Transforming Health an Inside Job: Using Motivational Interviewing to Build Health Momentum
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1 Transforming Health an Inside Job: Using Motivational Interviewing to Build Health Momentum Paul Warren, LMSW Deputy Executive Director, Director, Training Institute NDRI-USA, Inc., 71 West 23 rd Street, New York, NY 10010
2 Disclosures None to report
3 Goal To familiarize participants with Motivational Interviewing (MI), an evidence based practice, developed and refined to promote behavior change. To explore the application of this practice and how it can be used to identify and strengthen intrinsic motivation to change behaviors such as: high risk sexual activity, substance use and medication adherence.
4 Learning Objectives o State the difference between directional and directive counseling o Demonstrate the process of Focusing and the mutual development of a Change Goal o List at least four Discord Evoking, MI incongruent styles of interaction
5 Introductions o First name o Prior MI training, Yes or No o On a scale of 1 10, how important to use MI in your work?
6 Uncertainty or fluctuation, especially when caused by inability to make a choice or by a simultaneous desire to say or do two opposite or conflicting things. 6
7 MI Definition A client-centered, guiding method of communication & counseling to elicit and strengthen intrinsic motivation for change by exploring and resolving ambivalence. Primary goals include: o o o o Minimize resistance (Sustain Talk & Discord) Elicit change talk Explore and resolve ambivalence Nurture hope & confidence
8 Origins Therapist Effects Therapist empathy during treatment predicted a surprising two-thirds of the variance in client drinking 6 months later (r =.82, p <.0001). Even 12 and 24 months after treatment, counselor empathy continued to account for one-half (r =.71) and one-quarter (r =.51) of the variance in behavioral outcomes, respectively (Miller & Baca, 1983) A Clinical Style An unanticipated product of interacting with a group of colleagues there. He had been invited to lecture on behavioral treatment for alcohol problems, and also was asked to meet regularly with a group of young psychologists. Am Psychol September; 64(6):
9 Carl Rogers, American Psychologist Influenced the development of MI Rogerian Theory of client-centered counseling rs.html Rogers' requirements of the therapist in order to be effective, must have three very special qualities: 1. Congruence genuineness, honesty with the client 2. Empathy the ability to feel what the client feels 3. Respect acceptance, unconditional positive regard towards the client
10 Transtheoretical Model of Change Prochaska & DiClemente
11 The Paradox of Change When a person feels accepted for who they are & what they do, no matter how unhealthy, it allows them the freedom to consider change rather than needing to defend against it.
12 William Miller, PhD & Stephen Rollnick, PhD o Motivational interviewing was developed in the late 1980s by William Miller, PhD and Stephen Rollnick, PhD. They published Motivational Interviewing: Preparing People for Change in o Miller, WR, & Rollnick, S (2002). Motivational Interviewing: Preparing People for Change 2nd ed., New York: Guilford Press. o Miller, WR, & Rollnick, S (2012). Motivational Interviewing: Helping People Change 3rd ed., New York: Guilford Press.
13 Michelangelo Belief David within the stone The capacity and potential for change & adherence is within every client
14 Miller & Moyers, 2006 People possess substantial personal expertise and wisdom regarding themselves and tend to develop in a positive direction, given the proper conditions and support.
15 Helpful People - Activity When you needed & received help, what did they say and do? Small group discussion, focused on what they said and did, NOT why you needed help Develop list
16 Why DO People Change?
17 Dancing vs. Wrestling o Tapping vs. Pulling o Eliciting vs. Imparting o Consulting vs. Instructing o Guiding vs. Directing
18 Direction Language o o o Directing - as a counseling behavior Direction - as goal-oriented Directional - rather than DIRECTIVE
19 MI sometimes described as a way of helping people talk themselves into changing
20 30 Years of Research o Evidence-based >200 clinical trials o Relatively brief o Specifiable (but be careful with manuals) o Grounded in a testable theory o With specifiable mechanisms of action o Verifiable Is it being delivered properly? o Generalizable across problem areas o Complementary to other treatment methods o Learnable by a broad range of providers
21 The Elements o MI Spirit o MI Processes o OARS o Change Talk
22 MI Spirit 22
23 Four Processes of MI 1 Engaging Establish helpful connection & working relationship Focusing Particular agenda the client came to discuss Evoking Client s own motivation for change Planning Developing commitment to change, forming specific plan of action
24 24
25 Focusing - Activity Focusing Particular agenda the client came to discuss Review Steps next slide Follow trainers instructions
26 Focusing Steps 1. Acknowledge your own agenda: I d like to talk about how things are going with taking your blood pressure medication 2. Find out what matters to the patient: and I would also like to know what is on your mind today relating to your health or your medications 3. Use a menu of options to explore possible focus areas: some key areas we ve identified to discuss are your concerns about your food assistance, your questions about your foot and the thing about your blood pressure medication 4. Agree upon an agenda for your time together: we have about 15 minutes to talk today, would it be ok if we start with either your foot or your questions about food assistance and also be sure to keep enough time to check in on how you are doing with you blood pressures meds?
27 OARS (CORE Skills) O Open ended questions A Affirmations R Reflective listening S Summarizing listening Motivational Interviewing: Helping People Change 3 rd Ed. (Miller & Rollnick)
28
29 Change Talk continued Any speech that favors movement in the direction of change, linked to a particular behavior change target. Previously called self-motivational statements (Miller & Rollnick, 1991)
30
31 Roadblocks to Listening Giving information Giving advice Giving solutions Giving logical reasoning Asking questions Reassuring, Agreeing Praising Telling people what to do Warning Changing the subject Interpreting Analyzing Withdrawing Humoring Judging Shaming Labeling Blaming Threatening
32 Sustain Talk Any speech that favors maintaining the status quo (behavior).
33 Discord Sustain Talk - about target behavior I really don t want to stop smoking I have to have my pills to make it through the day Resistance - about your relationship You can t make me quit You don t understand how hard it is for me Both are highly responsive to interactive style
34 Discord Evoking Interactive Styles Confronting - Showing the way Pressuring Persuading - Taking charge Criticizing Nagging - Directing - Scaring Interrupting - Talking down to - Rescuing Ordering - Shaming - Judging Exerting authority - Scolding
35 Productive Responses to Discord o Breathe o o Manage your own reaction Use simple reflections if you are feeling flustered o Resistance takes energy to sustain o Support autonomy & personal choice o o It s up to you what to do when you leave here today. It s always your choice to make o Shift focus o o Open-ended questions Collaborative agenda mapping
36 Thank You Please fill out the evaluation Paul Warren, LMSW Deputy Executive Director, NDRI-USA; Director, Training Institute; Training Director, NeC-ATTC Northeast & Caribbean Addiction Technology Transfer Center (NeC-ATTC) National Development & Research Institutes, Inc. (NDRI) NDRI-USA, Training Institute 71 W 23rd Street, 4th Floor New York, NY warren@ndri.org
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