Motivational Interviewing Presented by: Beth A. Cassel Mary M. LeVasseur Mary Lee Steffy Theresa Whitesel Motivational Interviewing (MI) http://www.ctri.wisc.edu/hc.providers/healthcare_o ndemand_tug.htm Motivational Interviewing
Motivational Interviewing Motivation is an intrinsic process Ambivalence Alternative behaviors have pluses and minuses Motivation arises out of discrepancy Values/goals conflict with current behavior Ambivalence discrepancy change Change Talk facilitates change Scott M. Strayer, MD, MPH, Associate Professor of Family Medicine University of Virginia Health System Stages of Change: Primary Tasks Source http://www.uclaisap.org/cod/assets/pdf/stage%20of%20change%20matching%20guide.pdf Afternoon at the Improv Pre-contemplation
Spirit of MI MI approach Collaboration Evocation Autonomy Non-MI approach Confrontation Education Authority Miller, W.R. & Rollnick, S.(2002) Ch-Ch-Ch-Changes Pair up with the person on your left.(last in row be an observer to the people on your right) Decide in your pair who will be the counselor/advisor and who will be the client thinking about making a change. One minute I think I can I think I can Counselor / Advisor Open ended questions: Tell me about your or How does (insert behavior to change) affect your health / life. Affirm Reflecting Summarizing Client A change you are thinking about but have not committed to Something you feel you should do but.
MI Begins with Lending an Ear Reflective Skills Paraphrasing Reflecting Focusing Clarifying Summarizing Prompts Open ended questions Recognize dual messages Attending Skills Attention Space Posture Eye Contact Time Facial Expressions Voice Energy Dress Principles of MI 1. Express Empathy 2. Develop Discrepancy 3. Roll with Resistance 4. Support Self Efficacy Afternoon at the Improv Contemplation
Commitment Language Intention/decision/readiness High I will / promise / swear / guarantee I intend to / agree to / am ready to / am going to I plan to / expect to / resolve to / aim to I hope to / will try to / will see about / I guess / will think about it / suppose I will Low The intensity of commitment language is related to the likelihood of change. Steven J. Feinstein, Ph. D. Anne Marie Kuchera, MS, MA, RD Collaborative Change Solutions Change Talk Desire I want to I would like to I wish Ability I could I might be able to I can Reason I would feel better if I want to have more energy to play with my kids. Need I ought to I have to I really should Afternoon at the Improv Preparation
Readiness Ruler Ask the client to rate their level of readiness to make a change in their behavior. ---------------------------------------------------------------------------- 0 5 10 Ask Key Questions: How important is it for you to? If 0 was not important at all and 10 very important, what number would you give yourself? If you decided right now to, how confident do you feel that you would succeed? If 0 was not at all confident and 10 was very confident, what number would you give yourself? OARS Open-ended questions What do you think you ll do about your smoking vs Do you plan to quit smoking? Affirmations I appreciate your openness today, you re a strong person Reflective listening What I think I hear you saying is Summarization Giving the individual all of the information that you have gathered throughout your conversation Making the Plan Set Goals Consider Change Options Arrive at a Plan Explore barriers and identify support Elicit Commitment
Top Ten Reason MI won t work.. 1. Not enough time 2. Patients not willing 3. Staff not engaged (Not My Job) Responding to Resistance Reactance Theory Triggered when Freedom is threatened Reactance leads to overvaluing forbidden behavior Responding to Resistance Shift focus Redirect Agreement with a twist Emphasize personal choice Develop discrepancy Marc L. Steinberg, Ph. D., Assistant Professor of Psychiatry UMDMJ Setting the Stage When a person feels accepted for who they are and what they do no matter how unhealthy it allows them the freedom to consider change rather than needing to defend against it. Steven J. Feinstein, Ph. D. Anne Marie Kuchera, MS, MA, RD Collaborative Change Solutions
MI information Literature on MI and information on training (MINT) www.motivationalinterview.org Miller and Rollnick. Motivational Interviewing: Preparing People for Change. Guilford Press. New York and London. 2002 Rollnick, Miller and Butler. Motivational Interviewing in Health Care: Helping Patients Change Behavior. Guilford Press. New York and London. 2008 Utube motivational interviewing Questions?