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Motivational Interviewing Web3

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Motivational Interviewing Web3

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jattdhillon1074

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Motivational Interviewing

The Basics
Learning Objectives
At the end of the session, you will be able to—
1. Define motivational interviewing (MI).

2. Identify the tasks of MI.

3. Describe the spirit of MI.

4. Define the principles of MI.

5. Identify MI techniques to help patients change.

Definition of Motivational
Interviewing
“Motivational interviewing
is a client-centered,
directive method for
enhancing intrinsic
motivation to change by
exploring and resolving
ambivalence.”
Motivational Interviewing
The tasks of MI are to—
 Engage, through having sensitive conversations with patients.
 Focus on what’s important to the patient regarding behavior,
health, and welfare.
 Evoke the patient’s personal motivation for change.
 Negotiate plans.

Motivating often means resolving conflicting and

ambivalent feelings and thoughts
Motivational Interviewing Spirit
“People are generally better persuaded by
the reasons which they have themselves
discovered than by those which have come
into the mind of others.”
—Blaise Pascal
Spirit of MI
A way of being with patients that is…
 Collaborative
 Evocative
 Respectful of autonomy
 Compassionate
Spirit of MI (continued)
Collaboration (not confrontation)
 Developing a partnership in which
the patient’s expertise,
perspectives, and input are central
to the consultation

 Fostering and encouraging power

sharing in the interaction
Spirit of MI (continued)

Evocation (not education)

 Motivation for change resides
within the patient.

 Motivation is enhanced by eliciting

and drawing on the patient’s own
perceptions, experiences, and
goals.

 Ask key open-ended questions.

Spirit of MI (continued)
Autonomy (not authority)
 Respecting the patient’s right to make
informed choices facilitates change.
 The patient is in charge of his/her choices and
thus is responsible for the outcomes.
 Emphasize patient control and choice.
Spirit of MI (continued)
Compassion
 Empathy for the experience
of others
 Desire to alleviate the suffering of others
 Belief and commitment to act in the best
interests of the patient
What MI Is Not
 A way of tricking people into doing
what you want them to do
 A specific technique
 Problem solving or skill building
 Just patient-centered therapy
 Easy to learn
 A panacea for every clinical
challenge Miller, W. R., & Rollnick, S. (2012).
Motivational Interviewing
Principles
MI Principles (continued)
MI is founded on four basic principles:
 Express empathy.

 Develop discrepancy.

 Roll with resistance.

 Support self-efficacy.
Reference: Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1992). Motivational
enhancement therapy manual: A clinical research guide for therapists treating individuals with
alcohol abuse and dependence. Rockville, MD: National Institute on Alcohol Abuse and
Alcoholism.
MI Principles (continued)
Express empathy.
Express Empathy
What is empathy?
 Reflects an accurate
understanding

– Assumes the person’s perspectives are

understandable, comprehensible, and valid

– Seeks to understand the person’s feelings and

perspectives without judging
Express Empathy (continued)
Why is empathy important in MI?
 Communicates acceptance, which
facilitates change

 Encourages a collaborative alliance,

which also promotes change

 Leads to an understanding of each

person’s unique perspective, feelings,
and values, which make up the material
we need to facilitate change
Express Empathy (continued)
Tips…
 Good eye contact

 Responsive facial expression

 Body orientation

 Verbal and nonverbal “encouragers”

 Reflective listening/asking clarifying questions

 Avoid expressing doubt/passing judgment

The Bottom Line on Empathy
 Ambivalence is normal.

 Our acceptance facilitates

change.

 Skillful reflective listening

is fundamental to
expressing empathy.
Miller, W. R. & Rollnick, S. (2012)
MI Principles
Develop discrepancy.
Develop Discrepancy

 Current behavior
versus future goals
Example: “Sometimes when you drink
during the week, you can’t get out of
bed to get to work. Last month, you
missed 5 days. But you enjoy your work,
and doing well in your job is very
important to you.”
MI Principles
Roll with resistance.
Roll With Resistance
Examples
Patient: I don’t plan to quit drinking anytime soon.

Clinician: You don’t think that abstinence would

work for you right now.

Or
Patient: My husband is always nagging me about
my drinking—always calling me an alcoholic. It
really bugs me.

Clinician: It sounds like he really cares about you

and is concerned, although he expresses it in a way
that makes you angry.
MI Principles
Support self-efficacy.
Support Self-Efficacy

 Patients are
responsible for
choosing and
carrying out
actions to change.
Four Other Guiding MI
Principles
1. Resist the righting reflex.
 If a patient is ambivalent about change,
and the clinician champions the side of
change…
Four Other Guiding MI
Principles (continued)
2. Understand your patient’s motivations.
 With limited consultation time, it is more
productive asking patients what their reasons
are and why they choose to change, rather
than telling them they should.
Four Other Guiding MI
Principles (continued)
3. Listen to your patient.
 When it comes to behavior change, the
answers most likely will lie within the patient,
and finding answers requires listening.
Four Other Guiding MI
Principles (continued)
4. Empower your patient.
 A patient who is active in the consultation,
thinking aloud about the why, what, and how
of change, is more likely to do something
about it.
Conclusion of MI Basics
 Evidence based