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## Cognitive Behavioral Therapy (CBT)
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**Core principle:** Thoughts, feelings, and behaviors are interconnected. Changing unhelpful thought patterns leads to changes in emotions and actions.
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### Key Techniques
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**Cognitive Restructuring**
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- Identify automatic negative thoughts
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- Examine evidence for and against the thought
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- Develop balanced, realistic alternative thoughts
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- Challenge cognitive distortions (catastrophizing, black-and-white thinking, mind-reading, etc.)
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**Behavioral Activation**
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- Identify activities that improve mood
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- Schedule positive activities, especially when motivation is low
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- Track activity and mood connections
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- Gradually increase engagement with rewarding activities
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**Exposure**
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- Gradually face avoided situations
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- Build exposure hierarchies (least to most anxiety-provoking)
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- Process what was learned after each exposure
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- Challenge avoidance patterns
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**Thought Records**
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When the client describes a difficult situation, guide them through:
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1. Situation: What happened?
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2. Automatic thought: What went through your mind?
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3. Emotion: What did you feel? (0-100 intensity)
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4. Evidence for: What supports this thought?
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5. Evidence against: What doesn't support it?
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6. Balanced thought: What's a more realistic view?
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7. Outcome: How do you feel now?
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### When to Use CBT
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- Anxiety (generalized, social, phobias)
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- Depression
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- Rumination and worry
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- Perfectionism
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- Procrastination
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- Negative self-talk
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### CBT Homework Examples
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- Daily thought record
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- Behavioral experiment ("Test your prediction")
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- Activity scheduling
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- Worry time (contained worry practice)
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- Graded exposure task
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## Compassion-Focused Therapy (CFT)
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**Core principle:** Many psychological difficulties stem from an overactive threat system and an underdeveloped soothing system. By deliberately cultivating compassion—toward self and from self—we can rebalance the emotional regulation systems and reduce shame-driven suffering.
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### Three Emotion Regulation Systems
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**1. Threat and Protection System**
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- Detects danger, drives fight/flight/freeze
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- Emotions: anxiety, anger, disgust, shame
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- Fast, powerful, designed to dominate attention
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- Often overactive in people with harsh inner critics or trauma histories
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**2. Drive and Resource-Seeking System**
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- Motivates pursuing goals, rewards, achievements
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- Emotions: excitement, anticipation, pleasure
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- Can become compulsive (always chasing, never resting)
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- Activating but not soothing
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**3. Soothing and Contentment System**
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- Creates feelings of safety, connection, calm
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- Emotions: peacefulness, warmth, contentment
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- Linked to attachment, caregiving, and oxytocin
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- Often underdeveloped in people who grew up without consistent warmth
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### Key Concepts
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**Compassionate Self** — A version of self deliberately cultivated to embody wisdom, strength, warmth, and commitment to alleviating suffering. Not who you are yet, but who you practice becoming.
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**Self-Criticism → Self-Compassion** — The inner critic often developed as a protection ("If I attack myself first, I stay safe"). CFT doesn't fight the critic—it understands its function, then offers an alternative voice.
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**Shame** — A core focus of CFT. Shame says "I am bad" (not "I did something bad"). CFT works directly with shame by building tolerance for it and offering compassionate counter-responses.
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**Common Humanity** — Suffering is not a personal failing. Our brains evolved for survival, not happiness. Many difficulties arise from "tricky brains" we didn't choose and didn't design.
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### Key Practices
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**Compassionate Letter Writing**
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- Write to yourself from the perspective of your compassionate self
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- Acknowledge suffering without minimizing
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- Offer understanding of how you got here
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- Express warmth and encouragement
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**Compassionate Image/Figure**
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- Visualize a being (real, imagined, or archetypal) that embodies perfect compassion toward you
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- Practice receiving warmth, understanding, and strength from this figure
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- Build the felt sense of being cared for
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**Soothing Rhythm Breathing**
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- Slow, rhythmic breathing to activate the parasympathetic system
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- Typically: inhale for a count, exhale slightly longer
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- Used as a foundation before other compassion practices
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### Key Questions
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- "What would your compassionate self say to you right now?"
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- "What system is running the show in this moment—threat, drive, or soothing?"
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- "What did your inner critic learn to protect you from?"
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- "What would it feel like to receive compassion in this moment?"
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- "How would you respond to a dear friend experiencing this?"
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### When to Use CFT
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- Persistent self-criticism or harsh inner voice
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- Shame (especially chronic or toxic shame)
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- Difficulty receiving care, warmth, or compliments
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- Trauma histories involving criticism, neglect, or conditional love
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- Perfectionism driven by fear of inadequacy
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- Depression with strong self-blame component
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- When standard CBT thought-challenging feels invalidating
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### CFT Exercises
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- Three-system check-in: "Which system is most active right now?"
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- Compassionate letter to self about a current struggle
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- Soothing rhythm breathing (2-3 minutes daily)
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- Compassionate self visualization
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- Rewriting self-critical thoughts in a compassionate voice
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## Internal Family Systems (IFS)
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**Core principle:** The mind is naturally multiple—everyone has sub-personalities or "parts," and each part has positive intent, even when its behavior is harmful. Healing happens when the Self (our core, undamaged essence) builds compassionate relationships with all parts.
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### The System
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**Parts** are sub-personalities that carry emotions, beliefs, and roles. They develop to protect us, especially from early pain. No part is bad—but parts can take on extreme roles when burdened.
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**Self** is the core of a person—who they are beneath all protective layers. Self is always present, never damaged, and naturally possesses the 8 C's:
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- Calm, Curiosity, Clarity, Compassion
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- Confidence, Courage, Creativity, Connectedness
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When someone is "in Self," they can relate to their parts with openness rather than reactivity.
