cricos provider code: 0113b motivational interviewing an empowerment approach dr. annette dunham...

CRICOS Provider Code: 0113B

MOTIVATIONAL INTERVIEWINGAN EMPOWERMENT APPROACH

Dr. Annette Dunham MAPS

School of Psychology

Deakin Universityannette.dunham@deakin.edu.au

CRICOS Provider Code: 0113B

OVERVIEWWe will look at the principles and characteristics of

Motivational Interviewing (MI) and discuss why MI is an empowerment approach.

We will look at two of the four key processes in MI: Engaging

Focusing

Evoking

Planning

With particular emphasis on the EVOKING phase

We will practice some motivational interviewing skills.

CRICOS Provider Code: 0113B

“Health professionals should regularly advise obese patients about healthy living”.

Dominion Post 09/06/14

CRICOS Provider Code: 0113B

“Experts are trained to deliver prescriptions and advice, and they often work harder than we do trying to help us. But the expert approach actually lets us off the hook, sending the subtle message: ‘You aren’t in charge…’

When patients leave the clinic or office, they can and do veto recommendations a health professional makes”.

(Glasgow & Anderson, 1999, pp. 2090-2092)

CRICOS Provider Code: 0113B

WHY DO WE NEED TO ENCOURAGE CLIENT SELF-MANAGEMENT & AUTONOMY?

CRICOS Provider Code: 0113B

THE ACTIVE SERVICE MODELHTTP://WWW.BAYSIDE.VIC.GOV.AU/COMMUNITY_SERVICES/SMR_ASM.HTM

Supported by five key principles:1.People want to remain autonomous2.People have potential to improve their capacity3.People's needs should be viewed in a holistic way4.HACC services should be organised around the person and carer; 5.A person's needs are best met where there are strong partnerships and collaborative working relationships between the person, their carers and family, support workers and service providers

CRICOS Provider Code: 0113B

USING A COACHING APPROACHMOORE & TSCHANNEN-MORAN (2010)

•Accept the client where they are today•Guide clients towards building their self-efficacy•Help clients define a meaningful purpose for health and wellbeing

•Ask clients to take charge –to take “the driver’s seat” in their own health management.

CRICOS Provider Code: 0113B

COMPARING MODELS (ANDERSON & FUNNELL, 2005; BODENHEIMER ET AL., 2002)

CRICOS Provider Code: 0113B

DEFINITION(1) Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.

(2) Motivational interviewing is a person-centred counselling style for addressing the common problem of ambivalence about change. Miller & Rollnick (2012, p.29)

CRICOS Provider Code: 0113B

DEFINITION(3) Motivational interviewing is a collaborative goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. Miller & Rollnick (2012, p.29)

CRICOS Provider Code: 0113B

WHY MOTIVATIONAL INTERVIEWING?

CRICOS Provider Code: 0113B

WHAT MAKES IT MOTIVATIONAL INTERVIEWING? 4 KEY PROCESSESMILLER & ROLLNICK (2012)

CRICOS Provider Code: 0113B

THE “SPIRIT” OF MOTIVATIONAL INTERVIEWING

MILLER & ROLLNICK (2012)

Collaboration

AcceptanceCompassion

Evocation

CRICOS Provider Code: 0113B

RESIST THE RIGHTING REFLEXMILLER & ROLLNICK (2012)

CRICOS Provider Code: 0113B

FIVE QUESTIONSMILLER & ROLLNICK (2012, P.11)

1. “Why would you want to make this change?”

2. “How might you go about it in order to succeed?”

3. “What are the three best reasons for you to do it?”

4. “How important is it for you to make this change and why?

5. “So what do you think you’ll do?”

CRICOS Provider Code: 0113B

ENGAGING: OARSMILLER & ROLLNICK (2012)

•Open Questions

•Affirmation

•Reflection

•Summaries

CRICOS Provider Code: 0113B

FOCUSINGMILLER & ROLLNICK (2012)

1. “I know where we’re going, the focus is clear.”

