Motivational Interviewing: Nuts and Bolts
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Transcript of Motivational Interviewing: Nuts and Bolts
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Motivational InterviewingSession 1: The Spirit of MI
Stephen R. Andrew, LCSW LADC CCS
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Engaging PatientsAttitudes and behaviors
What you’ve done or witnessed
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MI: What is it?
Definition: Motivational interviewing is a collaborative, person-centered evidence-based, guiding method of communication for enhancing and strengthening intrinsic motivation for change.
Spirit: Collaboration, Autonomy, Respect, Compassion
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Motivational Interviewing...
assumes motivation is fluid and can be influenced
motivation is influenced in context of a relationship
principle task: to guide conversation towards eliciting motivation for change
goal: to influence change in the direction of health
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Communication is hard...
Here are the places it can break down.
Speaker Listener
1. What the speaker means
2. What the speaker says
3. What the listener hears
4. What the listener thinks the speaker
means
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What is listening?Focus all purpose, attention, and energy on understanding
What is the person experiencing right now?
Hearing what they are NOT
saying
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Five General Principles
Express accurate empathy
Amplify ambivalence
Avoid arguments
Support self-efficacy
Roll with resistance
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*Power/Control*Connection
What People Seek/Need
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Imagine...
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Motivational Interviewing Process:
The Structure
Ambivalence
Ambivalence
CHANGE TALKDesireAbilityReasonNeed
CHANGE TALKDesireAbilityReasonNeed
COMMITMENT LANGUAGE
COMMITMENT LANGUAGE CHANGE
BEHAVIORTOWARDS
and/or HEATLH
CHANGE BEHAVIORTOWARDS
and/or HEATLH
IncreasIncreasee
desiresdesires
ObservObservee
NoticeNotice
1
LowerLower
10
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The Skills “OARS”
O = open-ended questions
A = affirm
R = reflection
S = summarize
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Amplify Ambivalence
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The Accuracy Function of Reflection
Speaker Listener
1. What the speaker means
2. What the speaker says
3. What the listener hears
4. What the listener thinks the speaker
means
Bridge the gap byreflection
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The Case53 year-old male came to clinic one week ago for concern of high blood pressure reading at work. He presents now for follow up and BP is in control.
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“Now that we have a plan to manage your blood pressure, Mr. Jones, I wonder if I can talk with you about some preventive health care. Specifically, I wanted to mention some recommendations for all patients over age 50 to undergo colon cancer screening. Would it be okay with you to talk a little about this today?”
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Jones: “ Geez, doc, like I said, I only came in ‘cause my wife made me after that nurse at work got that abnormal blood pressure reading. I’m not here for the works. You know what I’m say-in’?”
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What is this patient telling you?
How will you respond?
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Next Steps
We’ll teleport up to two sky platforms in order to practice your MI technique
Click on your assigned color (red or blue) teleport device, to the left or right of the screen
See you at 300 meters!