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Motivational Interviewing

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Model of Change. Prochaska and DiClemente's. Precontemplation ' ... Daniel D.Squires and Theresa B Moyers. University of New Mexico, Albuquerque, New Mexico ... – PowerPoint PPT presentation

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Title: Motivational Interviewing


1
Motivational Interviewing
  • Suzanna Theodoras, RN, CDE
  • Ohio University, College of Osteopathic Medicine
  • Cornwell Diabetes Center Education Program
  • 740-566-4872
  • theodors_at_ohio.edu

2
Motivational Interviewing
  • MI is an approach to health behavior change
    consultation that employs high-quality listening
    to discuss the whys and hows of change, with
    the goal of increasing the clients readiness for
    and commitment to the adoption of a healthier
    lifestyle.
  • More simply Encouraging people to resolve their
    ambivalence about changing their behavior, while
    not evoking their resistance.
  • Diabetes Spectrum, Volume 19, Number 1, 2006

3
Motivational Interviewing Research Practice and
Puzzles
  • Foremost in my own mind is the fundamental
    question of why this approach works at all. . .
    How could it possibly be that a session or two of
    asking clients to verbalize their own suffering
    and reasons for change would unstick a behavior
    pattern that has been so persistent? What is
    going on here?
  • Miller-1996

4
Motivational Psychology
  • The underlying principle is that people will make
    the most long-lasting behavior change when their
    motivation is internal rather than external.

5
Motivational Interviewing
  • An amalgam of philosophies, principles and
    techniques drawn from several existing models.
  • Carl Rogers and his Force of Life
  • Bems Self-Perception Theory
  • Janis and Manns Decisional Balance Theory
  • Prochaskas Transtheoretical Model
  • Empowerment Model
  • HandbookMotivational Interviewing Preparing
    People for Change provides more detail of the
    theoretical background

6
Motivational Interviewing Network of Trainers
(MINT)
  • Founded in 1995
  • www.motivationalinterviewing.org

7
Motivational Interviewing
  • Client-centered counseling style.
  • Elicits behavior change by helping clients
    explore and resolve their ambivalence.
  • Help clients recognize the discrepancy between
    their current behavior and their desired goal.
  • Empathic listening minimizes their resistance.
  • Sobell Sobell 2003

8
Motivational Interviewing Model of Change
  • Prochaska and DiClementes
  • Precontemplation What problem?
  • Contemplation Should I change?
  • Decision/Preparation Can I change?
  • Action How do I change?
  • Maintenance Is it worth it?
  • Relapse
  • Prochaska DiClemente, J Consult Clin Psychol,
    1983

9
Daniel D.Squires and Theresa B Moyers University
of New Mexico, Albuquerque, New Mexico
10
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11
Motivational Interviewing and Diabetes
  • Motivational Interviewing (MI) is a counseling
    approach that is
  • Non-confrontational
  • Practical Focus
  • Problem solving
  • Goal setting
  • Clients identify behavior they would like to
    change
  • List benefits of the change
  • Discuss difficulties in making that change
  • Set Realistic goals

12
Motivational Interviewing
  • HCPs feel responsible for fixing
  • Carry-over from acute care model
  • Unrealistic for the chronic care model
  • Use of direct questioning, active persuasion, or
    advice-giving from the top down has proven to
    be of limited effectiveness in the long term
    management of chronic illnesses.
  • Face-to-face agreement but weak follow-through
  • Motor boat responseYes, but. . ., Yes, but.
    . ., Yes, but. . .

13
The Spirit of Motivational Interviewing
  • Empower and collaborate with our clients
  • A dual expertise Lets put our heads together
    and look at the options.
  • Support and respect for the clients autonomy and
    problem-solving capabilities.
  • Elicit change talk from the client regarding
    behavior change and goal.

14
Key Elements of Motivational Interviewing
  • Express empathy
  • Use Reflective Listening
  • Develop discrepancy
  • Avoid arguing
  • Roll with resistance
  • Support self-efficacy or empowering

15
Motivational Interviewing1. Expressing Empathy
  • Expressing empathy is the key to building rapport
    with clients.
  • Accept people as they are and where they are.
  • Recognize ambivalence to change is normal and
    consistent with reality.
  • Encourage their positive self-motivational
    statements.

16
Motivational Interviewing1. Expressing Empathy
  • Seek permission before asking a question, before
    giving information, or before giving advice.
  • Do you mind if I ask . . . .
  • May I share some information. . . .
  • With your permission I would like to . . . .
  • Asking permission shows respect.
  • Establishes a safe environment.

17
Motivational Interviewing 2. Reflective Listening
  • Use Reflective listening to
  • Understand the clients perspective and let them
    know you are truly listening to them.
  • Emphasize the clients positive statements about
    changing so they hear their positive statements
    twiceonce themselves and once from the HCP.
  • Diffuse resistance.

