MOTIVATIONAL INFLUENCE (A NEW APPROACH TO COUNSELING )

Transcription

1 MOTIVATIONAL INFLUENCE (A NEW APPROACH TO COUNSELING ) photo Douglas L. Beck, Au.D. Board Certified Audiologist Director of Professional Relations Oticon, Inc., Somerset, NJ dmb@oticonusa.com

2 STATUS QUO SERGEI KOCHKIN MARKETRAK VIII HEARING REVIEW, OCTOBER million people in the USA million hearing impaired. 3 of 4 people with hearing loss don t seek amplification.

3 HEARING AID MARKET PENETRATION RATES: CONVENTIONAL, PRACTICAL, AND TAX CREDITS AMLANI (2010) FEDERAL SUBSIDIES & U.S. HEARING AID MARKET PENETRATION RATE. AUDIOLOGY TODAY 22(3):40-46 ONLY HALF with hearing loss have a compelling need for HA amplification.

4 SURVEY OF CURRENT BUSINESS PRACTICES REVEALS OPPORTUNITIES FOR IMPROVEMENT. BRIAN TAYLOR. HEARING JOURNAL, SEPTEMBER 2009 Of those that do come into the office approx 50% do NOT acquire hearing aids.

5 VAST OPPORTUNITY TO IMPROVE!!!!!!!!!

6 INSANITY Doing the same thing over and over and expecting a different result

7 Let s explore a few different ways to manage this situation

8 There are no outcomes-or-evidenced-based studies which scientifically determined the best, most pragmatic or most efficient way to dispense amplification! We do what we do because that s how we were taught to do it!

9 AND WE KNOW In general, people do not want to wear hearing aids! (duh..)

10 Fortunately people do want to improve/maximize their personal QUALITY OF LIFE!

11 HOW TO FIT HEARING INSTRUMENTS TO CHALLENGING PEOPLE. Influence Motivational Interviewing

12 Robert B. Cialdini Ph.D. How to ETHICALLY influence people to make decisions (truly) in their own best interest and to improve the quality of their lives!

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14 RECIPROCATION Giving back, shaking hands, salutations, charitable groups, sending trinkets. Trial periods with amplification.

15 SCARCITY Wanting more of what you can only have less of. The perception of scarcity increases demand and desirability. Combine products and skills, dentists, optometrists

16 AUTHORITY Knowing the professional is an authority, display credentials, certificates etc

17 COMMITMENT & CONSISTENCY People want to be consistent. Words predict behaviors. Important part of Motivational Interviewing

18 LIKING People like to work with people they like. Genuine two way street. Friendly, not threatening.

19 CONSENSUS AND/OR SOCIAL PROOF Seek others JUST LIKE ME, scrapbooks, testimonials

20 HOW TO FIT HEARING INSTRUMENTS TO CHALLENGING PEOPLE. Influence Motivational Interviewing

21 AMBIVALENCE:

22 AMBIVALENCE Freud: All major decisions involve ambivalence. The co-existence of opposing thoughts. Love/Hate, Yin/Yang, Yes/No, Good/Bad, Right/Wrong.

23 MOTIVATIONAL INTERVIEWING William R. Miller and Stephen Rollnick 2002 The Guilford Press A client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

24 MOTIVATIONAL INTERVIEWING MI has been successfully used with drug addicts, smokers, obesity, alcoholics To elicit an intrinsic motivation to change.

25 MILLER & ROLLNICK S GUIDING PRINCIPLES Empathy (skillful reflective listening) Develop the Discrepancy (examine the differences between the status quo and the desired goal) Roll with Resistance (do not oppose resistance) Support Self Efficacy (the belief in the ability to change is powerful)

26 BUILDING MOTIVATIONAL INTERVIEWING SKILLS A PRACTITIONER WORKBOOK ROSENGREN, DB. (2009): THE GUILFORD PRESS MI Principles: R - U - L - E - Resist the RIGHTING REFLEX Understand your patient s motivation Listen to the patient (reflective listening) Empower your patient

27 BUILDING MOTIVATIONAL INTERVIEWING SKILLS A PRACTITIONER WORKBOOK ROSENGREN, DB. (2009): Metaphorically Traditional counseling is like wrestling MI is like ballroom dancing

28 FROM: BUILDING MOTIVATIONAL INTERVIEWING SKILLS A PRACTITIONER WORKBOOK ROSENGREN, DB. (2009): THE GUILFORD PRESS Match your strategy to their readiness to change. Our goal is to move them along the readiness continuum.

