Motivational Interviewing The Process of Change Gloria Sayler, Seattle, U.S. Communication Skills Teacher
Change • Think about a pt who is trying to make a change • Consider a change you tried to make • What helped, what didn’t?
Goals • Integrating Motivational Interviewing with Stages of Change theory • Understanding the process of behavior changes • Decreasing frustration for both pt and provider • Increasing effectiveness
Advice Giving • Works about 25% of the time • The key is timing – using it in a pt centered approach
The Nature of Change • Change is rarely a discrete, single event • Sometimes, after a crisis, a person will readily change
Stages of Change • Precontemplation – Pt is not interested or is deeply ambivalent • Contemplation – patient is considering a change • Change usually involves loss – in spite of the perceived gain
What is your role • Elicit, understand the behavior’s meaning • How are they thinking about the benefits and difficulties of changing X
Preparation • Preparing to make a change • Experiment with small steps • Elicit and provide information
Action • Pt starts making the changes in behavior more consistently • Encourage • Anything else ?
Maintenance • Keeping the change in behavior in place • Occasional “slips” • Discouragement • Encourage • Provide information
Dancing vs. Wrestling • Eliminates persecutor /victim roles • Enhances provider and pt empowerment/partnership
Elicit – Provide - Elicit • What do they know/Want to know? • What additional information can you provide? • Generate options • What do they /family/friends think about that? • Goals – what do you think will work?
Provider Blocks • Anxious for change we end up: • Lecturing – • Ask questions • Cheerleading • Acknowledging/eliciting
Patient Blocks • What is going to happen when you leave? • Resistance - argument: • quick summary// Identify and use discrepancies • Helplessness : • Acknowledging challenges/empathy; • Eliciting previous successes
Resources: • Miller WR and Rollnick: articles and books • “Stages of Change and 12 Problem Behaviors…” article • Motivational Interviewing (book) – preparing people to change Prochaska, et al: articles and books Changing for Good