Communication

MOTIVATIONAL INTERVIEWING

STYLE

“MI can help providers connect with their patients, one cannot help but to feel

empowered to change behavior.Pam Burke, PhD, RN

“As information technology relentlessly invades the realm of patient care, we find ourselves w/ less time to communicate with and teach our patients, so the time we do have must be optimize. Registered Nurse

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Top Stressors and Challenges

1- _________________________________

2- _________________________________

3- _________________________________

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Purpose

To introduce motivational interviewing as an evidence-based communication style for enhancing participation, compliance, and healthy lifestyle change

C-O-O

Communication that Optimizes Outcomes

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Objectives1. Examine the efficacy and effectiveness of motivational

interviewing in creating an environment that promotes compliance, participation, follow through, and change readiness

2. Learn the essentials of Motivational Interviewing Spirit

3. Identify the core principles and strategies of

Motivational Interviewing

4. Analyze three core communication styles and skills

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Research and Efficacy• Tremendous impact on science and service in

substance abuse, mental health, and health care

• Gold stamp of approval – 100’s of Randomized Clinical Trials

medication adherence, health and lifestyle change

• Effective compared to other intervention styles-educational, persuasive, instructive.

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Taste of Motivational Interviewing* 7

Motivational Interviewing

MI is a person-centered, provider-guided

method for enhancing intrinsic motivation to

change by exploring and resolving ambivalence

Miller and Rollnick 2002

Ambivalence and Resistance

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Normal Human Reactions to the Righting Reflex (Teach/Direct)

Invalidated Resist Withdraw

Not respected Arguing Disengaged

Not understood Discounting Disliking

Not heard Defensive Inattentive

Angry Oppositional Passive

Ashamed Denying Avoid/leave

Uncomfortable Delaying Not return

Unable to change Justifying

Normal Human Response to Listening/Evoking/Empathic Style

Affirmed

Understood

Accepted

Respected

Heard Comfortable

Safe

Empowered

Hopeful

Accepted

Open

Un-defensive

Interested

Cooperative

Listening

Approach

Talk more

Liking

Welcoming

Engaged

Activated

Come Back

Able to Change© Pathways to Empowerment

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Motivational Interviewing Spirit

“We believe it is vital to distinguish

between the spirit of motivational

interviewing and techniques that we

have recommended to manifest that spirit”

Dr. Miller, Founder, Author

MI Spirit A-C-E

• Autonomy

• Collaboration

• Evocation

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Autonomy

Dictionary definition• Right or state of self government• Freedom to determine one’s own actions,

behaviors• Right and pursuit of/by self determination

High in Autonomy/Support• Ensure, directly or indirectly, that the topic of

choice and control is raised• View the person as having the potential to

move in the direction of health• Helps person recognize choices• May explicitly acknowledge the person has the

choice to change or maintain the status quo• May express an optimism about the person’s

ability to change.

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Collaborate

• To work one with another, cooperate (usually willingly)

• Join, collude, assist

Implies mutuality interests

High in Collaboration• Work cooperatively with the person toward the goals of

the session

• Do not rely on dominance, expertise, or authority to achieve progress

• Are curious about person’s ideas and are willing to be influenced by them

• Can hold the reins on their own expertise, using it strategically and not before the person is ready to receive it

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Evocation

• Call forth, call up, call out

• Bring out

• Produce

Patient-language, conversation, dialogue (relevant to exploring problem, needs, intent)

High in Evocation• Are curious about persons’ ideas on why change

may or may not be good for them

• Actively seeks to learn about these ideas

• May provide information, but don’t rely on it as a means of “helping” the person to change

• Actively creates opportunity for the person to engage in their own language in favor of change

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MI Principles D-E-R-S

• Developing Discrepancy

• Expressing Empathy

• Roll with Resistance

• Support Self Efficacy

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Resistance

• Natural response to ambivalence• Natural response to teaching, telling, advice

giving, arm twisting• Natural response to disagreement,

defensiveness• Behavioral• Interpersonal- It takes two• Creates a wrestling, rebellious dynamic

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MI Strategies O-A-R-S

• Open Ended Questions

• Affirmations

• Reflections

• Summaries

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A Continuum of Styles

Directing <=> Guiding <=> Following

A Continuum of Styles

Directing <=> Guiding <=> Following

Behavior therapyCognitive therapyReality therapyDr. Phil

Motivational interviewingSolution-focused therapy

Psychodynamic psychotherapyClient-centered therapy

A Continuum of Styles

Directing <=> Guiding <=> Following

Prochaska and DiClemente’s Cycle of Change

Pre-Contemplation

Contemplation

PreparationAction

Maintenance

Relapse

Not considering Change. Having fun!

Determined to Change;Formulating the Plan

Change Started (3-9 months)

ConsciousnessRaising

Ambivalent

Provide OptionsPractical Strategies

Develop DiscrepancyConsolidation (1-2 yrs)

Back to the Behavior!

Relapse Prevention

Avoid Demoralization

“Our job is to facilitate the birth of internal motivation

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Metaphor

• Revolving door at the airport or department store.

• If you push the revolving door it locks

“Do not push, the door will lock”

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How does Motivational Interviewing reduce Your take home stress?

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References

• Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations AJN, American Journal of Nursing, October 2007

• Motivational Interviewing in Nursing Practice: Empowering the Patient Michelle A. Dart, MSN, PNP, CDE

• Nursingcenter.com

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Thank you for your participation

Debra Neal dneal@pathwaystoempowerment.net

(816) 805-0732

www.pathwaystoempowerment.net

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