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Quantum Units Education®

Motivational Interviewing

Executive Summary

1. Counselors’ use of _____ is key to enhancing clients’ motivation to change.

A. Authority

B. Sympathy

C. Power

D. Empathy


2. Resistance to change is:

A. An expression of ambivalence about change

B. A client trait or characteristic

C. Both an expression of ambivalence and a client trait or characteristic

D. Neither an expression of ambivalence nor a client trait or characteristic


3. The spirit of motivational interviewing is the foundation of the core counseling skills required for enhancing clients’ motivation to change, which include all of the following features, except:

A. Partnership

B. Acceptance

C. Capitulation

D. Evocation


4. All of the following are core counseling skills of motivational interviewing, except:

A. Asking open questions

B. Reflective listening

C. Affirming

D. Risk reduction


5. The key to helping the client move in the direction toward changing substance use behaviors is to evoke change talk and soften or lessen the impact of sustain talk on the client’s decision-making process.

A. True

B. False


6. Reflective listening is fundamental to person-centered counseling in general and motivational interviewing in particular and is essential for setting the tone of authority.

A. True

B. False


7. All of the following are processes in motivational interviewing that provide an overarching framework for employing the core skills in conversations with a client, except for:

A. Engaging

B. Directing

C. Evoking

D. Planning


8. Providing personalized feedback on assessment results and involving significant others in counseling sessions are key strategies for raising concern and moving the client toward:

A. Precontemplation

B. Contemplation

C. Preparation

D. Action


9. All of the following are goal-sampling strategies that may be helpful to the client who is not committed to abstinence as a change goal, except for:

A. Sobriety sampling

B. Tapering down

C. Interim abstinence

D. Trial moderation


Chapter 1 - A New Look at Motivation

10. All of the following are key aspects of alcohol use disorder, except:

A. Addiction

B. Loss of control

C. Tolerance

D. Withdrawal


11. Multiple factors influence whether and how rapidly a person will develop an SUD, including the substance itself, the genetic vulnerability of the user, and the amount, frequency, and duration of the misuse.

A. True

B. False


12. Which of the following is an extrinsic motivation described by the self-determination theory?

A. Needs

B. Consequences

C. Values

D. Goals


13. Which of the following is a component of motivation that predicts good treatment outcomes?

A. Treatment adherence and completion

B. Help-seeking behavior

C. Client confidence in their ability to make changes

D. Positive social interactions


14. In addiction treatment, clients have to “hit bottom” or experience terrible, irreparable consequences of their substance misuse to become ready to change.

A. True

B. False


15. Which type of counselor style predicts increased retention in treatment and reduced substance use across a wide range of clinical settings and types of clients?

A. Interpersonal

B. Authoritative

C. Agreeable

D. Empathetic


16. An argumentative or confrontational style of counseling, such as challenging client defenses and arguing, tends to be counterproductive and are associated with poorer outcomes for clients.

A. True

B. False


17. A counselor’s task is to:

A. Help clients begin taking action

B. Teach

C. Instruct

D. Give unsolicited advice


18. Which of the following represents a final step in which a person finally decides to change a particular behavior?

A. Ability

B. Willingness

C. Desire

D. Ready


19. Which of the following personality traits has been found to predict that an individual will develop an SUD?

A. Denial

B. Projection

C. Poor self-esteem

D. No distinctive personality traits have been found to predict that an individual will develop an SUD


20. Adversarial confrontation is one of the most effective methods for helping clients change substance use behavior, can increase motivation for beneficial change, and often contributes to better outcomes.

A. True

B. False


21. All SUDs increase in severity.

A. True

B. False


22. The crucial variable in a client’s recovery from an SUD is:

A. The severity of the substance use pattern

B. The client’s readiness for change

C. The counselor’s interpersonal skill level

D. A strong therapeutic alliance


23. Many adults in the United States resolve an alcohol or drug use problem without assistance.

A. True

B. False


24. Individuals in the _____ stage often are not convinced that their pattern of use is problematic.

A. Precontemplation

B. Contemplation

C. Preparation

D. Action


25. During which stage of the SOC model do the pros and cons of continuing to use substances or changing substance use behaviors tend to balance or cancel each other out?

A. Precontemplation

B. Contemplation

C. Preparation

D. Action


Chapter 2 - Motivational Counseling and Brief Intervention

26. Personalized feedback to clients should address cultural differences and norms related to substance misuse.

A. True

B. False


27. All of the following are immediate risks of intoxication or binge drinking, except:

A. Intimate partner violence

B. Depressed mood

C. Gastric distress

D. Fires


28. The key to using feedback to enhance motivation is to:

A. Continue to explore the client’s understanding of the information and what it may suggest about possible behavior change.

