motivational interviewing: who's driving the change?

Motivational Interviewing: Who’s Driving the Change?

Sara Beth Martin, RN, MPH

September 19, 2012

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Objectives: Discuss the general principles of

Motivational Interviewing. Identify communication skills used

in Motivational Interviewing. Identify opportunities for the use of

Motivational Interviewing in home visitation.

What is Motivational Interviewing?

“If you treat an individual as he is, he will stay as he is, but if you treat him as if he were what he ought to be and could be, he will become what he ought to be and could be.” –Johann Wolfgang Von Goethe

http://www.youtube

.com/watch?v=cj1BDPBE6Wk&feature=player_detailpage

Stages of Change

Precontemplation Contemplation Preparation Action Maintenance

(Prochaska & DiClemente, 1984.)

The Four General Principles of Motivational

Interviewing Express empathy

Develop discrepancy

Roll with resistance

Support self-efficacy

Express Empathy Empathy can be

defined as the capacity for participation in another’s feelings or ideas

Neutrality without judgment or evaluation

Truly hearing and listening to what another is saying

Develop Discrepancy Build discrepancy between

the way things currently are and the way a client would like things to be

Helping the client determine how important a change could be (ie. Discprepancy between current behavior and important goals or values held by client)

Helpful tool: Decisional balance worksheet

Roll With Resistance Rolling means

getting out of the way and not engaging in it

Rather than arguing against resistance, rolling with it and it is likely reduced

Support Self-Efficacy One’s belief in his

or her ability to carry out a specific act or behavior

Critical in MI, as this attitude can make or break an effort for change

Assessment of readiness to change

Personal Views on Change

Skills Used in Motivational Interviewing

Open-ended questions

Affirmations

Reflective listening

Summarizing

Eliciting change talk

Open-ended Questions Open vs. closed Allows client to

take control of the direction of the reply

Active participation of client in discussion

Open and collaborative tone

Affirmations Genuine, direct

statements of support

Usually directed at something specific and change-oriented

Demonstrate understanding and appreciation

Reflective Listening Active listening

and expression of empathy

Reflecting the essence of what was said or what you think was meant

Summarizing Communicates

that you have followed what the client shared

Structure session and keep on track

Emphasize certain elements of what was said

Eliciting Change Talk Change talk is

statements in favor of change

Indicates a desire, ability, reason, or need for change

Recognize and emphasize these statements and move towards commitment

Behavioral Rehearsal “Motivation is a fire from within. If

someone else tries to light that fire under you, chances are it will burn very briefly.” Stephen R. Covey

Let’s practice how to apply these skills to our work in home visitation.

Behavior Rehearsal and Debrief

Debriefing Questions: How did it feel to be interviewed with

these techniques? What examples of the principles and

methods of MI were used? Which techniques seemed to work

best? What was the most challenging aspect?

Summary and Application Although these skills may appear

simple, they are not always easy to use. Mastery requires considerable practice. How might you incorporate these into

your practice to help move your families in the direction of positive change?

References Boston University School of Public Health. Building Blocks to Peer

Success: Motivational Interviewing Skills, 2012. Web. 5 Aug 2012.

Miller, William R and Rollnick, Stephen. Motivational Interviewing Preparing People for Change. 2nd ed. New York: Guilford, 2002. Print.

  Miller, William R. "Motivational Interviewing William Miller Video Clip."

06 April 2009. Online video clip. YouTube. Accessed on 6 August 2012.

NIDA-SAMHSA. Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency, 2006. Web. 2 Aug 2012.

Rollnick, Stephen, Miller, William R, and Butler, Christopher C. Motivational Interviewing in Health Care. New York: Guilford, 2008. Print.

United States Department of Agriculture. WIC Works Resource System: Motivational Interviewing, 2012. Web. 6 Aug 2012.