Motivational Interviewing: Who's Driving the Change?
• Motivational Interviewing: Who’s Driving the Change? Sara Beth Martin, RN, MPH September 19, 2012
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.
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
The Four General Principles of Motivational Interviewing Express empathy Develop discrepancy Roll with resistance Support self-efficacy
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
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
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
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
Skills Used in Motivational Interviewing Open-ended questions Affirmations Reflective listening Summarizing Eliciting change talk
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
Affirmations Genuine, direct statements of support Usually directed at something specific and change-oriented Demonstrate understanding and appreciation
Reflective Listening Active listening and expression of empathy Reflecting the essence of what was said or what you think was meant
Summarizing Communicates that you have followed what the client shared Structure session and keep on track Emphasize certain elements of what was said
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
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.
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?
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?
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.