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.
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.
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.
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.
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.
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.
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.
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.
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
“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”
“I will have to take all theclothes off my bunk bed, so they can have a place to sleep!”
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
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”
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.
“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”