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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.
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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
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Stages of Change
Precontemplation Contemplation Preparation Action Maintenance
(Prochaska & DiClemente, 1984.)
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The Four General Principles of Motivational
Interviewing Express empathy
Develop discrepancy
Roll with resistance
Support self-efficacy
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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
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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
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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
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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
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Personal Views on Change
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Skills Used in Motivational Interviewing
Open-ended questions
Affirmations
Reflective listening
Summarizing
Eliciting change talk
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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
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Affirmations Genuine, direct
statements of support
Usually directed at something specific and change-oriented
Demonstrate understanding and appreciation
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Reflective Listening Active listening
and expression of empathy
Reflecting the essence of what was said or what you think was meant
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Summarizing Communicates
that you have followed what the client shared
Structure session and keep on track
Emphasize certain elements of what was said
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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
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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.
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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?
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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?
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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.