Motivational InterviewingRita Haverkamp, RNClinical Trainer, UW AIMS CenterPatrick Raue, PhDAssociate Director of Behavioral Interventions, UW AIMS Center

Social Innovation Fund (SIF) March 08, 2017

Objectives

• Discuss how motivational interviewing can beused in therapeutic work with patients

• Review core motivational interviewingstrategies

• Increase your ability to confidently usemotivational interviewing techniques in yourpractice

Behavioral Components

MI Umbrella

PhysicalActivation

PleasantEvents

ProblemSolving

Treatment

Reflective listening

SocialActivation

SubstanceAbuse

Treatment

Three Essential Elements of MI1. MI is a particular kind of conversation

about change2. MI is collaborative

– Not expert recipient– Patient centered– Partnership– Honors autonomy

3. MI is evocative– Seeks to call forth the person’s own motivation

and commitment

SIF Webinar: Motivational Interviewing March 8, 2017

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Motivational Interviewing (MI)• Collaborative, goal oriented style ofcommunication

• Pays attention to the patient’s language ofchange

• Strengthens personal motivation for andcommitment to a specific goal

• Elicits and explores a patient’s own reasonsfor change

• Atmosphere of acceptance and compassion

When MI Can Help

• Building a therapeutic relationship; engagement• Developing treatment goals• Resistance to treatment (behavioral or medical)• Ambivalence about a goal/change• Substance use/abuse• Relationship issues (in their lives)• We find ourselves judging or pushing for achange and resulting resistance of patient

Reflections

• In what ways has MI helped you work withpatients?

“Traditional” Approach

• People should WANT to change• They are either motivated or not• Now is the only time to change• I’m the expert and they should follow myadvice

• If people don’t change, treatment has failed• We do not accept the person where she/he isat

SIF Webinar: Motivational Interviewing March 8, 2017

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Interacting with the Patient

• Our pressure, persuasion, or directing tomove a patient forward triggers “reactance”– Patients protect their freedom – maintaining thestatus quo

• Motivation is a fluctuating state• Our interactions influence a patient’smotivation– Understand and resolve ambivalence

Stages of Change

• Pre contemplation– Not important; not confident– “I don’t have a problem with depression.”

• Contemplation–Maybe important; maybe confident– “Maybe talking would help.”

• Preparation– Important; becoming confident– “I need to do something different.”

Reflections

• Think of a time when you gave direct adviceto a patient before s/he was ready– What pulled you to try to move the patientforward in this way?

– How did the patient respond?–What did this indicate about the patient’s stageof change?

MI Processes

Planning

Evoking

Focusing

Engaging

Planning

Evoking

Focusing

Engaging

SIF Webinar: Motivational Interviewing March 8, 2017

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Process Engaging

• Making the obvious explicit;setting the stage;provider transparency

• Non judgmental• Respectful• Genuine• Empathetic• Building a therapeutic relationship

Planning

Evoking

Focusing

Engaging

Process Focusing• Strategically finding a topic

to discuss• Agenda matching

– Find out their concerns (“What would you liketo talk about today?”)

– Ask to discuss your agenda (“Would it be okayif we also talk about _____?”)

– Menu of options for discussion (“Of all thethings you’ve mentioned, what is mostimportant to you right now?”)

Planning

Evoking

Focusing

Engaging

Process – Evoking/Eliciting

• Pulling out the whole storyabout the issue from theperson’s perspective

• Eliciting and highlighting their Change Talk• Hallmark of MI: eliciting Change Talk• Where you put your energy

Planning

Evoking

Focusing

Engaging

• Always ask permission– “Could I share some information I have?”– “There’s something that concerns me. Could I sharemy thoughts?”

• Provide clear information or feedback– “What happens to some people is that . . .”– “The results of your tests suggest that . . .”

• Elicit their reaction– “What are your thoughts?”– Don’t argue, defend, interpret, or advise

Elicit, Provide, Elicit

SIF Webinar: Motivational Interviewing March 8, 2017

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Process Planning• Occurs when the person is

ready to make some change• Key Question:

– “What do you think you will do? What changes areyou considering? Where do you go from here?”

• Menu of options – Patients can:– Manage the behavior– Do nothing– Eliminate the behavior– Seek help

• Provider non judgmental stance

Planning

Evoking

Focusing

Engaging

Common MI Traps

Question – AnswerExpertScare

CheerleaderTaking sides

Information dumpingPouncing

Fix itPremature action planning

Try InsteadAvoidOpen ended questionsPartnershipAppropriate info givingTailored support for changeReflect, join in explorationLearn what’s relevantListen, help patient focusAvoid righting reflexCt centered appropriate plan

“Resistance”

• Resistance results from thepatient’s ambivalencebutting into the provider’s “righting reflex”

• Indicates a problem in interaction betweenprovider and patient

• Arguing against it just entrenches it• Change your approach

Rolling with Resistance

• Reflect – simply acknowledge it– Simple, amplified or double sided

• Shift focus – re direct attention to a moreworkable issue

• Autonomy – emphasize the patient makestheir own choices and is in control

• Reframe – acknowledge validity of patient’sviews but offer a new meaning for them

SIF Webinar: Motivational Interviewing March 8, 2017

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Reflections

• What ways have you “rolled with” or “rightedresistance? What works best for you?

Summary of MI CommunicationTechniques: OARS Model

O = Open ended questions

A = Affirmations

R = Reflective Listening

S = Summarizing

Behavioral Components

MI Umbrella

PhysicalActivation

PleasantEvents

ProblemSolving

Treatment

Reflective listening

SocialActivation

SubstanceAbuse

Treatment

Upcoming Case CallWednesday, April 12– 9:00 AM – 10:30 AM AKST– 10:00 AM – 11:30 AM PST– 11:00 AM – 12:30 PMMST

SIF Webinar: Motivational Interviewing March 8, 2017

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