– Move to next steps: the evoking and planning processes

2. “There are several options - we need to decide.”

– Work with client to identify possibilities and priorities

– Agenda mapping may be useful with multi-issues

3. “The focus is unclear and we need to explore”

– Use core skills to help client move from general to specific,

e.g. OARS

CRICOS Provider Code: 0113B

AGENDA MAPPING MILLER & ROLLNICK (2012)

CRICOS Provider Code: 0113B

CHANGE AND SUSTAIN TALKMILLER & ROLLNICK (2012)

CRICOS Provider Code: 0113B

EVOKING CHANGE TALK: DARN CATS MILLER & ROLLNICK (2012)

Preparatory:

Desire to change(want, like, wish…)

Ability to change(can, could…)

Reasons to change(If……then…….)

Need to change(need, have to, got to…)

Mobilising:

Commitment(Intention, decision, promise)

Activation(willing, ready, preparing)

Taking Steps(doing)

CRICOS Provider Code: 0113B

EVOKING CHANGE TALKMILLER & ROLLNICK (2012)

Desire: “How would you like things to change?”

“What do you hope our work will accomplish?”

Ability: “How might you do it?”

“How confident are you that you could…?”

Reasons: “What might be the best reasons for…?”

“What might be good about quitting?”

Need: “How important is it that you change?”

“What do you think has to change?”

CRICOS Provider Code: 0113B

IMPORTANCE RULER:

HOW IMPORTANT IS THE CHANGE?(1= NOT IMPORTANT; 10= EXTREMELY IMPORTANT)

Evoking Change TalkMiller & Rollnick (2012)

CRICOS Provider Code: 0113B

EVOKING: SNATCHING CHANGE TALK OUT OF THE JAWS OF AMBIVALENCE

MILLER & ROLLNICK (2012)

•Change talk is often inter-twined with sustain talk…

•Show preferential reflection of change talk

CRICOS Provider Code: 0113B

CHANGE TALK OUT OF AMBIVALENCE

I really need to start having a regular walk to help maintain my weight, but I hate the thought of having to get up early to do it.

1.You really don’t want to be bothered getting up early.2.You understand that you need to increase your exercise level to be healthy.3.You don’t think that you could keep this exercise going.

CRICOS Provider Code: 0113B

CONFIDENCE RULER:

HOW CONFIDENT ARE YOU THAT YOU CAN MAKE THIS CHANGE? (1= NOT CONFIDENT AT ALL; 10 = EXTREMELY CONFIDENT)

Evoking ConfidenceMiller & Rollnick (2012)

CRICOS Provider Code: 0113B

RAISING CHALLENGES AND PROBLEMS MILLER & ROLLNICK (2012)

•“What might you do if…?”

•“How could you respond if…?”

•“What do you think would happen if…?”

CRICOS Provider Code: 0113B

RECOGNISING READINESSMILLER & ROLLNICK (2012)

•Diminished sustain talk

•Resolve•Increased change talk

•Questions about change

•Envisioning•Taking steps

Time for planning when:•Sufficient engagement•A clear shared change goal•Sufficient client motivation for change

CRICOS Provider Code: 0113B

EVOKING A CHANGE PLANMILLER & ROLLNICK (2012)

•Setting goals

•Considering change options

•Arriving at a plan

•Strengthening confidence

•Eliciting confidence

CRICOS Provider Code: 0113B

WHAT MAKES IT MOTIVATIONAL INTERVIEWING? 4 KEY PROCESSESMILLER & ROLLNICK (2012)

CRICOS Provider Code: 0113B

REFERENCES

Anderson, B., & Funnell, M. (2005).The Art of Empowerment (2nd ed.). Alexandria, Virginia: American Diabetes Association.

Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. Journal of the American Medical Association, 288:19, pp.2469-2475.

Miller, W. & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd ed.). New York, NY: Guildford Press

Moore, M., & Tschannen-Moran, B. (2010). Coaching psychology manual. Philadelphia, PA: Lippincott, Williams & Wilkins.