Motivational Interviewing for Family Planning Providers Motivational ...

Motivational Interviewing
for
Family Planning Providers
Developed By:
Disclosure
•I I have no real or perceived vested
interests that relate to this
presentation nor do I have any
relationships with pharmaceutical
companies, biomedical device
manufacturers, and/or other
corporations whose products or
services are related to pertinent
therapeutic areas.
To provide the underlying spirit and approach of
Motivational Interviewing
To recognize reflective listening responses and
apply them appropriately to client situations
To recognize change talk and be able to evoke it
using proper motivational interviewing methods
To list and demonstrate several different
strategies for eliciting change talk
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Motivational Interviewing
Motivational Interviewing
Introduction & Perspectives
Drs. Miller, Rollnick & Moyers
Overview of the Spirit of Motivational
Interviewing
Early approach:
Doctor or therapist seen as
expert whose task was
to…
educate
persuade
cajole
confront or coerce
Motivational Interviewing from the work of Miller and Rollnick
MOTIVATIONAL INTERVIEWING
MOTIVATIONAL INTERVIEWING
Emphasis was on …
conditioning
medicating
punishing
training
humiliating
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MOTIVATIONAL INTERVIEWING
MOTIVATIONAL INTERVIEWING
Why Use Motivational Interviewing?
Intuitive
Focused
Helpful with difficult clients / situations
Useful in short, brief encounters
Motivational Interviewing
Motivational Interviewing
Central to the efficacy of MI
quality of accurate empathy
Blended with other interpersonal
skills
Characterized by
collaboration rather than prescription
respect for and honoring client autonomy
evoking motivation rather than trying to install it
Motivational Interviewing
Motivational Interviewing
Works by causing clients to
verbalize their own arguments for
change
Change Talk
client expressing
disadvantages of status quo
advantages of changing
ability to change
intention to change
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Evoking Self-Motivational Statements
Problem Recognition (I’ve noticed that lately…)
Concern (I am beginning to feel…)
Intent to Change (I am going to do something, I just
don’t know what)
Optimism for Change (I know I can do better or I
want to do better)
Change Talk
Counsel in a way that invites the person to make
the arguments for change
Common dimensions to ask about (DARN)
Desire - want, prefer, wish, etc.
Ability - able, can, could, possible
Reasons - specific arguments for change - Why do it?
Need - important, have to, need to, matter, got to
Commitment to change
RATIONALE AND BASIC
PRINCIPLES
MOTIVATIONAL INTERVIEWING
• Responsibility and capability for change
lies within the client.
Task to create a set of conditions that
will enhance the client’s own motivation
for and commitment to change.
Mobilize the client’s inner resources,
helping relationships, support intrinsic
motivation for change
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MOTIVATIONAL INTERVIEWING
MOTIVATIONAL INTERVIEWING
Can be used for:
Lessening resistance
Resolving ambivalence
Ambivalence
Mixed feelings or emotions; simultaneous and
contradictory attitudes or feelings
Inducing change
eliciting self-motivational statements
What Motivational
Interviewing is
NOT…
How Do You Know When You Got It
Right?
Some of the key signals are:
1. You are speaking slowly.
2. The client is doing much more of the talking
than you.
3. The patient/client is actively talking about
behavior change.
4. You are listening very carefully and gently
directing the interview at appropriate
moments.
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Eight Skills in Learning
Motivational Interviewing
1. Openness to the underlying
assumptions and spirit of the method
• collaborative rather than prescriptive
• eliciting motivation rather than installing it
• honoring client autonomy –non-confrontational
2. Developing proficiency in
interpersonal skills of client-centered
counseling
• accurate empathy
• skill & comfort in forming accurate reflections
3.Recognizing “change talk”and
distinguishing it from other forms
of client’s ways of speaking.
4.Learning to elicit change talk
(evocation) and to reinforce it
5.Learning to minimize resistance
and how to respond to “sustain
talk”
6.Knowing when client is ready to
discuss a change plan that is their
own.
7.Continuing to elicit client’s
commitment to the change plan.
8.Flexibly blending MI with other
therapeutic methods.
