Motivational Interviewing for Behavior Change

March 13, 2015

Pam Pietruszewski, MA

Integrated Health Consultant

National Council for Behavioral Health

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My own motivation level:

A. Is always rock bottom low

B. Goes up and down depending on the day, circumstances, etc.

C. Is always sky high

Polling question #1

Motivational interviewing is a

collaborative, person-centered, guiding method designed to elicit and strengthen

motivation for change.

Miller & Rollnick, 2012

Miller & Rollnick, 2009

MI is not….

• A way of tricking people into doing what you want them to do

• A specific technique• Problem solving or skill building• Just client-centered therapy• Easy to apply• A remedy for every clinical challenge

What do we know with reasonable confidence about MI?

• MI improves treatment retention, adherence, and outcomes across a range of behaviors

• Outcomes vary widely across providers, programs, and research sites

• MI skill is reliably measurable and predicts better outcomes

• MI generalizes fairly well across cultures• Therapeutic relationship matters

The Continuum

Directing Guiding Following

Behavioral Therapy Cognitive TherapyReality Therapy

Motivational InterviewingSolution-focused therapy

Psychodynamic psychotherapy Client-centered therapy

Informing -------------------- Asking ------------------------- Listening

4 Fundamental Processes

Engaging

Focusing

Evoking

Planning

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EngagingFocusing

EvokingPlanning

MI Spirit

Partnership

Evocation

Compassion

Acceptance

MI Spirit

Partnership

Evocation

Compassion

Acceptance

Evocation

Autonomy

EngagingFocusing

EvokingPlanning

Open-ended inquiry

• Not fact-finding• Not yes/no or brief answer

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• Anticipate response• Ask for examples & elaboration• How…What…Tell me…

Tell me about the role smoking has in your life.How are you taking your medication?

Polling question #2

Which of the following is the an example of open-ended inquiry?

A. How many cigarettes do you smoke per day?

B. What concerns you about your smoking?

C. Do you want to quit smoking?

D. I really recommend you quit all tobacco use. Ok?

Affirmations

• Supportive, encouraging statements• Genuine, direct reinforcements• Demonstrate understanding

You are very committed to your grandchildren.You’ve found creative ways to fit in exercise.

EngagingFocusing

EvokingPlanning

Sustain Talk

Change Talk

Ambivalence

Amount of change talk is more predictive than amount of readiness.

Preparatory Commitment

Desire - Ability - Reasons - Need - Commitment - Action - Taking Steps

Darren

When the doctor said I had high blood pressure, I couldn’t believe it! I want to feel better but I’m not quitting smoking.

Can’t I just cut out fried foods or something else? I’ve dieted before, so I can do it again.

• You want to feel better.

• You’re surprised by the results.

• While you don’t want to quit smoking, you are open to making some changes.

Reflections When the doctor said I had high blood pressure, I couldn’t believe it! I want to feel better but I’m not quitting smoking. Can’t I just cut out fried foods or something else? I’ve dieted before, so I can do it again.

Polling question #3“I don’t have time for patches and pills and support groups. My wife nags me about it and I know I have to do it at some point. I just don’t want to deal with it right now.”

Which reflection best elicits change talk?

A. You know you need to make some changes.

B. You are a busy man.

C. Your wife is a nag.

EngagingFocusing

EvokingPlanning

Is your client with you?

• What would be good about…?• What else have you been thinking about?• How might you make the best of it?• What keeps you going?• What could you do differently?• So where does this leave you now?• What is your next step?

Decisional Balance Tool

Good Not so good

No change

Change

1 2

4 3

EngagingFocusing

EvokingPlanning

People often say that motivation doesn’t last. Well, neither does bathing – that’s why

we recommend it daily.

– Zig Ziglar

How do clinicians best learn MI?

• “One-shot” trainings don’t create competence (Miller & Mount, 2001; Walters et al., 2005)

• Workshops + feedback + coaching most likely combination to significantly and substantially change patient’s change talk (Miller, 2013)

Questions?

MI Training Opportunities

Pam Pietruszewski: pamp@thenationalcouncil.orgDawn Tenia: dawnt@thenationalcouncil.org

http://www.thenationalcouncil.org/areas-of-expertise/motivational-interviewing/

Introduction (1-2 hrs)

Strategies for Behavior Change (4-8 hrs)

Building Competency Workshop (Two days)

Proficiency through Coaching & Feedback

Upcoming Webinars

• April 7th, 2:00-3:30pm – Tobacco Cessation • May (exact date TBD) – Alcohol & SBIRT

Register at www.nationalcouncil.org/conference

Exclusive GTAC discount! Enter: GTAC200