why do people change? consequences dose of treatment faith, hope, “self-efficacy” counselor...
TRANSCRIPT
HOW CAN I PUT MOTIVATIONAL
INTERVIEWING INTO PRACTICE?
Lynn S. Massey, LMSWUniversity of Michigan
Departments of Psychiatry and Emergency Medicine
WHY DO PEOPLE CHANGE?
Consequences Dose of treatment Faith, hope, “self-efficacy” Counselor effects – empathy vs. confrontation Change talk Willing to Change - importance Able to Change - confidence Ready to Change - priority
MI INTEGRATION IN BEHAVIOR CHANGE COUNSELING
Behavior change is at the heart of most modern health care concerns (heart disease, obesity, depression, cancers, diabetes, liver disease, respiratory problems)
Most health care practitioners have conversations / encounters regarding behavior change in daily work
More attention has been on information vs how to approach (style) behavior change with the person
WHAT TYPES OF SETTINGS? Mental Health Substance Abuse Access/Intake Primary Care Emergency Department Hospital School Setting Probation
HOW DO I DETERMINE IF MI WOULD BE USEFUL IN MY SETTING?
Are you working with people who need/want to change a behavior?
Are you working with people who would benefit from being more motivated?
Would you like to increase participation in a treatment program?
Overworked
MI Spirit
Change
Talk
MI Principles
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.
ELEMENTS OF MI
LEARNING MOTIVATIONAL INTERVIEWING:IS A PROCESS OF LEARNING ABOUT AND USING STRATEGIES TO BOOST PROBLEM RECOGNITION, MOTIVATION AND STRENGTHEN COMMITMENT TO CHANGE
ASSUMPTIONS OF MI Motivation
“the probability that a person will enter into, continue, and adhere to a specific change strategy” or plan
Motivation is a dynamic state (of readiness to change)
Part of clinician’s job
Occurs in an interpersonal context
“Noncompliance”, “resistance” and ”lack of motivation” are all partially due to therapists strategies
ASSUMPTIONS OF MI Ambivalence
is normal, acceptable and understandable
helps clinician to appreciate the complexity of the individual and their situation
is at the heart of motivation
Usually mistaken for resistance (yes, but…)
MI Spirit
Change
Talk
MI Principles
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.
ELEMENTS OF MI: MI SPIRIT
MI SPIRIT
Empathy – genuine curiosity about client’s perspective (understanding)
MI Spirit:
Collaboration – fostering power sharing in the interaction
Evocation – elicitation / acceptance / understanding of client’s own ideas about change
Respect Autonomy – active fostering of client perception of choice
MI Spirit
Change
Talk
MI Principles
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.
ELEMENTS OF MI: OARS
EARLY STRATEGIES: OARS
Open Ended Question: (“are you concerned about your health?” vs “to you, what are important reasons to cut down on your drinking?”)
Affirmation: (“It really sounds like you have been committed to being the best father you can”)
Reflection: (“It sounds like on one hand you feel …..and were scared by the emergency room visit, but on the other hand, you don’t want to give up drinking completely right now”) listening
Summary(“Let me try to pull together what we have been talking about, let me know if I missed something……”)
RESPONDING TO RESISTANCE
Simple Reflection – you feel stuck, etc.
Amplified Reflection – C: My wife thinks its worse than it is. I: It seems to you she has no reason for concern.
Double-sided Reflection - You don’t like the way this makes you feel sometimes, and you’re not sure how you might change things.
Reframing – C: I’ve tried to quit 3 times and failed. I: You’ve given it 3 good tries, and every try gets you closer. Its probably helped you learn some things that will and won’t work for you.
Emphasize personal choice and control – What you decide to do is completely up to you
MI Spirit
Change
Talk
MI Principl
es
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.
ELEMENTS OF MI: MI PRINCIPLES
4 PRINCIPLES OF MI
1) Acceptance of people as they are frees them to change whereas non-acceptance immobilizes the change process
2) Between present behavior and broader goals and values; helping people get un-stuck
3) Avoid arguing for change; new ideas/goals/options are not imposed; used as a signal
4) Belief in ability to change is a powerful predictor of change; counselor self-fulfilling prophesy
MI PRINCIPLES
1) Practitioners want to help! Leads to strong urge to correct behavior that is harmful – Righting reflex. But, it is a natural human tendency to resist persuasion – Resist
2) The patients own reasons for change are much more powerful than ours – Understand
3) The answers regarding behavior change come from the patient – Listen
4) Outcomes are better when patient takes and active role in deciding on outcomes - Empower
MI Spirit
Change
Talk
MI Principles
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.
ELEMENTS OF MI: CHANGE TALK
CHANGE TALK (BEM SELF PERCEPTION THEORY)
“It is the truth we hear ourselves speak rather than the treatment we receive that heals us.”
- O. Hobart Mowrer
THE FLOW OF CHANGE TALK
MI
Desire, Ability, Reasons, Need
Commitment
Change
ELICITING CHANGE TALK
Evocative Questions
Importance Ruler
Exploring Decisional Balance
Querying Extremes (worst thing if you continue. . ., best things if you change)
Looking Back (prior to the problem and compare with now)
Looking Forward (If you make a change . . ., Suppose you don’t make a change, what do you think your live might be like)
VIDEO EXAMPLE
http://www.youtube.com/watch?v=URiKA7CKtfc
Reference: Demonstration of the motivational interviewing approach in a brief medical encounter. Produced by University of Florida Department of Psychiatry. Funded by Flight Attendant Medical Research Institute Grant #63504
PRIMARY CARE
BRIEF INTERVENTIONS IN THE ED
VIRTUAL THERAPIST
BRIEF INTERVENTION
BRIEF INTERVENTION
BRIEF INTERVENTION
Contact information:
Lynn Massey, LMSW
RESOURCE:
MI website to visit:www.motivationalinterview.org
THANK YOU