Motivational Interviewing: Helping People Change

Jerica Berge, Ph.D., MPH, LMFTAssistant ProfessorDepartment of Family Medicine and Community Health University of Minnesotamohl0009@umn.edu

Disclosure Statement

I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity.

Motivational Interviewing

PREPARINGPEOPLE

FOR CHANGE

Ambivalence

The Dilemma of Change

Ambivalence

State of having simultaneous, conflicting feelings:Mixed Feelings UncertaintyIndecisiveness

Consequences of Ambivalence

The result of being in a state of ambivalence can lead to avoidance or procrastination

OR…to deliberate attempts to resolve the ambivalence that may result in success or failure

Ambivalence

Ambivalence about proposed behavior change is NORMAL

Direct persuasion or advice giving is NOT an effective method for resolving ambivalence for most patients

The Righting Reflex

Our desire to keep people from going down the wrong path, and to set things aright

Righting Reflex vs. Ambivalence

Advice Regarding Health Behavior Change

We like to give itWe’ve been trained to give itIt’s not very effective We do it anyway

http://www.youtube.com/watch?v=80XyNE89eCs

Bad Example MI

“Motivation to change is not a personality trait, but is affected by interpersonal interaction”

Miller & Rollnick, 1991

Express empathy

Develop discrepancy

Roll with resistance and avoid argumentation

Support self-efficacy

Four key principles

http://www.youtube.com/watch?v=URiKA7CKtfc

Good Example of MI

What You Can’t Do with MI

Ex. With a parent of a child who is overweight

In one given interaction you probably CANNOT: Get the parent to totally change both the child’s

eating AND exercise habits Get the parent to change both the home food

environment AND physical activity environment

What You Can Do with MI

You probably CAN: Assess readiness for change Engage with the parent so that she sees you as someone who would be willing to help if and when she wants help

Use reflective listening to encourage the parent to consider even a small step toward change

Plant the seed for behavior change by using the “confidence ruler” technique