Motivational Interviewingin the Primary Care Setting

Presented by: Jonathan Betlinski, MDDate: 02/26/2015

Disclosures and Learning Objectives

Learning Objectives:•Know the 6 Stages of Change•Know the 1 goal of Motivational Interviewing•Know the 3 parts of the Spirit of MI•Know the 4 principles of MI•Know the 4 core communication skills of MIDisclosures: Dr. Jonathan Betlinski has nothing to disclose except his profound gratitude to the late Jon Emerson, LCSW, for his mentoring in teaching this topic. Some of these slides are from a lecture of his.

Motivational Interviewing in Primary Care

• Review the history of MI

• Review the basic elements of MI

• Discuss the impact of MI in the Primary Care Setting

• Discuss clinical scenarios in which MI may be helpful

• Reveal next week’s topic

Motivational Interviewing: History

Originally developed for use in Addiction• First described in 1983 article• Miller and Rollnick published 2nd Edition in 2002• By 2013, more than 3,000 formally trained• More than 3 million clients in 47 languages• Number of studies doubles every 3 years

Now listed in SAMHSA’s NREPPhttp://nrepp.samhsa.gov/ViewIntervention.aspx?id=346

http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf

Motivational Interviewing: Current Uses

Sexual Health

Dietary Change

Weight Loss

Voice Therapy

Gambling

Promote Physical Activity

Medication Adherence

Fibromyalgia

http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf

Diabetes

Chronic Leg Ulceration

Criminal Justice

Stroke Rehabilitation

Chronic Pain

Self-Care

Domestic Violence

Mental Health

Stages of Change

The Transtheoretical Model posits a series of steps to adopting healthy behaviors1.Precontemplation

2.Contemplation

3.Preparation

4.Action

5.Maintenance

6.Relapsewww.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf

http://www.socialwork.career/2013/02/motivational-interviewing-client_20.html

Stages of Change

http://www.socialwork.career/2013/02/motivational-interviewing-client_20.html

Motivational Interviewing: Definition

Motivational interviewing is

“a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.”

--Rollnick & Miller (1995) 

Emerson

Motivational Interviewing: Definition

Motivational interviewing is

“a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.”

--Miller and Rollnick (2002) 

http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf

Motivational Interviewing: Definition

Motivational interviewing is

“a person-centered method of guiding to elicit and strengthen personal motivation for change.”

--Miller and Rollnick (2009) 

http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf

Motivational Interviewing: Goal

The Goal of MI is simple:

Behavior Change

Commitment

Not

Capitulation

http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf

Motivational Interviewing: The Spirit

Collaboration (not confrontation)

• Counselor is a partner, not an authority

• Motivation for change is elicited, not imposed

• Task is to help client articulate and resolve ambivalence

Evocation (not imposition)

• Draw knowledge out rather than imparting it

• The patient is the expert in their own lives

Autonomy (not authority)

• Responsibility for change belongs to client

• The client presents the arguments for changehttp://www.ytporegon.org/content/spirit-motivational-interviewing

Motivational Interviewing: The Principles

• Express Empathy

• Develop Discrepancy

• Roll with Resistance

• Support Self-Efficacy

http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf

Express Empathy

• Accepting the person, their situation, their point of view

• Respecting their explanations• Reflective, nonjudgmental listening• Avoiding criticism and blaming• Support self-esteem

Emerson

Develop Discrepancy

• Identify problematic behavior• Remind of goals and values• Ask for help in understanding –

Columbo• Be sincerely curious• Use “so”, “if” reflectively• Let client make the argument for

changeEmerson

Roll with Resistance

• Argument breeds defensiveness• Go with the direction of the client’s

argument• Suggest new perspectives, but don’t

insist on them• “Take what you want, leave the

rest”Emerson

Roll with Resistance

Argument breeds defensivenessGo with the direction of the client’s

argumentSuggest new perspectives, but don’t

insist on them“Take what you want, leave the rest”“Yes….and”Emerson

Support Self-Efficacy

• Believe in the client’s capability• Explore strengths• Highlight positive exceptions• Emphasize small steps – realistic

hope• Maintain confidence and optimism• Anticipate a different futureEmerson

Motivational Interviewing: Core Skills

Core MI Communication Skills – OARS• Asking Open-ended Questions• Making well-timed Affirmations• Making frequent Reflective Listening

Statements• Using Summaries to communicate

understanding

http://www.ytporegon.org/sites/default/files/fileattachments/HelpDocForOARSYTPWebPage_0.pdf

http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf

Motivational Interviewing: Inconsistent Items

MI Inconsistent Items•Unsolicited Advice, Direction-Giving or Feedback

•Emphasis on Abstinence

•Direct Confrontation of Client

•Emphasis on Powerlessness and Loss of Control

•Asserting Authority

http://www.drugabuse.gov/blending-initiative/motivational-interviewing-assessment

Summary

• Motivational Interviewing is an effective way to elicit healthy behavior change

• The Spirit of MI is one of Collaboration, Evocation and Autonomy

• The Principles of MI include Expressing Empathy, Developing Discrepancy, Rolling with Resistance, and Supporting Self-Efficacy

• Remember to use your OARS skills

The End!

Psychosis in the

Primary Care

Setting

03/06/15

http://proof.nationalgeographic.com/2015/02/04/photo-of-the-day-best-of-january-2/?source=photosite