Successful Behavior Change through

Motivational Interviewing

Brevard Health Alliance

Presentation Overview Clients and Change Motivational Interviewing: Principles Clinical Applications Overcoming Obstacles Stages of Change

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Your Experience with Patients & Behavior Change

What have been your experiences with patients and their expectations of treatment related to behavior changes?

How do you typically approach this topic?

Do you think that our patients that don’t change are just unmotivated?

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Why DON’T People Change? (INSERT EXCUSES) – Comfort, defense,

habit, it has worked in the past

How do you respond to these excuses?-Normalize excuses and explain we all do things that are bad for us

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Why Do People Change? Individuals change voluntarily when

they… Become interested in/concerned

about need for change Become convinced that change is best

option in cost-benefit analysis Organize a plan of action that they are

committed to implementing Take necessary actions to make and

sustain change

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Stages of Change

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What is Motivational Interviewing?

“…a method of communication rather than a set of techniques. It is not a bag of tricks for getting people to do what they don’t want to do; rather, it is a fundamental way of being with & for people – a facilitative approach to communication that evokes change” (Miller & Rollnick 2002)

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More on Motivational Interviewing… Clinical style that elicits patient’s own

motivations for behavior change into action. Collaborative: working with the patient to

decide importance of behavior change. Evocative: activate skills, motivation, and

resources for change. Honoring patient autonomy: acceptance

of choices made by our patients. Goal-oriented: moves toward a particular

goal and develops discrepancy between person’s current behavior and what their goals/values are.

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Four General Principles of MI1. Express Empathy2. Develop discrepancy3. Support self-efficacy4. Roll with resistance

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Principle 1: Express Empathy

Listen actively with the goal of understanding patient’s motives.

Use open-ended questions, reflections, and brief summaries of what patient says.

Resist the righting reflex! Acceptance facilitates change.

Ambivalence is normal.

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Ambivalence “I want to, and I don’t want to” Passing through ambivalence is a natural phase

in the process of change. Ambivalence is a reasonable place to visit but

you wouldn’t want to live there. As the provider, we can empathize with &

reflect back this ambivalence!

RESISTANCE AMBIVALENCE MOTIVATION

COMPONENTS of CHANGE

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Principle 2: Develop Discrepancy Motivation for change occurs when

people perceive a discrepancy between where they are and where they want to be.

Values and beliefs are key factors. The patient rather than the practitioner

should make the arguments for change.

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Questions to Assess Motivation and Develop

Discrepancy

Desire: What do you want, like, wish, hope, etc?

Ability: What is possible? What can or could you do? What are you able to do?

Reasons: Why would you make this change? What would be some specific benefits? What risks would you like to decrease?

Need: How important is this change? How much do you need to do it?

D

A

R

N

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Principle 3: Support Self-Efficacy

A person's belief in the possibility of change is an important motivator.

The patient, not the practitioner, is responsible for choosing and carrying out change.

The practitioner's own belief in the person’s ability to change becomes a self-fulfilling prophecy.

Practitioner plays the role of “Guide” instead of “Director”

Utilize positive affirmations, crediting person for action, values, or traits!

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Informing Within MI while preserving Self-Efficacy Ask permission to discuss necessary behavior

change “May I talk to you about the health risks

associated with your diabetes?” Talk about what others do

“Some patients in your situations reduce their intake of fatty foods, others tackle their smoking. I wonder what makes more sense to you”

Offer choices “…these strategies could all benefit your

health. What makes most sense to you right now?”

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Listening for Commitment Listen to patient’s words to determine what the

patient is… READY

WILLING& ABLE

to do regarding health behavior change! Give the patient ample opportunity to arrive at

the point of commitment Reinforce language about making healthy

changes

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Principle 4: Roll with Resistance Avoid arguing for change (Resist the righting

reflex!) The patient is the primary resource in

finding answers and solutions. New perspectives from the patient are invited and not directly opposed. Find out more information from them instead of providing them information.

Resistance is a signal to respond differently. Reluctance and ambivalence are to be

acknowledged (and even respected) and not confronted directly.

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Overcoming Patient Obstacles

“ I can’t see why I need to change” (DENIAL) Use listening to unlock underlying issues can lay path

to behavior change

“I can see what you mean but…” Use patience and acceptance of this seemingly

irrational process

“Just tell me what you think I should do” Offer 1+ suggestions and use a guiding question to

check if it makes sense to patient, i.e., “How will this work for you”

“I really can’t cope at all” Convey your understanding through reflective

listening

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Overcoming Practitioner Obstacles

Strive for awareness of your feelings and moods

Keep both your aspirations and the patient’s aspirations in mind

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Common Practitioner Traps… Directing patient behavior Persuading too hard Rescuing the patient Overloading the patient with

information

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In Summary… Listen to the patient Communicate understanding Guide more than direct Respect autonomy Align your aspirations with that of the

patient Listen for, encourage, and reinforce

language about change

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Questions? Any questions, comments or concerns

you would like addressed?

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