B. Ask about the client’s initial reaction to the tests.

C. Offer information in a neutral, nonjudgmental, and respectful way.

D. Provide small chunks of information.


29. All of the following are strategies for emphasizing client responsibility, except:

A. Ask clients’ permission to talk about their substance use.

B. State clearly that you will not ask clients to do anything they are unwilling to do.

C. Use open questions to explore the client’s understanding of the information.

D. Determine a common agenda for each session.


30. The client does most of the talking when a counselor uses an empathic style.

A. True

B. False


31. In addiction treatment, _____ usually refers to clients’ ability to identify high-risk situations that trigger their urge to drink or use drugs and to develop coping skills to manage that urge and not return to substance use.

A. Confidence

B. Self-efficacy

C. Foresight

D. Preparedness


32. Which of the following is a behavioral catalyst for change?

A. Consciousness raising

B. Emotional arousal

C. Stimulus control

D. Self-reevaluation


33. All of the following are viable approaches to adapting motivational interviewing for African Americans, except:

A. Training peers to deliver motivational interviewing

B. Incorporating moderate amounts of advice

C. Implementing motivational approaches in community settings such as a local church

D. Providing a purely client-centered approach


34. Having any mental disorder increases the risk of substance misuse.

A. True

B. False


35. Research has found that brief intervention may be more effective than brief treatment in reducing illicit drug use patterns.

A. True

B. False


Chapter 3 - Motivational Interviewing as a Counseling Style

36. Reflective listening is fundamental to the four motivational interviewing processes and core counseling strategies.

A. True

B. False


37. Motivational interviewing is particularly helpful when clients are in the _____ stage of the SOC.

A. Contemplation

B. Preparation

C. Action

D. Maintenance


38. Collaborative counselor-client relationships are the essence of motivational interviewing, without which motivational interviewing counseling techniques are ineffective.

A. True

B. False


39. Which component of acceptance honors and respects a client’s right to and capacity for self-direction?

A. Absolute worth

B. Accurate empathy

C. Autonomy support

D. Affirmation


40. The needs of which of the following take precedence?

A. The client

B. The counselor

C. The organization

D. The needs of the client, counselor, and organization should all have equal precedence


41. All of the following are misconceptions about motivational interviewing, except:

A. Motivational interviewing is a counseling technique.

B. Motivational interviewing motivates clients to change or move toward a predetermined treatment goal.

C. Motivational interviewing is an essential part of the SOC.

D. Motivational interviewing does not always use assessment feedback.


42. Frequently, a client’s _____ is a roadblock to change.

A. Lack of knowledge

B. Lack of skills

C. Ambivalence

D. Denial


43. How should ambivalence be viewed in the change process?

A. Counterproductive

B. Normal

C. Denial

D. Resistance


44. In motivational interviewing, the counselor’s main goal is to evoke change talk and minimize evoking or reinforcing sustain talk in counseling sessions.

A. True

B. False


45. All of the following are core counseling skills of motivational interviewing, except for:

A. Obliging

B. Affirming

C. Reflective listening

D. Summarizing


46. Which of the following is the key component of expressing empathy?

A. Obliging

B. Affirming

C. Reflective listening

D. Summarizing


47. The counselor’s attitude should be one of:

A. Approval

B. Acceptance

C. Agreement

D. Admiration


48. Reflective listening is simply a matter of being quiet while the client is speaking.

A. True

B. False


49. Complex reflections engage clients and let them know that you’re genuinely interested in understanding their perspective.

A. True

B. False


50. The first step in making a complex reflection of meaning or feelings is to:

A. Express empathy.

B. Highlight the discrepancy between values and current behavior.

C. Avoid reinforcing sustain talk.

D. Make a hypothesis in your mind about what the client is trying to say.


51. An open question should be followed with at least _____ reflective listening response(s) before asking another question.

A. 1

B. 2

C. 3

D. 4


52. Which essential component of person-centered counseling does careful reflective listening accomplish?

A. It builds a strong therapeutic alliance.

B. It facilitates the client’s self-exploration.

C. It builds a strong therapeutic alliance and facilitates the client’s self-exploration.

D. Careful reflective listening is not associated with the essential component of person-centered counseling.


53. Which type of motivational interviewing summarization wraps up a conversation or task and moves the client along the change process?

A. Collecting summary

B. Linking summary

C. Recapitulation summary

D. Transitional summary


54. What is the first step in all counseling approaches?

A. Reflective listening

B. Engaging the client

C. Making the client feel accepted

D. Acknowledging the client’s ambivalence


55. Even without identifying a target behavior, change talk can still be evoked.

A. True

B. False


56. Which of the following is the core of motivational interviewing and differentiates it from other counseling methods?

A. Evoking

B. Summarizing

C. Accepting

D. Empathizing


57. When responding to sustain talk, a counselor should try to persuade the client to take the change side of ambivalence.

