Disclosure. What s this all about? From wrestling to dancing with patients: Motivational Interviewing in 10 minutes
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1 From wrestling to dancing with patients: Motivational Interviewing in 10 minutes Delwyn Catley, Ph.D. Professor Department of Psychology University of Missouri Kansas City Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity I do not intend to discuss an unapproved/ investigative use of a commercial product/ device in my presentation. What s this all about? Motivational Interviewing (MI) is a method of brief counseling More recently applied to health behavior change Meta-analyses show MI is effective for: addictive behaviors Diet, exercise, smoking treatment engagement, retention, and adherence 1
2 Overview: The Express Tour! What makes people change? Definition and spirit of Motivational Interviewing approach Principles and strategies for using the motivational approach Video demonstration of principles/ strategies What Triggers Change? Myths! Knowledge (aka advice!) is sufficient Confrontational style is needed Truths! connection to things valued ambivalence is typical explore ambivalence to see what person truly values Motivational Interviewing (MI) Motivational Interviewing (Rollnick & Miller, 2002) A directive, patient centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence 2
3 Motivational Spirit Collaboration It s a partnership not expert/recipient Evocation elicit motivation, don t impose direct clien to examine and resolve ambivalence Autonomy No persuasion! Client articulates and resolve ambivalence The BIG FOUR general principles Express empathy through acceptance and reflective listening (JOIN) Develop discrepancy between current behavior and important goals or values (FOSTER MOTIVATION) Roll with resistance and avoid arguing Support self-efficacy and optimism Four basic skills: (OARS) OPEN ended questions no short yes/no answers, or loaded questions use to develop discrepancy AFFIRM client strengths and efforts REFLECT what the person says use to express empathy/develop discrepancy/ increase change talk SUMMARIZE the patient s perspective 3
4 Begin with an open-ended question Get the patient talking: Tell me how you feel about your weight/ eating habits What are your thoughts about your smoking? I know you may be afraid you ll be lectured about having to eat healthier. I won t do that, but I would really like to know how YOU feel about your eating habits Follow-up with a reflective statement Statement, not a question Hypothesis testing If I understand you correctly it sounds like... Affirms and validates Keeps the patient thinking and talking Much more effective than questioning May take more time (use wisely) More difficult skill Reflective listening examples It sounds like you feel overwhelmed when... It sounds like this has been tough for you... It sounds like you have mixed feelings It sounds like you re not ready to. Etc. 4
5 Implementing the principles and basic skills The righting reflex problem Develop discrepancy Explore patient views of the status quo and what would be ideal Elicit change talk Counsel in a way that invites the patient to make the arguments for change Eliciting Change Talk We become more committed to that which we voice Can use as an indicator that you are doing good MI Eliciting Change Talk: What is change talk? Recognizing disadvantages of status quo I realize it s not the best thing for my health but. Recognizing advantages of change I know I would feel better if I drank less Optimism for change I know at some point I ll quit Intention to change I m definitely going to make some changes in this area 5
6 Eliciting Change Talk (& developing discrepancy): Evocative questions Disadvantages of the status quo: What worries you about your current situation? What do you think will happen if you don t change anything? Advantages of change: How would you like things to be different? What would be the advantages of making a change? Optimism about change: What personal strengths do you have that will help you succeed? Intention to change: I can see you re stuck at the moment, what s going to have to change? What would you be willing to try Eliciting Change Talk (& developing discrepancy) Importance Ruler On a scale of 1 to 10, with 10 being very important, how important is it to you to test your blood sugar? Not at all Somewhat Very You said a 4 that s a lot higher than a 1, so you ve been thinking about this what makes you so it as that important? What would need to happen for you to get from 4 to a 7 or 8? Responding to change talk and Resistance Change talk and resistance are viewed as a function of the interaction Goal is to reinforce and encourage more change talk Eventually develop a plan for change (Phase II) 6
7 Responding to resistance Goal is to avoid pushing against and instead to roll with resistance Acknowledge and empathize with any resistance Remember to affirm autonomy (you need to believe this too!) Rolling with resistance Simple reflection Amplified reflections I don t know why my family gets so worked up about this, I ve cut back and I m starting to study more So your family is worrying needlessly Double-sided reflections I know I ve had some problems lately and that you want me to go see a counselor, but I m not going to do that You can see that there are some real problems here, but you re not ready to get help from a counselor Shift focus Giving information and advice Ask permission Emphasize autonomy, diminish expert role This may or may not fit your situation but... Give menu of options 7
8 Giving information and advice: a simple framework Elicit, Provide, Elicit Tell me what you know about the importance of always taking your medications as prescribed? That s true. May I share some other information you may find interesting about that. Research shows/ many of my patients tell me What s your reaction to that? Useful References Miller & Rollnick (2002). Motivational Interviewing: Preparing people for change. The Guilford Press; New York. Rollnick, Mason, & Butler (1999). Health Behavior Change: A guide for practitioners. Churchill Livingstone. Rollnick, Butler, Miller (2007). Motivational Interviewing in Health Care: Helping Patients Change Behavior. The Guilford Press. Rollnick S., Butler C.C., & Stott N. (1997). Helping smokers make decisions: the enhancement of brief intervention for general medical practice. Patient Education and Counseling, 31, Catley, D., Goggin, K., & Lynam, I (2010). Motivational Interviewing. In C. Ramseier, J. Suvan (Eds.) Health Behavior Change in the Dental Practice, Blackwell/Munksgaard: Ames, Iowa. 8
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