1 Ch2- Cont d Motivational Interviewing FNU 425-FAR SPRING 1435-1436 10/ 5/ 1436 outline 2 Motivational Interviewing Definition Intrinsic vs. Coerced motivation Motivational factors MI elements MI spirit OARS MI principles RULE Change talk 1
Motivational Interviewing (MI)- Definition a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. 3 Intrinsic vs. Coerced Motivation Intrinsic (internal) motivation is due to specific values I want to be able to be a good role model for my children. Coerced (forced) Motivation comes from external forces Lose weight or you can t be in my wedding. 4 2
Motivational factors(table 2.5) 1. Knowledge of consequences 2. Self-efficacy 3. A perception that a course of action has been chosen freely 4. Self-analysis (giving arguments for change) 5. Recognition of a discrepancy between present condition and desirable state of being 6. Social support 7. Feeling accepted 5 MI interconnected elements 6 3
MI- Spirit components 7 MI Spirit Collaboration Counselor s knowledge and client experience Evocation Counselor facilitate client to evoke motivation to bring about behavior change Autonomy Counselor recognize decision to change comes for client MI- OARS 8 OARS Techniques Open ended Qs Affirmation Reflective listening Summaries 4
MI- OARS cont d 1.Open-ended questions Avoid yes no questions Help client feel change is possible 2.Affirmation Statements that recognize client strength Good for building rapport Counselor must be sincere It will move momentum forward to know when change can be created 9 OARS cont d 3. Reflective listening Counselor listens carefully to client Counselor actively guide client towards certain material Change level of reflection 4. Summaries Specialized form of reflective listening Used to communicate interest in client Focus of important elements of discussion Use to Shift attention or direction 10 5
MI- Guiding Principles Guiding Principles (RULE) Resist the righting reflex Understand and explore motivation Listen with empathy Empower the client 11 RULE- cont d 1. Resist the righting reflex Desire to Make things right to help others lead a healthy life Will promote resistance by an ambivalent client 2. Understand and explore motivation To explore ambivalence Encourages client to use change talk 3. Listen with empathy Acceptance facilitates change 4. Empower the client Confidence in ability to change increases motivation 12 6
Change talk MI-Change talk To resolve ambivalence Provide encouragement Provide opportunities 13 Change talk- cont d 14 Objective of change talk Resolve ambivalence by providing opportunities and encouragements for the client, rather than to make an argument for change Encouraging client by listening to when he/she expresses the need for change Increase commitment which motivates behavior change 7
Change talk statements 15 Problem recognition (cognitive) I get headaches form my high blood pressure Optimism for change (cognitive) Lots of people have to take insulin, I can do it too Expression of concern (Affective) I am worried about my diabetes, I hope eating better and exercising lowers my blood sugar level Intention to change (Behavioral) I have enjoyed eating fruits previously, I can eat an apple for midday snack and a banana at night Eliciting Change talk 16 8
Change talk strategies 1. Evaluate importance and confidence Rate importance for change from 0-10 Rate confidence in making change from 0-10 2. Value clarification Card sort Sort cards with personal core health according to importance Connect personal care cards to personal values 3. Change roles Identify contemplated behavior change Client to changes roles with the counselor and try to convince counselor to make the contemplated behavior change 4. Typical day strategy 17 General MI strategies 18 9
Summary of key concepts (table 2.10) The Transtheoretical Model Behavior change is described as a series of changes Behavior change occurs over time Specific behavior change strategies are identified for each stage Motivational Interviewing Explore and resolve ambivalence Client-centered, directive Develop discrepancy Reduce resistance Support self-efficacy Listen reflectively 19 10