Motivational Interviewing in the Primary Care Setting Presented by: Jonathan Betlinski, MD Date: 02/26/2015
Dec 21, 2015
Motivational Interviewingin the Primary Care Setting
Presented by: Jonathan Betlinski, MDDate: 02/26/2015
Disclosures and Learning Objectives
Learning Objectives:•Know the 6 Stages of Change•Know the 1 goal of Motivational Interviewing•Know the 3 parts of the Spirit of MI•Know the 4 principles of MI•Know the 4 core communication skills of MIDisclosures: Dr. Jonathan Betlinski has nothing to disclose except his profound gratitude to the late Jon Emerson, LCSW, for his mentoring in teaching this topic. Some of these slides are from a lecture of his.
Motivational Interviewing in Primary Care
• Review the history of MI
• Review the basic elements of MI
• Discuss the impact of MI in the Primary Care Setting
• Discuss clinical scenarios in which MI may be helpful
• Reveal next week’s topic
Motivational Interviewing: History
Originally developed for use in Addiction• First described in 1983 article• Miller and Rollnick published 2nd Edition in 2002• By 2013, more than 3,000 formally trained• More than 3 million clients in 47 languages• Number of studies doubles every 3 years
Now listed in SAMHSA’s NREPPhttp://nrepp.samhsa.gov/ViewIntervention.aspx?id=346
http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf
Motivational Interviewing: Current Uses
Sexual Health
Dietary Change
Weight Loss
Voice Therapy
Gambling
Promote Physical Activity
Medication Adherence
Fibromyalgia
http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf
Diabetes
Chronic Leg Ulceration
Criminal Justice
Stroke Rehabilitation
Chronic Pain
Self-Care
Domestic Violence
Mental Health
Stages of Change
The Transtheoretical Model posits a series of steps to adopting healthy behaviors1.Precontemplation
2.Contemplation
3.Preparation
4.Action
5.Maintenance
6.Relapsewww.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf
http://www.socialwork.career/2013/02/motivational-interviewing-client_20.html
Motivational Interviewing: Definition
Motivational interviewing is
“a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.”
--Rollnick & Miller (1995)
Emerson
Motivational Interviewing: Definition
Motivational interviewing is
“a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.”
--Miller and Rollnick (2002)
http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf
Motivational Interviewing: Definition
Motivational interviewing is
“a person-centered method of guiding to elicit and strengthen personal motivation for change.”
--Miller and Rollnick (2009)
http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf
Motivational Interviewing: Goal
The Goal of MI is simple:
Behavior Change
Commitment
Not
Capitulation
http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf
Motivational Interviewing: The Spirit
Collaboration (not confrontation)
• Counselor is a partner, not an authority
• Motivation for change is elicited, not imposed
• Task is to help client articulate and resolve ambivalence
Evocation (not imposition)
• Draw knowledge out rather than imparting it
• The patient is the expert in their own lives
Autonomy (not authority)
• Responsibility for change belongs to client
• The client presents the arguments for changehttp://www.ytporegon.org/content/spirit-motivational-interviewing
Motivational Interviewing: The Principles
• Express Empathy
• Develop Discrepancy
• Roll with Resistance
• Support Self-Efficacy
http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf
Express Empathy
• Accepting the person, their situation, their point of view
• Respecting their explanations• Reflective, nonjudgmental listening• Avoiding criticism and blaming• Support self-esteem
Emerson
Develop Discrepancy
• Identify problematic behavior• Remind of goals and values• Ask for help in understanding –
Columbo• Be sincerely curious• Use “so”, “if” reflectively• Let client make the argument for
changeEmerson
Roll with Resistance
• Argument breeds defensiveness• Go with the direction of the client’s
argument• Suggest new perspectives, but don’t
insist on them• “Take what you want, leave the
rest”Emerson
Roll with Resistance
Argument breeds defensivenessGo with the direction of the client’s
argumentSuggest new perspectives, but don’t
insist on them“Take what you want, leave the rest”“Yes….and”Emerson
Support Self-Efficacy
• Believe in the client’s capability• Explore strengths• Highlight positive exceptions• Emphasize small steps – realistic
hope• Maintain confidence and optimism• Anticipate a different futureEmerson
Motivational Interviewing: Core Skills
Core MI Communication Skills – OARS• Asking Open-ended Questions• Making well-timed Affirmations• Making frequent Reflective Listening
Statements• Using Summaries to communicate
understanding
http://www.ytporegon.org/sites/default/files/fileattachments/HelpDocForOARSYTPWebPage_0.pdf
http://www.a-healthcoaching.com/docs/motivational-interviewing-in-primary-care.pdf
Motivational Interviewing: Inconsistent Items
MI Inconsistent Items•Unsolicited Advice, Direction-Giving or Feedback
•Emphasis on Abstinence
•Direct Confrontation of Client
•Emphasis on Powerlessness and Loss of Control
•Asserting Authority
http://www.drugabuse.gov/blending-initiative/motivational-interviewing-assessment
Summary
• Motivational Interviewing is an effective way to elicit healthy behavior change
• The Spirit of MI is one of Collaboration, Evocation and Autonomy
• The Principles of MI include Expressing Empathy, Developing Discrepancy, Rolling with Resistance, and Supporting Self-Efficacy
• Remember to use your OARS skills