DIPC 5001 - Motivational Interviewing

purpose of motivational interviewing

its a communication guide for patient counseling approaches

- not just for clinicians, but also to motivate friends, family, and employees at future practices

MI is a _____-based counseling approach

evidence-based counseling approach

definition of motivational interviewing

an empathic, person-centered way to prepare patients for change by helping them resolve ambivalence, enhance intrinsic motivation, and build confidence in change

MI utilizes a directive, patient-centered style of interaction, promoting behavioral change by allowing patients to

explore and resolve their ambivalence

MI addresses ambivalence about change by

respecting and promoting individual autonomy

- this encourages people to explore their OWN reasons and motivations for change, guiding them through the process

MI serves as a collaborative conversation style that

empowers patients to uncover and strengthen their intrinsic motivation and commitment to change

- helps them take ownership of their journey towards positive transformation

exploring ____ is a fundamental component of MI

ambivalence

rather than viewing ambivalence as a weakness or reluctance to change, its recognized as

a natural part of the change process

true or false: attempting to override ambivalence can often lead to increased resistance

true

- you should work through the resistance to foster constructive change talk that propels the patient towards positive outcomes

ambivalence recognizes both ______ and ______

the reasons to change AND the reasons to maintain the status quo

- reflects conflicting feelings about change

ex: "I want to get up, but it hurts"

evocation

the process of identifying a patient's intrinsic motivation and tapping into their available resources

- rather than IMPOSING change, this emphasizes the importance of eliciting the patient's own motivation for transformation

- important for the patient, not the provider, to explore and address their feelings of ambivalence regarding change

evocation process aims to

understand and resolve the patient's ambivalence

when providers advocate for a particular change, patients may instinctively

adopt a contrary position or take the opposite stance

the essence of MI lies in its collaborative nature, highlighting a

partnership between the provider and the patient

the providers primary role is to

facilitate change while respecting, fostering, and promoting the patient's autonomy

- fosters a supportive environment where providers actively engage with patients, address their concerns, and aid them in achieving their self-defined goals

in MI, ____ are empowered as the primary decision makers

patients

while patients are the primary decision makers, MI practitioners focus on eliciting

both concerns and potential solutions from their patients

In MI, absolute worth is

the core concept of treating every individual with unconditional positive regard and acknowledging their inherent value and potential as a human being

absolute worth is considered a key aspect of the

"acceptance" pillar within the MI spirit

the two important pieces of the practice of MI are

1) techniques, strategies, tools used

2) spirit

the _____ is the foundation upon which the practice of MI is built

spirit of MI

the four main components of the spirit of MI

PACE

1) partnership

2) acceptance

3) compassion

4) evocation

1) partnership

the nature of the relationship between client and clinician

- clinician brings expertise (through education, training, and experience)

- client knows themself better than anyone

the opposite of a partnership is a ______

paternalistic relationship

2) acceptance

the clinician's deep appreciation for the client and their world view

the four components of acceptance are

- absolute worth

- accurate empathy

- autonomy support

- affirmation

opposite of absolute worth is called

attitude of judgement

accurate empathy

the clinician's effort to understand the world from the client's point of view, rather than imposing their POV onto the patient

autonomy support

acknowledges everyone has an irrevocable right and basic psychological need for self determination

- opposite: deciding for the client, coercing them

affirmation

clinician's efforts to acknowledge the client's positive characteristics and efforts

- opposite: to look for what is wrong and try to fix it

3) compassion

guides the clinician to prioritize the needs and welfare of the client above that of the clinician

- opposite: exploitation

4) evoking

reminds the clinician that the client has strengths, resources, thoughts, ideas, solutions, motivation, expertise, wisdom, and experience that can be tapped in the service of healthy behavior change