A. True

B. False


58. The paradox of _____ is that it helps people tolerate more discrepancy and, instead of avoiding that tension, propels them toward change.

A. Affirmation

B. Acceptance

C. Compassion

D. Empathy


59. The “Columbo approach,” where the counselor expresses understanding and continuously seeks clarification of the client’s problem but appears unable to perceive any solution, is particularly useful with a client who is in the:

A. Precontemplation stage

B. Contemplation stage

C. Preparation stage

D. Action stage


60. One of the most consistent predictors of positive client behavior change is _____ change talk.

A. Willingness

B. Desire

C. Ready

D. Ability


61. Which of the following is associated with change talk?

A. Using open questions

B. Simple and complex reflective listening responses

C. Affirmations

D. Using open questions, simple and complex reflective listening responses, and affirmations are all associated with change talk


Chapter 4 - From Precontemplation to Contemplation: Building Readiness

62. From a change perspective, it is more important to understand how the status quo came to be than it is to recognize an individual’s current views on change and address their reasons for not wanting to change.

A. True

B. False


63. A key strategy to helping clients move from the Precontemplation stage to contemplating change is to:

A. Be nonjudgmental about client’s low motivation to change and instead focus on building a strong working alliance.

B. Raise their level of concern and awareness of the risk associated with their current substance use behaviors.

C. Involve family members and significant others.

D. Commend the client for coming to treatment.


64. A client in Precontemplation is often moved to enter the cycle of change by extrinsic sources of motivation.

A. True

B. False


65. A counselor must inform the client which information will be kept private, which can be released with permission, and which must be sent back to a referring agency.

A. True

B. False


66. A counselor should avoid:

A. Agreeing with the client’s position.

B. Disagreeing with the client’s position.

C. A counselor should avoid agreeing or disagreeing with the client’s position.

D. A counselor should always take a position on the topic being discussed but the topic will direct whether the counselor agrees with or disagrees with the client.


67. The simplest way to assess the client’s readiness to change is to use the Importance Ruler and the Confidence Ruler.

A. True

B. False


68. Which style of expressing is the Precontemplation Stage manifested as the client being afraid of losing control over their lives and having a large investment in their substance of choice?

A. Reveling

B. Reluctance

C. Rebellion

D. Resignation


69. A counselor can help move clients from Precontemplation to Contemplation by raising doubts about the harmlessness of their substance use and concerns about their substance use behavior.

A. True

B. False


70. One way to raise concern in the client is to focus only on negative aspects of substance use.

A. True

B. False


71. Clients should be provided with personalized feedback on the risks associated with their own substance use and how their consumption compares with others of the same culture, age, or gender.

A. True

B. False


72. Unless used by the client, the counselor should avoid the word _____ in relation to substance use, as it might create discord.

A. Problem

B. Addiction

C. Misuse

D. Disorder


73. All of the following are important principles to keep in mind during the first session, except:

A. Honor the client’s anger and sense of powerlessness.

B. Use the Action stage interventions immediately.

C. Avoid assumptions about the type of treatment needed.

D. Make it clear that you will help the client explore what he or she perceives is needed and useful from your time together.


Chapter 5 - From Contemplation to Preparation: Increasing Commitment

74. Which category of self-efficacy is the ability to successfully deal with situations that tempt one to use substances, such as being assertive with friends or talking with someone when upset rather than using the substance?

A. Treatment behavior self-efficacy

B. Control self-efficacy

C. Abstinence self-efficacy

D. Coping self-efficacy


Chapter 6 - From Preparation to Action: Initiating Change

75. In the Preparation stage, the counselor uses motivational strategies to increase clients’ readiness.

A. True

B. False


76. When the goals of the client and counselor differ, the counselor can choose any of the following strategies, except to:

A. Negotiate

B. Push

C. Approximate

D. Refer


77. One of the most important tasks of the counselor is to ensure that the change plan is realistic and can be carried out.

A. True

B. False


Chapter 7 - From Action to Maintenance: Stabilizing Change

78. Setbacks, particularly with maintenance of substance use behavior change, often occurs between _____ months after treatment, and the counselor should plan regular follow-up sessions with clients to reinforce and support maintenance of treatment gains.

A. 1 and 3

B. 3 and 6

C. 6 and 9

D. 9 and 12


79. A return to substance use after a period of abstinence indicates that a client has failed and is no longer in recovery.

A. True

B. False


Chapter 8 - Integrating Motivational Approaches in SUD Treatment Settings

80. Perhaps the most challenging aspect of group-based motivational interviewing is:

A. The possibility of group members reinforcing each other’s sustain talk instead of reflecting change talk.

B. The counselor’s ability to translate motivational interviewing skills to the group context.

C. Varying needs and experiences of group participants.

D. Fewer opportunities for group members to express change talk and receive reflective listening responses from the counselor.


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