Motivational Interviewing:  Helping People Change
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Motivational Interviewing: Helping People Change. Jerica Berge, Ph.D., MPH, LMFT Assistant Professor Department of Family Medicine and Community Health University of Minnesota [email protected] Disclosure Statement.

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Motivational interviewing helping people change

Motivational Interviewing: Helping People Change

Jerica Berge, Ph.D., MPH, LMFT

Assistant Professor

Department of Family Medicine and Community Health

University of Minnesota

[email protected]


Disclosure statement

Disclosure Statement

I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity.


Motivational interviewing

Motivational Interviewing

PREPARING

PEOPLE

FOR

CHANGE


Ambivalence

Ambivalence

The Dilemma of Change


Ambivalence1

Ambivalence

  • State of having simultaneous, conflicting feelings:

    • Mixed Feelings

    • Uncertainty

    • Indecisiveness


Consequences of ambivalence

Consequences of Ambivalence

  • The result of being in a state of ambivalence can lead to avoidance or procrastination

  • OR…to deliberate attempts to resolve the ambivalence that may result in success or failure


Ambivalence2

Ambivalence

  • Ambivalence about proposed behavior change is NORMAL

  • Direct persuasion or advice giving is NOT an effective method for resolving ambivalence for most patients


The righting reflex

The Righting Reflex

Our desire to keep people from going down the wrong path, and to set things aright


Motivational interviewing helping people change

Righting Reflex vs. Ambivalence


Advice regarding health behavior change

Advice Regarding Health Behavior Change

  • We like to give it

  • We’ve been trained to give it

  • It’s not very effective

  • We do it anyway


Bad example mi

Bad Example MI

http://www.youtube.com/watch?v=80XyNE89eCs


Motivational interviewing helping people change

“Motivation to change is not a personality trait, but is affected by interpersonal interaction”

Miller & Rollnick, 1991


Four key principles

Four key principles

  • Express empathy

  • Develop discrepancy

  • Roll with resistance and avoid argumentation

  • Support self-efficacy


Good example of mi

Good Example of MI

http://www.youtube.com/watch?v=URiKA7CKtfc


What you can t do with mi

What You Can’t Do with MI

Ex. With a parent of a child who is overweight

  • In one given interaction you probably CANNOT:

    • Get the parent to totally change both the child’s eating AND exercise habits

    • Get the parent to change both the home food environment AND physical activity environment


What you can do with mi

What You Can Do with MI

You probably CAN:

  • Assess readiness for change

  • Engage with the parent so that she sees you as someone who would be willing to help if and when she wants help

  • Use reflective listening to encourage the parent to consider even a small step toward change

  • Plant the seed for behavior change by using the “confidence ruler” technique


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