- opposite: deficit view, that the client is missing something that the clinician needs to provide

the spirit of MI provides

the ethical guidelines and underlying philosophy mindset and heart set that guides the clinician

without the spirit of MI, motivational interviewing becomes

a way to trick people into doing what you want, rather than helping them

process of MI

EFEP

- engage

- focus

- evoke

- plan

engage

establish a supportive rapport by expressing genuine empathy, asking open-ended questions, offering affirmations, and encouraging individual autonomy

focus

facilitate deeper understanding by reflecting on the conversation, summarizing key points, and highlighting discrepancies between current behaviors and personal values

evoke (ii)

inspire motivation by allowing space for concerns to be voiced and fostering a sense of urgency about the need for change

plan

initiate discussions on potential changes, support self-efficacy, and identify specific elements and strategies for implementing change effectively

behaviors driven by ____ are far more effective than those influenced by external factors

autonomy and intrinsic motivation

the actual skill of MI lies in

drawing out the intrinsic motivations of the patients

- extrinsic motivations may not be effective

the 4 principles of MI

DEAR

1) developing discrepancy

2) expressing empathy

3) enhancing self-efficacy

4) rolling with resistance

1) developing discrepancy

provider highlights the gap between the patients current behavior and recognize their personal goals, fostering motivation for change

2) expressing empathy

provider connects with the patients feelings and perspectives, creating a supportive environment that encourages open dialogue

3) enhancing self-efficacy

provider reinforces the patients confidence by acknowledging their past success and personal strengths, empowering them to believe in their ability to change

4) rolling with resistance

provider aims to build a collaborative partnership, avoiding arguments and confrontations, and instead "walking" alongside the patient on their journey toward change

the 4 fundamental interaction skills

OARS

1) open-ended questions: encourage patients to share their story without steering them toward a predetermined response

2) affirmations: expressions that recognize and highlight the patient's strengths

3) reflective listening: actively engaging with what the patient is saying, demonstrating interest, and valuing their insights

4) summarize: helps encapsulate key points discussed during the conversation

3 fundamental levels of reflective listening that can transform the emotional tone of a conversation

1) repeating or rephrasing: mirroring the patients words by restating them or using synonyms, ensuring the core message is intact

2) paraphrasing or rephrasing

3) reflection of feeling: the most profound form of listening, where the EMOTIONAL aspect of what the patient is expressing are highlighted

2 types of reflective responses

1) simple reflections: paraphrasing or restating the explicit content of what the patient said. helps ensure the patient feels heard and understood

2) complex reflections: include the patient's unspoken meanings, feelings, intentions, or experiences, which deepen the conversation and improve the relationship

listening breakdown (going downhill) occurs when

- provider needs to grasp what the patient is communicating fully

- provider offers a different interpretation from the patients original message

- patient needs to convey their understanding of the providers message adequately

- the provider repeatedly requests information the patient already discussed, making the patient feel like they aren't listening

decisional balance

a crucial tool in MI that helps patients reflect on the pros and cons of their current behavior vs making a change.

- patients can discover their internal motivations

- change comes with its own set of benefits and drawbacks

change talk

active advocation for transformation while steering clear of sustained talk or arguments against change

- encompasses statements made BY the patient that reflect their consideration/ motivation for or commitment to change

change talk can be categorized as _____ or _____

strategic or probing

strategic change talk example

"you've successfully cut down your drinking in the past! what do you think contributed to that success then?"

probing change talk

"you mentioned experiencing shortness of breath as a negative consequence of your weight. can you think of other negative consequences?"

patients are engaging in change talk when they

- acknowledge the existence of a problem

- identify their concerns regarding the issue

- express an awareness about the situation

- recognize the benefits from making a change

- understand the consequences of not making a change

change talk pneumonic

DARN

- desire: I want

- ability: I can

- reasons: it is important

- need: i should

commitment talk pneumonic

CAT

- commitment: i will

- activation: i am ready

- taking steps: i am doing it

readiness ruler scores 0-3

patient is not ready at ALL to change; pre-contemplation

- provider should elicit perceived consequences and express concern, offer information, and follow up

readiness ruler scores 4-7

patient is either THINKING about changing/contemplating, or planning and making a commitment or preparation

- providers should negotiate a plan to cut back or quit, offer support, and follow up

readiness scores 8-10

patient is ACTIVELY changing

- provider should assist patient develop an action plan, identify resources, and instill hope

after the patient selects a number from the scale, its crucial to

ask an open-ended question that encourages change talk

ex: "tell me why a 4 and not a 1?"

- ask why not a LOWER number. if you ask why not a higher number, they might become defensive. lower number evokes positive reason for change