ASAM.10/17/97

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Motivational Interviewing Helping People Change
Jerica Berge, Ph.D., MPH, LMFT Assistant
Professor Department of Family Medicine and
Community Health University of
Minnesota mohl0009_at_umn.edu
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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.

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Motivational Interviewing

• PREPARING
• PEOPLE
• FOR
• CHANGE

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Ambivalence

• The Dilemma of Change

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Ambivalence

• State of having simultaneous, conflicting
  feelings
• Mixed Feelings
• Uncertainty
• Indecisiveness

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Consequences of Ambivalence

• The result of being in a state of ambivalence can
  lead to avoidance or procrastination
• ORto deliberate attempts to resolve the
  ambivalence that may result in success or failure

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Ambivalence

• Ambivalence about proposed behavior change is
  NORMAL
• Direct persuasion or advice giving is NOT an
  effective method for resolving ambivalence for
  most patients

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The Righting Reflex

• Our desire to keep people from going down the
  wrong path, and to set things aright

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Righting Reflex vs. Ambivalence
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Advice Regarding Health Behavior Change

• We like to give it
• Weve been trained to give it
• Its not very effective
• We do it anyway

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Bad Example MI
http//www.youtube.com/watch?v80XyNE89eCs
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• Motivation to change is not a personality trait,
  but is affected by interpersonal interaction
• Miller Rollnick, 1991

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Four key principles

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

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Good Example of MI
http//www.youtube.com/watch?vURiKA7CKtfc
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What You Cant 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 childs
  eating AND exercise habits
• Get the parent to change both the home food
  environment AND physical activity environment

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What You Can Do with MI

• You 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