Motivational Interviewing: Nuts and Bolts

Motivational Interviewing Session 1: The Spirit of MI
Stephen R. Andrew, LCSW LADC CCS

Engaging Patients
Attitudes and behaviors
What you’ve done or witnessed

MI: What is it?
Definition: Motivational interviewing is a collaborative, person-centered evidence-based, guiding method of communication for enhancing and strengthening intrinsic motivation for change.
Spirit: Collaboration, Autonomy, Respect, Compassion

Motivational Interviewing...
assumes motivation is fluid and can be influenced
motivation is influenced in context of a relationship
principle task: to guide conversation towards eliciting motivation for change
goal: to influence change in the direction of health

Communication is hard...
Here are the places it can break down.
Speaker Listener 1. What the speaker means 2. What the speaker says 3. What the listener hears 4. What the listener thinks the speaker means

What is listening?
Focus all purpose, attention, and energy on understanding
What is the person experiencing right now?
Hearing what they are NOT
saying

Five General Principles
Express accurate empathy
Amplify ambivalence
Avoid arguments
Support self-efficacy
Roll with resistance

What People Seek/Need *Power/Control *Connection

Imagine...

Motivational Interviewing Process: The Structure Ambivalence CHANGE TALK Desire Ability Reason Need COMMITMENT LANGUAGE CHANGE BEHAVIOR TOWARDS and/or HEATLH Increase desires Observe Notice 1 Lower 10

The Skills “OARS” “OARS”
O = open-ended questions
A = affirm
R = reflection
S = summarize

Amplify Ambivalence

The Accuracy Function of Reflection Speaker Listener 1. What the speaker means 2. What the speaker says 3. What the listener hears 4. What the listener thinks the speaker means

The Case
53 year-old male came to clinic one week ago for concern of high blood pressure reading at work. He presents now for follow up and BP is in control.

“ Now that we have a plan to manage your blood pressure, Mr. Jones, I wonder if I can talk with you about some preventive health care. Specifically, I wanted to mention some recommendations for all patients over age 50 to undergo colon cancer screening. Would it be okay with you to talk a little about this today?”

Jones: “ Geez, doc, like I said, I only came in ‘cause my wife made me after that nurse at work got that abnormal blood pressure reading. I’m not here for the works. You know what I’m say-in’?”

What is this patient telling you? How will you respond? How will you respond?

Next Steps
We’ll teleport up to two sky platforms in order to practice your MI technique
Click on your assigned color (red or blue) teleport device, to the left or right of the screen
See you at 300 meters!

Motivational Interviewing: Nuts and Bolts

by Robin Heyden

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Motivational Interviewing: Nuts and Bolts Presentation Transcript