Motivational Interviewing: Nuts and Bolts

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This is the slide deck from Second Life event #1 on Motivational Interviewing,

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Motivational Interviewing: Nuts and Bolts

  1. 1. Stephen R. Andrew, LCSW LADC CCS
  2. 2. Engaging Patients Attitudes and behaviors What you’ve done or witnessed
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. What is listening? Focus all purpose, attention, and energy on understanding What is the person experiencing right now? Hearing what they are NOT saying
  7. 7. Five General Principles Express accurate empathy Amplify ambivalence Avoid arguments Support self-efficacy Roll with resistance
  8. 8. *Power/Control *Connection What People Seek/Need
  9. 9. Imagine...
  10. 10. Motivational Interviewing Process: The Structure AmbivalenceAmbivalence CHANGE TALK Desire Ability Reason Need CHANGE TALK Desire Ability Reason Need COMMITMENT LANGUAGE COMMITMENT LANGUAGE CHANGE BEHAVIOR TOWARDS and/or HEATLH CHANGE BEHAVIOR TOWARDS and/or HEATLH IncreaseIncrease desiresdesires ObserveObserveNoticeNotice 1 LowerLower 10
  11. 11. The Skills “OARS” “OARS” O = open-ended questions A = affirm R = reflection S = summarize
  12. 12. Amplify Ambivalence
  13. 13. 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 Bridge the gap by reflection
  14. 14. 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.
  15. 15. “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?”
  16. 16. 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’?”
  17. 17. What is this patient telling you? How will you respond? How will you respond?
  18. 18. 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!

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