Motivational Interviewing

1
Motivational Interviewing
2
Objectives

• Participants will
• increase their skills to provide advice and
  referral to specialized treatment using
  motivational interviewing techniques

3
Five Principles

• Express empathy
• Develop discrepancy
• Avoid argument
• Roll with resistance
• Support self-efficacy

4
Stages of Change
5
Prochaska DiClemente Stages of Readiness to
Change
18-5
Stage Description Counseling
Objectives Pre-contemplation Not considering
change u Identify patients goals
u Provide
information
u Bolster self-efficacy Contemplation Ambival
ent about change u Develop discrepancy between
goal behavior
u Elicit self-motivational statements Determi
nation Cognitively committed to u Strengthen
commitment to change change
u Plan strategies for
change Action Involved in
change u Identify and manage new
barriers u
Recognize relapse or impending relapse Maintenanc
e Behavior change is stable u Assure
stability of change
u Foster personal development Relapse
Undesired behaviors occur u Identify
relapse u
Reestablish self-efficacy and commitment
u Develop new
behavioral strategies Termination Change
is very stable u Assure stability of change
6
Stage 1 Pre-Contemplation(Patient not ready for
change)

• Barrier - Lack of information
• Assess patients understanding
• Assess patients receptivity to new information
• Deliver information
• Assess patients reaction

7
Stage 1 Pre-Contemplation(Patient not ready for
change)

• Barrier - Low self-efficacy
• Explore origins of low self-efficacy
• Assess for reasons for relapse
• Assess for personal strengths
• Treat or refer any underlying psychiatric
  disorder or family dysfunction

8
Stage 1 Pre-Contemplation(Patient not ready for
change)

• Barrier - Contentment with the present
• Solicit patients views on beneficial aspects of
  the behavior
• Ask patient about less beneficial aspects of the
  behavior
• Explore patients goals
• Discuss compatibility between behavior and goals

9
Stage 2 Contemplation(Patient thinking about
change)

• Express empathy
• Develop discrepancy
• Avoid argumentation
• Roll with resistance
• Support self-efficacy

10
Stage 3 Determination(Patient made decision to
change)

• Strengthen commitment to change
• Plan strategies for change
• Make statements of partnership
• Arrange follow-up

11
Stage 4 Action(Patient involved in change)

• Review effectiveness of previous strategies for
  change
• Positive strategies
• Improvements for strategies
• New or future challenges
• Dealing with current and future challenges
• Statements of partnership
• Arrange follow-up

12
Stage 5 Maintenance(Patient has made changes)

• Ensure stability of change
• Identify goals for personal development
• Plan for progressing toward personal goals

13
Stage 6 Relapse(Patient has relapsed)

• Reinforce normalcy of relapse
• Bolster self-efficacy
• Identify reason(s) for relapse
• Re-frame relapse as learning experience
• Restage the patient

14
Stage 7 Termination

• Assure stability of change