Transcript Motivational Interviewing – Dr Annette Dunham
MOTIVATIONAL INTERVIEWING
AN EMPOWERMENT APPROACH Dr. Annette Dunham MAPS School of Psychology Deakin University [email protected]
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OVERVIEW
We will look at the principles and characteristics of Motivational Interviewing (MI) and discuss why MI is an empowerment approach.
We will look at two of the four key processes in MI: Engaging Focusing Evoking Planning With particular emphasis on the EVOKING phase We will practice some motivational interviewing skills.
CRICOS Provider Code: 0113B
“Health professionals should regularly advise obese patients about healthy living”. Dominion Post 09/06/14 CRICOS Provider Code: 0113B
“ Experts are trained to deliver prescriptions and advice, and they often work harder than we do trying to help us. But the expert approach actually lets us off the hook, sending the subtle message: ‘You aren’t in charge…’ When patients leave the clinic or office, they can and do veto recommendations a health professional makes”. (Glasgow & Anderson, 1999, pp. 2090-2092) CRICOS Provider Code: 0113B
WHY DO WE NEED TO ENCOURAGE CLIENT SELF-MANAGEMENT & AUTONOMY?
Burden of chronic disease Greater demands on health practitioners Need for models that empower clients to manage own condition Clients want to be autonomous CRICOS Provider Code: 0113B
THE ACTIVE SERVICE MODEL
HTTP://WWW.BAYSIDE.VIC.GOV.AU/COMMUNITY_SERVICES/SMR_ASM.HTM
Supported by five key principles:
1. People want to remain
autonomous
2. People have potential to improve their
capacity
3. People's needs should be viewed in a
holistic
way 4. HACC services should be organised around the
person
and carer; 5. A person's needs are best met where there are strong
partnerships
and
collaborative working relationships
providers between the person, their carers and family, support workers and service CRICOS Provider Code: 0113B
USING A COACHING APPROACH MOORE & TSCHANNEN-MORAN (2010)
• Accept the client where they are today • Guide clients towards building their self-efficacy • Help clients define a meaningful purpose for health and wellbeing • Ask clients to take charge –to take “the driver’s seat” in their own health management.
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COMPARING MODELS (ANDERSON & FUNNELL, 2005; BODENHEIMER ET AL., 2002)
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DEFINITION
(1) Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
(2) Motivational interviewing is a person centred counselling style for addressing the common problem of ambivalence about change.
Miller & Rollnick (2012, p.29)
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DEFINITION
(3) Motivational interviewing is a collaborative goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
Miller & Rollnick (2012, p.29)
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WHY MOTIVATIONAL INTERVIEWING?
Evidence based Relatively brief intervention Valid and reliable tools Complementary to other interventions and methods Skills can be applied by a wide range of health practitioners CRICOS Provider Code: 0113B
WHAT MAKES IT MOTIVATIONAL INTERVIEWING? 4 KEY PROCESSES MILLER & ROLLNICK (2012)
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THE “SPIRIT” OF MOTIVATIONAL INTERVIEWING
MILLER & ROLLNICK (2012) Collaboration Compassion Acceptance Evocation
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RESIST THE RIGHTING REFLEX
MILLER & ROLLNICK (2012)
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FIVE QUESTIONS
MILLER & ROLLNICK (2012, P.11)
1.
2.
3.
4.
5.
“Why would you want to make this change?” “How might you go about it in order to succeed?” “What are the three best reasons for you to do it?” “How important is it for you to make this change and why?
“So what do you think you’ll do?” CRICOS Provider Code: 0113B
ENGAGING: OARS
MILLER & ROLLNICK (2012)
•
O
pen Questions •
A
ffirmation •
R
eflection •
S
ummaries
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FOCUSING
MILLER & ROLLNICK (2012)
1.
“I know where we’re going, the focus is clear.” – Move to next steps: the evoking and planning processes 2.
“There are several options - we need to decide.” – Work with client to identify possibilities and priorities – Agenda mapping may be useful with multi-issues 3.
