What is Motivational Interviewing?
“Helping people talk themselves into changing”
Motivational Interviewing is a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” – Miller & Rollnick, 2002
Motivational Interviewing (MI) is an evidenced-based model to describe how people change. Demanding or telling someone to change is rarely effective. When the dentist told us “you really need to floss more” or the doctor told us “you need to lose weight”, did we run to the store for floss? No… Motivational interviewing is a therapeutic technique to encourage patients to find their own motivation for change and/or their resistances to change. By identifying a patient’s own fears and ambivalences about change, the therapist can help the patient overcome them. MI is not just a series of techniques to “trick” people into changing–it’s a skillful clinical style for eliciting from patients their own inner motivation for making changes. Motivational Interviewing is about guiding more than directing, eliciting more than imparting, and listening at least as much as telling. MI is effective across populations and cultures, improves adherence and retention in care (by involving individuals in their ow care), and reduces clinician burnout.
Guiding Principles of Motivational Interviewing
Resisting the “righting” reflex (telling people they “should” do something isn’t that effective)
Understanding and exploring the patients own motivation
Listening with empathy
Empowering and instilling hope and optimism
What is Motivation?
Motivation is the reason or reasons one has for acting or behaving in a particular way. It is the willingness of someone to do something. Motivation is multidimensional, dynamic, and has external and internal factors. It is the key to change. Motivation can be elicited and enhanced and is an important factor in someone’s readiness to change.
There are two important dimensions of motivation:
Importance: the “why” of change
Confidence: the “how” of change
Components of Motivation:
Ready: a matter of priorities
Willing: importance of change
Able: confidence to change
The ABCs of Motivation and change:
Accept: Patient must accept that the behavior is a problem
Believe: Patient must believe that they will be better off if they change
Confidence: Patient must have confidence in their ability to change
6 Stages of Change
Precontemplation: No way. (Denial)
Contemplation: Maybe I can do this. (Ambivalent)
Determination/Preparation: Let’s do this! (Motivated)
Action: Doing it.
Maintenance: Living it
Relapse/Recycle: Ugh!! Back to 1…
The OARS Tool
O: Open-ended Questions encourage the patient to talk more and helps the provider learn about the patient’s concerns.
- What makes you feel it might be time for a change?
- Can you tell me more about that?
- What have you noticed about your ____?
- What concerns you most?
- How would you like things to be different?
- What will you lose if you give up drinking?
- What have you tried before?
- What do you want to do next?
A: Affirmations are statements that show recognition of a patient’s attempts at change
- “So you’ve started walking this past week!”
- “You didn’t want to come today, but you did!”
- “You are down to 5 cigarettes/day?! That’s great! You were smoking 8 cigarettes last week!”
R: Reflective Listening means listening and trying to understand the patient’s point of view even if you disagree with it
- Communicating (to the patient) your understanding of his/her experience, behavior and/or feelings from their point of view.
- The following are not congruent with reflective listening:
- Ordering, directing or commanding
- Warning, cautioning or threatening
- Giving advice, making suggestions or providing solutions or providing solutions
- Persuading with logic, arguing, lecturing
- Telling people what they should do Telling
- Disagreeing, judging, criticizing or blaming
S: Summarizing: Special form of reflective listening that ensures clear communication and is used at transitions in conversation. Try to be concise and bring up the patient’s ambivalence/resistance to change.
- “Let me see if I understand thus far…”
The four (4) major tasks of the therapist
- Express Empathy
- Develop Discrepancy
- Roll with Resistance
- Support Self-efficacy
Examples of questions used in MI to motivate the patient, explore ambivalence, and minimize resistance
What are some of the good things about X behavior?
People usually do X because they feel it helps in some way. How has it helped you?
What do you like about the effects of X?
What would you miss if you weren’t doing X?
Can you tell me about the down side?
What are some aspects you are not so happy about?
What are the things you wouldn’t miss?
If you continued as before, how do you see yourself in a couple of years from now if you don’t change?
On a scale of 1-10, how important is it to you to change X behavior?
Why did you give it a higher # and not a (lower #) ?”
What would have to happen to raise that score from # to #