29 Change Is Really Hard Addictive behaviors persist despite negative outcomes. Increasing the severity of the negative outcome doesn t alter the negative behavior. Heart attacks, imprisonment, hangovers, drunk driving, lung cancer, obesity, diabetes, high blood pressure People don t always do what s in their own best interest.

30 WHAT ARE WE LOOKING FOR? The professional directs conversational discourse to probe and reveal the desired outcome. The professional sets up a context in which the patient states the reasons for change.

31 MI RULES OF ENGAGEMENT Change talk is impacted by the style of counseling and the relationship with the counselor. Confrontational styles increase resistance. Dose (length and number of sessions) is irrelevant. Ask the RIGHT questions. Don t ask the WRONG questions.

32 MOTIVATIONAL INTERVIEWING Self-Motivational Statements (change talk): 1- Problem Recognition 2- Expression of Concern 3- Intention to Change 4- Degree of Self-Efficacy

33 IS THIS REALLY THE BEST QUESTION TO ASK AN ALCOHOLIC? Do you have a problem drinking?

34 Nope. I drink, I fall down, no problem.

35 IS THIS REALLY THE BEST QUESTION TO ASK SOMEONE WHO S BEEN REFERRED IN? DO YOU HAVE A PROBLEM HEARING?

36 The problem is the kids mumble wife doesn t speak clearly mobile phones are terrible nobody speaks clearly anymore When I was a lad we were taught to speak clearly. blah, blah, blah

37 WRONG QUESTION Do you think you have hearing loss?

38 WRONG QUESTION Do you think you need hearing aids?

39 WRONG QUESTION Does your hearing loss cause problems?

40 WRONG QUESTION Are you concerned about your hearing loss?

41 THE ULTIMATE WRONG QUESTION How does that sound?

42 RIGHT QUESTION What caused your hearing loss?

43 RIGHT QUESTION Has your hearing loss gotten worse?

44 RIGHT QUESTION How long have you had hearing loss?

45 RIGHT QUESTION Which is worse; a noisy cocktail party or a noisy restaurant?

46 RIGHT QUESTION Who s voice is the hardest to understand?

47 RIGHT QUESTION Many of my patients with similar hearing loss tell me women s and children s voices are very difficult Is that true for you, too?

48 RIGHT QUESTION How long have you had difficulty hearing?

49 DO NOT WRESTLE When you push, they pull Don t challenge them, don t draw a line in the sand, don t back them into a corner.

50 DO NOT USE THE AUDIOGRAM AS A WEAPON!

51 Don t be in such a hurry to help

52 How Doctors Think Jerome Groopman On average, physicians interrupt their patients how often?

53 18 Seconds

54 MOTHER THERESA Before you speak, it is necessary to listen. They may not remember what you said or did, but they will remember how you made them feel.

55 TIME FOR HEARING... RECOGNIZING PROCESS FOR THE INDIVIDUAL Gitte Engelund Oticon s Research Centre If you intercede before the patient is ready to explore and accept amplification, the chances of success diminish.

56 The professional should get the PATIENT to do most of the talking. What the patient says is probably what they re gonna do

57 WHY CAN T I SAVE TIME AND ADMINISTER A QUESTIONNAIRE? It s important for your patient to tell you their story. RAPPORT, TRUST, LIKING

58 RED FLAGS FOR MENTAL HEALTH REFERRAL Suicidal verbalizations Expressions of hopelessness Tearfulness Manifestations of rage Person withdrawing from pleasurable activities Sleep disturbance Isolation ( No one understands ) Recent significant losses, e.g., spouse Abrupt change of behavior

59 AND IF YOU REFER HUMANIZE THE MENTAL HEALTH PROFESSIONAL I ve known Dr. Smith for over 20 years. She s nice, maybe about 55-years old, been practicing psychology for over 20 years. I think she also collects antiques. She has a dry sense of humor. I think you ll like her.

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61 THANK YOU FOR ATTENDING! To be eligible for CE credit Be sure to have your Attendance Form hole-punched as you exit! Douglas L. Beck, Au.D. Board Certified Audiologist Director of Professional Relations Oticon, Inc., Somerset, NJ These presentations slides will be available at ihsinfo.org