“The focus is unclear and we need to explore” – Use core skills to help client move from general to specific, e.g. OARS CRICOS Provider Code: 0113B
AGENDA MAPPING
MILLER & ROLLNICK (2012)
Improve my diet Get more exercise Improve my mood Lose weight Stop smoking Manage my medication Cut down drinking CRICOS Provider Code: 0113B
CHANGE AND SUSTAIN TALK
MILLER & ROLLNICK (2012)
Not Changing
Benefits:
SUSTAIN TALK
Costs:
CHANGE TALK
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Changing
Benefits:
CHANGE TALK
Costs:
SUSTAIN TALK
EVOKING CHANGE TALK: DARN CATS
MILLER & ROLLNICK (2012) Preparatory: D
esire to change (want, like, wish…)
A
bility to change (can, could…)
R
easons to change (If……then…….)
N
eed to change (need, have to, got to…)
Mobilising: C
ommitment (Intention, decision, promise)
A
ctivation (willing, ready, preparing)
T
aking
S
teps (doing) CRICOS Provider Code: 0113B
EVOKING CHANGE TALK
MILLER & ROLLNICK (2012) Desire: “
How would you like things to change?” “What do you hope our work will accomplish?”
Ability: “
How might you do it?” “How confident are you that you could…?”
Reasons:
“What might be the best reasons for…?” “What might be good about quitting?”
Need:
“How important is it that you change?” “What do you think
has
to change?” CRICOS Provider Code: 0113B
Evoking Change Talk
Miller & Rollnick (2012) IMPORTANCE RULER:
HOW IMPORTANT IS THE CHANGE?
(1= NOT IMPORTANT; 10= EXTREMELY IMPORTANT) 1 2 3 4 5 6 7 8 9 10 CRICOS Provider Code: 0113B
EVOKING: SNATCHING CHANGE TALK OUT OF THE JAWS OF AMBIVALENCE MILLER & ROLLNICK (2012)
•Change talk is often inter-twined with sustain talk… •Show preferential reflection of change talk CRICOS Provider Code: 0113B
CHANGE TALK OUT OF AMBIVALENCE
I really need to start having a regular walk to help maintain my weight, but I hate the thought of having to get up early to do it.
1.
You really don’t want to be bothered getting up early.
2. You understand that you need to increase your exercise level to be healthy.
3.
You don’t think that you could keep this exercise going.
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Evoking Confidence
Miller & Rollnick (2012) CONFIDENCE RULER:
HOW CONFIDENT ARE YOU THAT YOU CAN MAKE THIS CHANGE? (1= NOT CONFIDENT AT ALL; 10 = EXTREMELY CONFIDENT) 1 2 3 4 5 6 7 8 9 10 CRICOS Provider Code: 0113B
RAISING CHALLENGES AND PROBLEMS
MILLER & ROLLNICK (2012)
• “What might you do if…?” • “How could you respond if…?” • “What do you think would happen if…?” CRICOS Provider Code: 0113B
RECOGNISING READINESS
MILLER & ROLLNICK (2012)
•Diminished sustain talk •Resolve •Increased change talk •Questions about change •Envisioning •Taking steps Time for planning when: • Sufficient engagement • A clear shared change goal • Sufficient client motivation for change CRICOS Provider Code: 0113B
EVOKING A CHANGE PLAN
MILLER & ROLLNICK (2012)
•Setting goals •Considering change options •Arriving at a plan •Strengthening confidence •Eliciting confidence CRICOS Provider Code: 0113B
WHAT MAKES IT MOTIVATIONAL INTERVIEWING? 4 KEY PROCESSES MILLER & ROLLNICK (2012)
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REFERENCES
Anderson, B., & Funnell, M. (2005).
The Art of Empowerment
(2 nd ed.). Alexandria, Virginia: American Diabetes Association.
Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care.
Journal of the American Medical Association, 288:19
, pp.2469-2475.
Miller, W. & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3 rd ed.). New York, NY: Guildford Press Moore, M., & Tschannen-Moran, B. (2010). Coaching psychology manual. Philadelphia, PA: Lippincott, Williams & Wilkins.
CRICOS Provider Code: 0113B