, nonjudgmental tone; Avoid siding with clients or the referring agency about the fairness of possible consequences and punishments; Emphasize personal choice/responsibility (e.g., “It’s up to you whether you participate in treatment”).
M. Sobriety sampling is used with clients/patients who have expressed need or desire to address misuse but are not ready for abstinence or have had many past unsuccessful attempts to moderate; Tapering Down is used to reduce physical dependence and cravings before the quit date; Trial Moderation may be the only acceptable goal for some clients who are in the Precontemplation state.
N. Coping- dealing successfully with situations that tempt one to use substances; Treatment Behavior-the client’s ability to perform behaviors related to treatment, such as self-monitoring or stimulus control; Recovery- the ability to recover from a recurrence of the addictive behavior; Control- confdence in one’s ability to control behavior in risky situations; and Abstinence- confidence in one’s ability to abstain despite cues or triggers to use.
O. Assessing and enhancing self-effcacy; Identifying high-risk situations that trigger the impulse to drink or use drugs; Identifying coping strategies to manage high-risk situations; Helping clients practice and use effective coping skills.
P. Do not try to predict everything that could go wrong; Focus on events or situations that are likely to be problematic; Build alternatives and solutions into the plan; Before offering advice, explore clients’ ideas about how they might handle issues as they arise; Explore the ways clients may have overcome these or similar barriers in the past.
Q. Help clients lessen the power of cognitive traps; Help clients map out temptations and develop strategies for responding to them; Use Replacement Activities to help clients identify and engage in activities that provide fulfllment, long-term satisfaction, and a substitute for the short-term pleasure of substance use; Help the client prepare for relapse; Elicit clients’ positive coping strategies, and engage them in coping-skills training activities.
R. The therapist should not solely use refective listening. This technique might accidentally evoke sustain talk from the client and decrease his or her commitment to engaging in coping strategies. Instead, the therapist should use affrmations and refective listening responses.
S. Engaging in a brief motivational conversation before a client moves into a CBT-focused component of treatment; Alternating between MI and CBT, depending on the goals of each session; Using MI when the clinical focus is on engaging, focusing, evoking, and emphasizing the more directive style of CBT; Shifting to MI during CBT interventions when counselor–client discord or client ambivalence about a specifc change goal arises; Using the spirit of MI as a framework and interactional style in which to use CBT strategies.
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