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Motivational Interviewing: Elicit Change Talk
This document discusses strategies for eliciting and strengthening change talk during a session with a patient. It recommends finding where the patient is in their readiness for change using importance and confidence rulers. The session aims to develop discrepancy, amplify ambivalence, and elicit change talk using empathic reflection and exploring goals, values, strengths and solutions. While the clinician guides the intervention, the ultimate outcome is not their responsibility. Examples are provided to distinguish resistance from change talk. The goal is to meet patients where they are on the continuum of ambivalence and increase their importance and confidence in making positive changes.
Motivational Interviewing: Elicit Change Talk
- 1. Session 2: Elicitand Strengthen Change Talk Session 2: Elicit and Strengthen Change Talk Stephen R. Andrew, LCSW LADC CCS
- 2. An MI Conversation Target/purpose Expressempathy OARS Develop discrepancy/Amplify ambivalence Change talk/ “Change Theory” Change plan Commitment language
- 3. Goal-Oriented Interventions Empathic reflection Elicit,options, elicit... Importance, confidence and ruler Remember: We are responsible for the intervention, not the outcome
- 4. Find Out Wherethe Patient is Meet them where they are Continuum of ambivalence Explore importance and confidence
- 5. Readiness Ruler Importance. Howimportant is it for you right now to prevent illness? On a scale of 1-10, how important is it? 1-------------------------------10 How come you are a ___ and not a ___? What would it take to go from __ to __?
- 6. Confidence Ruler Confidence. Howconfident are you that you could complete a colon cancer screening test? How come you are a ___ and not a ___? What would it take to go from __ to __?
- 7. Strategies to Increase Importanceand Confidence ELicit & reflect change talk Explore goals & values Highlight personal strengths & supports Brainstorm solutions Hypothetical change (“I wonder if...”)
- 8. Resistance or Change Talk? “Iwant to lose weight.” “I’d like to spend less money.” “I could if I wanted to, but I don’t really want to.”
- 9. Resistance or Change Talk? “Iwish people understood me better.” “I want to get along with my wife.” “I wish my parents would stop nagging me.”
- 10. Resistance or Change Talk? “Idon’t want the colonoscopy but I need to do it for my family.” “I don’t want to go looking for trouble with those tests. I feel fine.” “I’m scared. But if you tell me I need it, I will do it.”
- 11. Thank You! Stephen Andrew,LCSW LADC CCS heti@gwi.net www.hetimaine.org
Editor's Notes
- #4 Complex Empathic Reflections.. amplify, double-sided, continuing paragraph, metaphor, affective... Elicit, Provide Options, Elicit.. Importance,Confidence & Energy Rulers.. Elicit Commitment Language.. We are responsible for the intervention, not the outcome...
- #5 Its important to meet the patient where he/she is at in terms of thinking about CRC screening. MI involves an approach to making this “diagnosis” or determination using a continuum of ambivalence that ranges from resistance to true ambivalence. The MI approach involves exploring IMPORTANCE and CONFIDENCE.