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Motivational InterviewingRita Haverkamp, RNClinical Trainer, UW AIMS CenterPatrick Raue, PhDAssociate Director of Behavioral Interventions, UW AIMS Center
Social Innovation Fund (SIF) March 08, 2017
Objectives
• Discuss how motivational interviewing can beused in therapeutic work with patients
• Review core motivational interviewingstrategies
• Increase your ability to confidently usemotivational interviewing techniques in yourpractice
Behavioral Components
MI Umbrella
PhysicalActivation
PleasantEvents
ProblemSolving
Treatment
Reflective listening
SocialActivation
SubstanceAbuse
Treatment
Three Essential Elements of MI1. MI is a particular kind of conversation
about change2. MI is collaborative
– Not expert recipient– Patient centered– Partnership– Honors autonomy
3. MI is evocative– Seeks to call forth the person’s own motivation
and commitment
SIF Webinar: Motivational Interviewing March 8, 2017
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Motivational Interviewing (MI)• Collaborative, goal oriented style ofcommunication
• Pays attention to the patient’s language ofchange
• Strengthens personal motivation for andcommitment to a specific goal
• Elicits and explores a patient’s own reasonsfor change
• Atmosphere of acceptance and compassion
When MI Can Help
• Building a therapeutic relationship; engagement• Developing treatment goals• Resistance to treatment (behavioral or medical)• Ambivalence about a goal/change• Substance use/abuse• Relationship issues (in their lives)• We find ourselves judging or pushing for achange and resulting resistance of patient
Reflections
• In what ways has MI helped you work withpatients?
“Traditional” Approach
• People should WANT to change• They are either motivated or not• Now is the only time to change• I’m the expert and they should follow myadvice
• If people don’t change, treatment has failed• We do not accept the person where she/he isat
SIF Webinar: Motivational Interviewing March 8, 2017
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Interacting with the Patient
• Our pressure, persuasion, or directing tomove a patient forward triggers “reactance”– Patients protect their freedom – maintaining thestatus quo
• Motivation is a fluctuating state• Our interactions influence a patient’smotivation– Understand and resolve ambivalence
Stages of Change
• Pre contemplation– Not important; not confident– “I don’t have a problem with depression.”
• Contemplation–Maybe important; maybe confident– “Maybe talking would help.”
• Preparation– Important; becoming confident– “I need to do something different.”
Reflections
• Think of a time when you gave direct adviceto a patient before s/he was ready– What pulled you to try to move the patientforward in this way?
– How did the patient respond?–What did this indicate about the patient’s stageof change?
MI Processes
Planning
Evoking
Focusing
Engaging
Planning
Evoking
Focusing
Engaging
SIF Webinar: Motivational Interviewing March 8, 2017
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Process Engaging
• Making the obvious explicit;setting the stage;provider transparency
• Non judgmental• Respectful• Genuine• Empathetic• Building a therapeutic relationship
Planning
Evoking
Focusing
Engaging
Process Focusing• Strategically finding a topic
to discuss• Agenda matching
– Find out their concerns (“What would you liketo talk about today?”)
– Ask to discuss your agenda (“Would it be okayif we also talk about _____?”)
– Menu of options for discussion (“Of all thethings you’ve mentioned, what is mostimportant to you right now?”)
Planning
Evoking
Focusing
Engaging
Process – Evoking/Eliciting
• Pulling out the whole storyabout the issue from theperson’s perspective
• Eliciting and highlighting their Change Talk• Hallmark of MI: eliciting Change Talk• Where you put your energy
Planning
Evoking
Focusing
Engaging
• Always ask permission– “Could I share some information I have?”– “There’s something that concerns me. Could I sharemy thoughts?”
• Provide clear information or feedback– “What happens to some people is that . . .”– “The results of your tests suggest that . . .”
• Elicit their reaction– “What are your thoughts?”– Don’t argue, defend, interpret, or advise
Elicit, Provide, Elicit
SIF Webinar: Motivational Interviewing March 8, 2017
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Process Planning• Occurs when the person is
ready to make some change• Key Question:
– “What do you think you will do? What changes areyou considering? Where do you go from here?”
• Menu of options – Patients can:– Manage the behavior– Do nothing– Eliminate the behavior– Seek help
• Provider non judgmental stance
Planning
Evoking
Focusing
Engaging
Common MI Traps
Question – AnswerExpertScare
CheerleaderTaking sides
Information dumpingPouncing
Fix itPremature action planning
Try InsteadAvoidOpen ended questionsPartnershipAppropriate info givingTailored support for changeReflect, join in explorationLearn what’s relevantListen, help patient focusAvoid righting reflexCt centered appropriate plan
“Resistance”
• Resistance results from thepatient’s ambivalencebutting into the provider’s “righting reflex”
• Indicates a problem in interaction betweenprovider and patient
• Arguing against it just entrenches it• Change your approach
Rolling with Resistance
• Reflect – simply acknowledge it– Simple, amplified or double sided
• Shift focus – re direct attention to a moreworkable issue
• Autonomy – emphasize the patient makestheir own choices and is in control
• Reframe – acknowledge validity of patient’sviews but offer a new meaning for them
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Reflections
• What ways have you “rolled with” or “rightedresistance? What works best for you?
Summary of MI CommunicationTechniques: OARS Model
O = Open ended questions
A = Affirmations
R = Reflective Listening
S = Summarizing
Behavioral Components
MI Umbrella
PhysicalActivation
PleasantEvents
ProblemSolving
Treatment
Reflective listening
SocialActivation
SubstanceAbuse
Treatment
Upcoming Case CallWednesday, April 12– 9:00 AM – 10:30 AM AKST– 10:00 AM – 11:30 AM PST– 11:00 AM – 12:30 PMMST
SIF Webinar: Motivational Interviewing March 8, 2017
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