18
Motivational Interviewing 2. Reflective Listening
  • Simplereflects exactly what was heard
  • Double-sidedreflects both sides by pointing out
    ambivalence
  • Amplifiedheightens the resistance that is heard
  • Self-motivational statementsclient tells how
    they are changing
  • Affirmsupport, encourage, recognize clients
    difficulties
  • Summary Statementpulls together comments made
    and transitions to the next topic

19
Motivational Interviewing 2. Reflective Listening
  • Repeating
  • Rephrasing
  • Empathic reflection
  • Reframing
  • Feeling reflection
  • Amplified reflection
  • Double-sided reflection

20
Motivational Interviewing 2. Reflective Listening
  • Summary Statement
  • Longer than a reflection.
  • Used mid-session to transition.
  • Highlight both sides of clients ambivalence.
  • Recap major points to end session.
  • Belinda Borrelli, Phd, MA

21
Motivational Interviewing 3. Develop Discrepancy
  • Motivation for change is created when people
    perceive a discrepancy between their present
    behavior and an important personal goal.
  • Where do you want to be?
  • Where are you currently?
  • When do you want to be there?
  • With effective listening and communication skills
    the HCP helps the client understand his/her
    ambivalence regarding change.

22
Motivational Interviewing4. Avoid Arguing
  • Start where the client is.
  • Avoid direct confrontation in order to avoid
    resistance.
  • Avoid labeling.
  • Use open-ended questions

23
Motivation Interviewing5. Roll with Resistance
  • Reframe statements of clients to create a new
    momentum towards change.
  • Invite the client to consider new information and
    perspectives.
  • The client becomes actively involved in finding
    solutions.

24
Motivational Interviewing6. Self-Efficacy/Empower
ment
  • Encourage the client to believe in him/herself.
  • Wanting to make a change is only the first half
    of the behavior change process. Having the
    confidence to carry out the chosen behavior
    change is the second half of the process.
  • Sees a way to succeed.
  • Sees a way to persist when roadblocks appear.
  • Client develops the plan and potential solution.

25
Thinking about the costs and benefits of
change.What specific behavior change are you
considering?
  • Create some ideas and reflections for each of the
    four boxes above.
  • This will help clarify your thoughts about what
    you want to do next.
  • Janis and Mann / Currently being used in an NIH
    study

26
How important is it for you to change?
  • 0__1__2__3__4__5__6__7__8__9__10
  • Not at all important Extremely important

27
How confident are you thatyou can make this
change?
  • 0__1__2__3__4__5__6__7__8__9__10
  • Not at all important Extremely important

28
Motivational Interviewing
How important is it for you to change ? How
confident are you that you can make this change?
On a scale of 1 to 10...
29
Motivational Interviewing
  • Confidence Ruler Incorporates
  • Careful listening
  • Appreciating ambivalence
  • Eliciting change talk
  • Empowering
  • Collaborating
  • Confidence Ruler yields a clear sense of
    readiness for change
  • Confidence Ruler reflects 2 independent
    dimensions
  • Why should I ?
  • How can I ?

30
Conclusion
  • Overall, the empirical evidence regarding the
    impact of MI, particularly as an additive to
    other effective treatments, is promising.
  • The next wave of MI intervention studies will
    tell us more and correct some of the
    methodological weaknesses of many articles to
    date.

31
Conclusion
  • MI instructs us to appreciate the limits of a
    direct-persuasion, advice-giving model of
    clinician influence.
  • MI guides us toward a strong appreciation of the
    role of ambivalence in behavior change and the
    value of eliciting client change talk.
  • MI models the use of effective listening skills
    to build rapport, engage, understand, and
    facilitate behavior change.

32
Conclusion
  • The spirit of MI shares much with the
    established Empowerment Model already used in
    diabetes education training. Whether one has the
    luxury of extended patient contact or must work
    within the parameters of a brief scheduled or
    opportunistic exchange, there are opportunities
    to integrate elements of the MI guiding style
    into everyday practice.

33
Conclusion
  • MI Training with Diabetes Educators
  • 2nd year of 4 year randomized controlled trial
    examining the usefulness of MI in the management
    of 296 patients with poorly controlled type 2
    diabetes.
  • MI spirit and strategies have been woven into the
    usual educational activities. Patients receive 7
    MI based sessions over a 1 year period and a 1
    year follow-up. Outcomes include bg control,
    QOL, self-mgmt behaviors, and health care
    utilization.

34
Conclusion
  • A Pilot Study of Motivation Interviewing in
    Adolescents with Diabetes at Department of Child
    Psychology, University Hospital of Wales, UK

35
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