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### Three Types of Parts
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**Exiles**
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- Young, wounded parts carrying pain, shame, fear, or loneliness
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- Often frozen in the past, in moments of overwhelm
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- Other parts work hard to keep Exiles out of awareness
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**Managers**
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- Proactive protectors that try to prevent pain before it happens
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- Strategies: people-pleasing, perfectionism, control, intellectualizing, caretaking
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- Keep life structured and Exiles locked away
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**Firefighters**
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- Reactive protectors that activate when Exiles break through
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- Strategies: numbing, bingeing, dissociation, rage, self-harm, substance use
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- Emergency responders—they don't care about consequences, only stopping pain now
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### Key Concepts
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**Blending** — When a part's feelings or beliefs merge with the person's sense of self. "I am worthless" (blended) vs. "A part of me feels worthless" (unblended).
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**Unblending** — Creating separation between Self and a part. The first step in all IFS work. Techniques: asking the part to "step back," noticing where the part lives in the body, asking "how do you feel toward this part?"
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**Unburdening** — The healing process where an Exile releases the pain, beliefs, or sensations it has been carrying, often through imagery (releasing to wind, water, fire, earth, or light).
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**Parts Mapping** — Identifying the parts involved in a pattern, their roles, and relationships to each other. Helps see the internal system as a whole.
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### Key Questions
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- "How do you feel toward that part?" (checks for Self-energy vs. another part responding)
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- "What does this part want you to know?"
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- "What is it afraid would happen if it stopped doing its job?"
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- "How old does this part seem?"
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- "Where do you notice this part in your body?"
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### When to Use IFS
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- Inner conflict ("Part of me wants X, but another part...")
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- Self-criticism and shame cycles
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- Patterns that resist change despite insight
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- Trauma work (with care and pacing)
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- Emotional overwhelm or numbness
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- Relationship difficulties driven by protective parts
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- Addictive or compulsive behaviors
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### IFS Exercises
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- Parts mapping or journaling (who shows up around this issue?)
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- "Getting to know" a part: approaching with curiosity, asking what it needs
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- Noticing blending in real time: "Is that me or a part?"
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- Self-energy check-in: "How much Self do I have access to right now?"
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- Guided unburdening visualization (only when parts are ready)
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## Motivational Interviewing (MI)
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**Core principle:** People are more likely to change when they talk themselves into it than when someone else tries to convince them. Motivational Interviewing is a collaborative conversation style that strengthens a person's own motivation and commitment to change by exploring and resolving ambivalence.
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### The Spirit of MI
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Four elements that define the approach:
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- **Partnership** — Working with, not on, the person. They are the expert on their own life.
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- **Acceptance** — Honoring autonomy, affirming strengths, expressing empathy, supporting their right to choose.
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- **Compassion** — Prioritizing the person's welfare and best interests.
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- **Evocation** — Drawing out what's already there, rather than installing what's missing.
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### OARS: Core Skills
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**Open Questions**
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- Questions that invite reflection and elaboration
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- "What concerns you about this?" vs. "Are you concerned?"
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- "How would you like things to be different?"
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**Affirmations**
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- Genuine recognition of strengths, effort, and values
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- Not praise ("Good job!") but reflection of character ("That took courage")
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- "You care deeply about your kids—that comes through clearly"
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**Reflections**
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- The most important MI skill—listening and giving back what you hear
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- Simple: repeating or rephrasing ("You're frustrated")
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- Complex: reflecting meaning, feeling, or what's unsaid ("Part of you really wants this, and part of you is scared of what it would mean")
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**Summaries**
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- Collecting what's been said, linking ideas together
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- Especially useful for gathering change talk into one place
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- "So on one hand... and on the other hand... and what matters most to you is..."
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### Change Talk vs. Sustain Talk
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**Change Talk** — Language that moves toward change:
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- Desire: "I want to..."
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- Ability: "I could..."
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- Reasons: "I'd be healthier if..."
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- Need: "I have to..."
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- Commitment: "I will..."
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- Taking steps: "I actually started..."
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**Sustain Talk** — Language that favors the status quo:
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- "I can't see myself doing that"
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- "It's not that bad"
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- "I've tried before and it didn't work"
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The goal is not to eliminate sustain talk but to gently tip the balance toward change talk.
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### Key Concepts
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**Ambivalence** — Wanting and not wanting to change at the same time. This is normal, not resistance. MI works with ambivalence rather than against it.
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**The Righting Reflex** — The helper's instinct to fix, advise, or argue for change. Paradoxically, this often increases resistance. MI resists the righting reflex.
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**Readiness Rulers** — "On a scale of 0-10, how important is this change to you?" followed by "Why a 5 and not a 2?" (elicits change talk, not deficit).
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### Key Questions
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- "What would you like to be different?"
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- "What's the best thing about the current situation? And the not-so-good things?"
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- "If you did decide to make a change, what would be your first step?"
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- "You rated importance at a 7—tell me about that."
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- "Where does this leave you?"
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### When to Use MI
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- Ambivalence about change (health, relationships, habits, career)
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- Addictive behaviors or harm reduction
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- Health behavior change (exercise, medication adherence, diet)
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- When advice-giving or persuasion has failed or backfired
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- Early stages of change (pre-contemplation, contemplation)
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- Any situation where autonomy and self-direction matter
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### MI Exercises
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- Decisional balance: exploring pros and cons of change and status quo
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- Readiness ruler with follow-up (why not lower?)
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- "A day in the life" of the changed future
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- Values card sort connecting values to desired change
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- Noticing and reinforcing change talk in conversation
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