Motivational Interviewing: Helping People Change
Jerica Berge, Ph.D., MPH, LMFTAssistant ProfessorDepartment of Family Medicine and Community Health University of [email protected]
Disclosure Statement
I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity.
Motivational Interviewing
PREPARINGPEOPLE
FOR CHANGE
Ambivalence
The Dilemma of Change
Ambivalence
State of having simultaneous, conflicting feelings:Mixed Feelings UncertaintyIndecisiveness
Consequences of Ambivalence
The result of being in a state of ambivalence can lead to avoidance or procrastination
OR…to deliberate attempts to resolve the ambivalence that may result in success or failure
Ambivalence Ambivalence about proposed behavior
change is NORMAL
Direct persuasion or advice giving is NOT an effective method for resolving ambivalence for most patients
The Righting Reflex
Our desire to keep people from going down the wrong path, and to set things aright
Righting Reflex vs. Ambivalence
Advice Regarding Health Behavior Change
We like to give itWe’ve been trained to give itIt’s not very effective We do it anyway
http://www.youtube.com/watch?v=80XyNE89eCs
Bad Example MI
“Motivation to change is not a personality trait, but is affected by interpersonal interaction”
Miller & Rollnick, 1991
Express empathy
Develop discrepancy
Roll with resistance and avoid argumentation
Support self-efficacy
Four key principles
http://www.youtube.com/watch?v=URiKA7CKtfc
Good Example of MI
What You Can’t Do with MI
Ex. With a parent of a child who is overweight
In one given interaction you probably CANNOT: Get the parent to totally change both the child’s
eating AND exercise habits Get the parent to change both the home food
environment AND physical activity environment
What You Can Do with MIYou probably CAN: Assess readiness for change Engage with the parent so that she sees you as someone who would be willing to help if and when she wants help
Use reflective listening to encourage the parent to consider even a small step toward change
Plant the seed for behavior change by using the “confidence ruler” technique