Ashley Owen, Ph.D. Department of Family and Preventive

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Motivational Interviewing

• Ashley Owen, Ph.D.
• Department of Family and
• Preventive Medicine
• Emory University

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An interactive, empathic listening style to
increase motivationand confidence by emphasizing
the discrepancy between personalgoals and
current health behaviors.
Motivational Interviewing What is it?
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Motivational Interviewing
Goal- to help patients move along the continuum
of change by
1. enhancing motivation for change
and 2. decreasing resistance to change
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Strategies designed to elicit, clarify, and
resolve ambivalence in a client-centered
and respectful counseling atmosphere. 
Motivational Interviewing
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 Ambivalence and Resistance
Motivational Interviewing
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Approach Avoidance Conflict TheoryThe more
one moves toward the goal (eg, quitting smoking)
the more one perceives the disadvantages of that
goal. GOAL Man, theres no
way I can handle all those jitters and I
gotta have a smoke when I
need to calm down!
Ambivalence and Resistance
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Approach Avoidance Conflict Theory As one
moves away from the goal, the goal appears more
attractive and the disadvantages recede.
Ambivalence and Resistance
GOAL
But if only I could quit, I would actually have
money for that new Playstation. My parents would
quit hounding me, I could play with the rest of
the kids without running out of breath!
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Motivational InterviewingVs.Standard
Practice 
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Whats Wrong with Standard Practice?
Standard Practice ? Providers address
ambivalence about change by trying to
persuade, lecture, advice-give. ?
Patient argues against change. ? Further
entrenches the patient into position of not
changing.
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Motivational Interviewing
Whats Right with Motivational Interviewing?
(Ambivalence) MI views ambivalence as part of
the natural process of change a
necessary phase before one can fully
commit to a decision.
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Motivational Interviewing
Whats Right with Motivational Interviewing?
(Ambivalence) Accepting change without a full
consideration of the pros and cons of changing
commonly leads to "buyers' remorse"
and early .
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Motivational Interviewing
Whats Right with Motivational Interviewing?
(Ambivalence) Very few decisions in life are
made with 100 resolve.
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Motivational Interviewing
The role of the provider ? Not to view
ambivalence or resistance as pathological. ?
To help patients resolve their ambivalence and
empathize with their ambivalence, (not argue for
change).
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Change Talk
Primary aim of MI is to elicit "change talk"
-positive statements about change and
-patients own reasons and arguments for
change.
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Change Talk
"It is the act of speech, of verbally defending
change (and hearing oneself do so) in the absence
of coercion that causes the person to change in
attitude and behavior. (Miller, 2004)
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Change TalkResearch indicates that
the more patients hear themselves argue for
change the more committed they become to that
change.
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Change Talk
BUT Remember Approach Avoidance Conflict Theory
GOAL Disadvantages Advantages People
who are ambivalent about change naturally tend to
present arguments from the opposing side of their
ambivalence.
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Change Talk

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Change Talk
? patients can literally talk themselves out of
change. But ? if patients can talk themselves
out of change, they can also talk themselves
into change.
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Transtheoretical Model (Prochaska and
DiClemente) describes how people prepare to
change their lifestyles. Motivational
Interviewing strives to help patients move along
the continuum of change by enhancing
motivation for change and decreasing
resistance to change.
Stages of Change
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Stages of Change
Relapse???
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Precontemplation Person not contemplating
change and may be totally unaware of the need to
make the change.
Stages of Change
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Contemplation Person is aware and is
contemplating making the change, e.g. concerned
about the health impacts of smoking.
Stages of Change
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Preparation Person is making the preparations
needed to make the change, e.g. setting a date to
quit, enrolling in a smoking cessation program,
speaking with the family physician.
Stages of Change
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Action Person is taking action to actively
make the lifestyle change a part of her or his
life.
Stages of Change
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Maintenance Person has successfully made the
change and is able to maintain the changed
lifestyle.
Stages of Change
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Stages of Change Match to Intervention
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Stages of Change
Match to intervention In one study (more than
4000 smokers)
? 42 were not thinking about quitting
at all ? 40 were thinking about quitting but
"on the fence. ? 18 were preparing to quit
smoking. Educational approaches only "match" 18
of the population who are ready and willing to
change.
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Match to intervention82 not ready to change.
Educational approach would be mismatch .
Likely perceived as irrelevant , inappropriate,
and possibly Education can
reduce, rather than increase, motivation
to change.
Stages of Change
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How to Handle Patient
Resistance Respond to resistance by diffusing
it rather than fueling it.Resistance is a
problem of communication between the patient and
practitioner, (rather than one that lies within
the patient alone). If youre hearing
resistance, it means youre doing something
wrong. The patient is telling you back up, were
not on the same pagehere.
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How to Handle Patient Resistance
Key questions to ask yourself when you encounter
resistance
? Does my
counseling style match the patient's readiness to
change? ? Am I pushing the patient to do more
than he or she is ready for? ? Am I dismissing
the patient's feelings and concerns? ? Am I
undermining the patient's sense of personal
autonomy to make a decision about their care? ?
Am I acting as expert and telling the patient
what changes he or she needs to make and how to
make them?
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How to Handle Patient Resistance
Reduce resistance by
using
reflective listening using empathic
statements focusing on building the
relationship rather than on patient change
engaging patients by first discussing issues that
are important to them emphasizing that the
issue of whether or not to change is their
decision
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Group Exercise
Think back to the behavior that you have been
considering changing, but about which you are
ambivalent. How long have you been considering
changing this behavior? What has stopped you
from making the change? What would need to
happen for you to make the change?