“A client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” – Miller & Rollnick, 2002

Basic Concept/Idea behind motivational interviewing: “Helping people talk themselves into changing”

Basics of Motivational Interviewing (MI):

• A model to describe how people change
• Identifies a client’s own fears and difficulties about change and helps to resolve the issues
• Not just a series of techniques for doing therapy but instead is a way of being with patients.
• Not a technique for tricking your patients into doing something that they do not want to do
• Skillful clinical style for eliciting from patients their own good motivation for making changes and identifying patients’ ambivalence about change and helping to resolve it
• Guiding more than directing, eliciting more than imparting and listening at least as much as telling

Theoretical Foundations of MI

• Client-centered therapy (Carl Rogers)
• Self-efficacy (Albert Bandura)
• Transtheoretical model (Prochaska & DiClemente)

Guiding Principles

• Resist the “righting” reflex
• Understand and explore the patients own motivation
• Listen with empathy
• Empower and instill hope and optimism

Why use MI?

• Evidence-based – it works!
• Effective across populations and cultures
• Improves adherence and retention in care by actively involving individuals in their own care
• Reduces clinician burnout: Promotes healthy “helping” role for clinicians

Motivation

• Motivation is multidimensional, dynamic, has external and internal factors, and is the Key to change
• Motivation can be elicited and enhanced and assess the state of readiness
• Two important dimensions of Motivation:
  • Importance: the “why” of change
  • Confidence: the “how” of change

Components of Motivation:

1. Ready: a matter of priorities
2. Willing: importance of change
3. Able: confidence to change

The ABCs of Motivation and change

1. Accept: Patient must accept that the behavior is a problem
2. Believe: Patient must believe that they will be better off if they change
3. Confidence: Patient must have confidence in their ability to change

6 Stages of Change

1. Precontemplation: No way. (Denial)
2. Contemplation: Maybe I can do this. (Ambivalence)
3. Determination/Preparation: Let’s do this! (Motivated)
4. Action: Doing it.
5. Maintenance: Living it
6. Relapse/Recycle: Ugh!! Back to 1…

Basic Tool: OARS

O: Open-ended Questions: Encourages patient to talk more and for provider to learn more about 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: Statements that show recognition of patient’s strengths

• “So you’ve started walking this past week!”
• “You didn’t want to come today, but you did!”

R: Reflective Listening: 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

• Ensures clear communication
• Use at transitions in conversation
• Be concise
• Reflect ambivalence
• Accentuate “change talk”
• “Let me see if I understand thus far…”

Principles of Motivational Interviewing:

1. Express Empathy
2. Develop Discrepancy
3. Roll with Resistance
4. Support Self-efficacy

Examples of questions used in MI to encourage patient (not provider), 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 #
• “How might I help you with that?”