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2 views

Strategic Questioning and Interviewing.pptx

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babjakas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Strategic Questioning and Interviewing

Professional Formation III

Session Objectives
Differentiate interviewing approaches
Discuss interpersonal guidelines to conduct effective and client-centered
interviews
Assess boundaries, vulnerabilities and sensitivities to interview questions using
MI
Describe connections between the TTM and MI
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Intentional Interviewing #Source: Taylor, 2020, p. 244-245


Assume differences exist between you and your client
A mismatch can occur:
Phrasing of questions
An inability to understand your client’s messages
Client fear of disclosing information
Anxiety or discomfort answering questions
Providing limited responses

Taylor’s 15 Interpersonal Guidelines #Source: Taylor, 2020, p.245-250


Creating a confidential and protective environment
Conveying a take-charge attitude
Assessing vulnerabilities and sensitivities
Orienting the client to the process and requesting consent
Rephrasing, reordering, or asking questions creatively
Detecting and respecting the client’s boundaries
Listening well
Responding to a response
Responding therapeutically
Never apologizing for interview length or for questions
Checking in and acting as an emotional buoy
Knowing when to stop
Redirecting hyperverbal or tangential clients
Spotting and clarifying ambiguities, addressing contraindications
Summarizing, seeking feedback

Strategic Questioning Source: Taylor, 2020, #p. 250-252


Basis for Motivational Interviewing (MI)
Provides other options to support behavior change
Types of questions
Origin or source questions
Questions that probe evidence
Questions that probe assumptions
Questions about viewpoint
Questions about consequences
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Introduction to Motivational Interviewing


Obtaining narrative information, social, environmental and occupational history
provides the basis for client-centered care

Occupational Profile
COPM
Worker Role Interview

Add a new option – Motivational Interviewing


Intention is behavioral change rather than narrative information or occupational
choices

Using the TTM and MI #Source: Sciacca, 1997, p.41-46


Change under the TTM
Change under MI
Precontemplation
Raise doubt about current behavior
Contemplation
Reasons to change; risk of not changing
Preparation
Help client plan best course of action
Action
Help client begin the process of changing behavior
Maintenance
Assist client to use strategies they developed
Relapse
Help client return to earlier steps, such as contemplation

Use of Motivational Interviewing


Compliance with home programs or medication
ADD/ADHD, Substance Abuse, mental health problems, smoking cessation, chronic
illness, health promotion lifestyle change
FRAMES acronym
F = feedback
R = client’s responsibility
A = advice suggestions (not advice giving)
M = exploration of many options
E = empathy and encouragement
S = development of self-efficacy
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MI Core Skills #Source: Oregon Public Health Department, 2010


O = Open Questions
A = Affirmations
R = Reflections
S = Summaries
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Reflection
Repetition
Repeat what the client said
Nonverbal gestures such as nodding
Verbal sounds that are supportive
Paraphrase
Use other words to resend the same message but add a component of clarification (no
questions)
“it sounds like”, “it appears as if”, “it seems as though”
Rephrase
Mirror the same sentence or slightly different
Be careful not to patronize or sound condescending
Reflect expressed feelings
Identify the emotion that the client is trying to express
Reflect back
Check in to ensure that your perceptions are accurate
“am I hearing you accurately”, “does that sound right”

Four MI Processes
Engaging
Focusing
Evoking
Planning

11

Self-Efficacy in Motivational Interviewing


Clients with poor efficacy from enduring or situational characteristics are more
difficult to motivate
Clients need to believe they can succeed
Clients will change if they reach contemplation
Encouraging mode help clients imagine a better future
Do not underestimate the impact of your belief in the client
Listen for statements that express some optimism
Change is a process that takes time.
The client may not succeed in changing behavior on the first try (think TTM)
Strategy review

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Using Motivational Interviewing Principles


Express empathy
Support expression of dissonance (wants change, wants to be different)
Support belief that change can occur
Reflect on client’s ambivalence
Client argues, interrupts (yes, but…), denial, ignores you
Do not fight back; the situation will escalate
Breathe, slow your speech and movements
Ask what might happen if they change
Get the client to state need to change
What are the advantages and disadvantages of change
Do not initiate instructing or problem solving mode immediately if the client
states they want to change
Brainstorm a course of action
Help decrease barriers to change through problem solving or advocacy
Help client find strategies that will work for them

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Example of Motivational Interviewing


Example of Motivational Interviewing that doesn't work

Example of Motivational Interviewing that does work

Case Study: Fred


52 y.o. divorced male, full-time Uber driver, with a recent amputation of his great
toe (R) side secondary to uncontrolled diabetes admitted to a subacute center for
wound management and therapy. Does not follow diabetes self-management principles,
glucose monitoring, diet, exercise, or follow-up medical care. Moderate PVD,
peripheral neuropathy BLE; Mild peripheral neuropathy BUE. Depressed over the loss
of his toe. Worried he will not be able to continue to drive. Worried about further
amputations (father died of DM complications). Scared.
Wants to change but does not believe he will be successful at controlling his
disease. Blames his divorce two years ago and his ex-wife for his unhappiness and
illness. Lives alone. Overtalkative in therapy to avoid action steps.
How might motivational interviewing help Fred?

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