Motivational Interviewing


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Copyright and property of Scotty Silva, Director of Pulmonary Services, UNM Hospital

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Motivational Interviewing

  1. 1.  What is MOTIVATIONAL INTERVIEWING?  Motivational interviewing is a directive, client- centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. What is AMBIVALENCE?  Webster’s defines ambivalence as; “Simultaneous conflicting feelings”  “I want to quit smoking and I don’t want to quit smoking”  You can’t have motivational interviewing without ambivalence.
  2. 2.  Collaboration (Not Confrontation)  Working in partnership and consultation with the patients. Evocation (Not Education)  Listening more than talking Autonomy (Not Authority)  Being respectful of the patient’s own ability to make decisions.  Honoring the patients autonomy, resourcefulness, and the ability to choose.
  3. 3.  Motivation is essential to change. Change is not an event, change is a process! Ambivalence is NORMAL. Motivation;  Ready – A matter of priorities.  Willing – Understanding the importance of change.  Able – Confidence in the ability to change.
  4. 4.  Precontemplation  Reluctant – Inertia or lack of information prevents the person from being fully aware of a problem.  Rebellious – A heavy investment in the problem behavior or in controlling a situation makes the person actively resistant and often hostile.  Resigned – A belief in the inability to change the behavior keeps the person “stuck”, lacks energy for and investment in change as a result.  Rationalizing – The patient determines that there is no problem, the odds of personal risk are in their favor, or the problem is really someone else’s.
  5. 5.  Contemplation  The patient is aware a problem may exist and seriously considers action, but is not ready to make a commitment to action. Preparation  The person is intent upon taking action soon.  This stage is a combination of behavioral actions and intentions.  Most patient’s will make a serious quit attempt soon.
  6. 6.  Action  The person is aware that a problem exists and actively modifies their behavior, experiences, and environment in order to overcome the problem.  Commitment is clear and a great deal of effort is expended towards making changes. Maintenance  The person has made a sustained change wherein a new pattern of behavior has replaced the old.  Behavior is firmly established and threat of relapse becomes less intense.
  7. 7.  Change Talk = Self-motivating speech. DARN  Desire to Change  Ability to Change  Reason to Change  Need to Change DARN is the patient’s own expression to change! In order to move beyond reflective listening, you need to recognize reflective listening.
  8. 8.  Develop Discrepancy – The difference between the patient’s present state and their desired goals. Without discrepancy there is no ambivalence and if there is no ambivalence, there is no potential for change! First intensify and resolve ambivalence by developing discrepancy between the actual present and the desired future.
  9. 9.  Communication Model (Thomas Gordon); The words the The words the speaker says listener hears What the speaker What the listener means thinks the speaker means
  10. 10. “I don’t think that we should have a foreign exchange student at our house because than I will have to take all my clothes off”
  11. 11. “I will have to take all theclothes off my bunk bed, so they can have a place to sleep!”
  12. 12.  Thomas Gordon’s 12 Roadblocks - Ordering, directing, or - Disagreeing, judging, commanding criticizing or blaming - Warning, cautioning, or - Agreeing, approving, or threatening praising - Giving advice, making - Shaming, ridiculing, or suggestions, or providing labeling solutions - Interpreting or analyzing - Persuading with logic, - Reassuring, sympathizing, arguing, or lecturing or consoling - Telling people what - questioning or probing they should do, moralizing - withdrawing, distracting, humoring, or changing the subject
  13. 13.  Question – Answer Trap Taking Sides Trap Expert Trap Labeling Trap Premature – Focus Trap Blaming Trap
  14. 14.  Express Empathy Develop Discrepancy Avoid Argumentation Support Self Efficacy
  15. 15.  Give information and advice about the concern with the patient’s permission;  “Would it be alright if I told you about a concern that I have about what you are proposing”  “I don’t know if this would work for you or not, but can I give you an idea of what some people have done in your situation”
  16. 16.  O-A-R-S  Ask Open Questions  Affirm – Statements of support, compliments, appreciation, and understanding.  Listen Reflectively – Offers a hypothesis about what the speaker means, but is done in the form of a statement rather than a question.  Summarize – Captures both sides of ambivalence and ends with an invitation for the patient to respond.
  17. 17.  “The goal of Motivational Interviewing is to enhance the patient’s confidence in his/her ability to cope with obstacles and to succeed in change”
  18. 18.  Listening statements Readiness Ladders Accomplishment Story Sidestepping