Motivational Interviewing

Introduction:

Rather than seeing patients as resistant, the assumption in MI is that it is normal for patients to be ambivalent, therefore representing an opportunity. An opportunity exists because ambivalence indicates that while a person may have some hesitation about change, they also have some interest in change

What is Motivational Interviewing?

• Collaborative, goal-oriented method of communication designed to strengthen a person's motivation and commitment to change.

• MI is based on the assumption that individuals are motivated to change when change is connected to something they value

• MI approach begins with an exploration of the patient’s view of the potential benefits of changing.

• The strength of the bond between clinician and patient can often be enhanced when the clinician recognizes the “expertise” of the patient regarding his or her own life.

Purpose of coaching/motivational interviewing:

• Elicit awareness: Thought-provoking questions provide the coachee with the necessary push to explore their current situation, challenges, and strengths.

• Drive self-discovery: Through the coach’s guidance, coachees may gain a deeper understanding of their motivations, values, and limiting beliefs.

• Empower action: Last but not least, these questions enable individuals to better identify solutions, set goals, and develop strategies to visualize them.

Evidence for Motivational Interviewing:

• Motivational Interviewing (MI) sessions with a trained dental hygiene provider led to improved periodontal health, as indicated by statistically significant reductions in gingival inflammation, plaque scores, and bleeding on probing.

• Conventional (health) education focuses on providing information and giving advice, which is typically insufficient to achieve sustained behavioral changes.

Express Empathy:

• “Empathy” refers to understanding the perspective of another person. Helps foster collaboration.

• Seek to understand the client’s feeling without judging, criticizing, or blaming

• It is possible to understand while not approving or endorsing

Develop Discrepancy:

• Create discrepancy between current behavior and client goals

• Too much discrepancy is likely to be demotivating to the client, and if there is not enough discrepancy then the importance goes down.

• Client needs to present arguments for change, NOT provider

Roll with Resistance:

➡Signs of resistance:

• The client may interrupt you.

• The client seems distracted (looking at watch, cell phone, etc.)

• The client may get defensive.

➡Ways of rolling with resistance that you could try are:

• Reflective listening

• Develop discrepancy

  • OARS

Support Self-Efficacy:

• The person must believe in their ability to carry out or succeed with a specific task

• Our goal is to enhance the client’s confidence

Use Open-Ended Questions:

• Open questions are those that cannot be answered with a simple “yes” or “no” or other one-word answer.

• Open questions lead the patient to talk more, providing more of a picture of the situation as he or she sees it.

• This aids the clinician in developing empathy and reduces the clinician’s burden by increasing the likelihood that the patient is doing the talking and thinking

Affirm Patients:

• An affirmation is a positive statement that emphasizes a desired belief or outcome, often used to increase self-confidence or motivate oneself.

• Affirming patients can enhance rapport and help support patients confidence.

• Affirmations should be specific and genuine, rather than general overenthusiastic statements

Use Reflective Listening:

• People do not always say what they mean ➡ listen and decode their meaning

• Try to form as a statement, not a question (“You don’t want to floss.” VS “You don’t want to floss?”)

• Allows the provider to check, rather than assume

• Important to use after open-ended questions

• Can be simple or complex (see link below: focus on repeat, rephrase, and feeling reflections)

Use Summaries:

• Links together and reinforces material that has been discussed

• Shows that you have been listening and helps client elaborate further