Motivational InterviewingSession 1: The Spirit of MI

Stephen R. Andrew, LCSW LADC CCS

Engaging PatientsAttitudes and behaviors

What you’ve done or witnessed

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

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

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

What is listening?Focus all purpose, attention, and energy on understanding

What is the person experiencing right now?

Hearing what they are NOT

saying

Five General Principles

Express accurate empathy

Amplify ambivalence

Avoid arguments

Support self-efficacy

Roll with resistance

*Power/Control*Connection

What People Seek/Need

Imagine...

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

The Skills “OARS”

O = open-ended questions

A = affirm

R = reflection

S = summarize

Amplify Ambivalence

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

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.

“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?”

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’?”

What is this patient telling you?

How will you respond?

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!