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FOUR BASIC PRINCIPLES
FOUR BASIC PRINCIPLES
EXPRESS EMPATHY
DEVELOP DISCREPANCY
ROLL WITH RESISTANCE
SUPPORT SELF-EFFICACY
EXPRESS EMPATHY
EXPRESS EMPATHY
Acceptance facilitates change
Understanding client’s feelings
and perspectives without
judging, criticizing, or blaming
through skillful reflective
listening
Ambivalence is seen as a
normal part of change
DEVELOP the DISCREPANCY
DEVELOP the DISCREPANCY
The client rather than the
worker should present the
arguments for change
Change is motivated by a perceived
conflict between present behavior
and important personal goals or
values
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ROLL WITH RESISTANCE
ROLL WITH RESISTANCE
Avoid arguing for change
Client Should not be directly opposed
New perspectives are invited but not
imposed
A signal to change strategy and respond
differently
Includes involving the client actively in
the process of problem-solving
SUPPORT SELF-EFFICACY
SUPPORT SELF-EFFICACY
Belief in the possibility of change
The client, not the worker, is responsible
for choosing and carrying out change
Worker’s belief in the client’s ability to
change
A reasonably good predictor of treatment
outcomes
Enhances a client’s confidence in his/her
capability to cope with obstacles and to
succeed in change
Counselors’role is not a directive one
of providing solutions, suggestions, or
analysis.
Instead, the counselor need only offer
three critical conditions to prepare
the way for natural change:
Accurate empathy
Non-possessive warmth
Genuineness
(Carl Rogers)
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Phases of
Motivational Interviewing
Phase I
Building Motivation to Change
Has implications to the earlier stages of change
Assessing current situation
Identifying problems or issues
Evoking self-motivational statements
Phases of
Motivational Interviewing
Phase II
Strengthening Commitment to
Change
Most useful in later stages of change
Increasing motivation to change
Recognizing Readiness to Change
Recapitulation
Key Questions
Traps to Avoid
Phase I
Question / Answer Trap
Confrontation / Denial Trap
Labeling Trap
Expert Trap
Premature Focus Trap
Blaming Trap
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OPEN-ENDED QUESTIONS
AFFIRMATIONS
REFLECTIVE LISTENING
SUMMARIZING
Forms the acronym OARS
Motivational Interviewing from the work of Miller and Rollnick
•Repeating
Stating exactly what was said
•Paraphrasing
Stating what was said in your own words
•Reframing
Early Strategies
Putting an issue in a different context
•Feelings (Deepest Level)
Naming the emotions attached to the content
Motivational Interviewing from the work of Miller and Rollnick
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OPEN-ENDED QUESTIONS
•Questions that do not invite brief
answers of “yes”or “no”
•Used to encourage clients to talk
•Client should do most of the
talking
•Helper listens and encourages
Motivational Interviewing from the work of Miller and Rollnick
AFFIRMATIONS
•Another way of building rapport
•Compliments or statements of
appreciation and understanding
•To acknowledge and affirm client’s
strengths and efforts
Motivational Interviewing from the work of Miller and Rollnick
REFLECTIVE LISTENING
One of the most important /
challenging skills in MI
Simple Reflection
Amplified Reflections
Double-sided Reflections
Motivational Interviewing from the work of Miller and Rollnick
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SUMMARIZING
•Used to link together material that has been
discussed.
•Should be done periodically.
•Reinforces what has been said.
•Shows that you have been listening carefully.
•Prepares the client to move on.
•One of the more “directive”applications of MI
Motivational Interviewing from the work of Miller and Rollnick
COMPONENTS OF A GOOD SUMMARY
STATEMENT
•Restates client’s statements regarding
problem recognition, concern, reasons for
change, and optimism about the change
•Don’t ramble - be concise
•End with an invitation for client to respond:
How did I do?
If this is a fair summary, are
there other points?
Is there anything you want to correct or add?
Motivational Interviewing from the work of Miller and Rollnick
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Empathic Listening
Using the skills of early
strategies in MI
Watch Your Assumptions
Many behavior change consultations fail because
the practitioner falls into the trap of making false
assumptions.
Consider these:
• This person OUGHT to change.
• This person WANTS to change.
• This patient’s health is the prime motivating factor for him/her.
• If he or she does not decide to change, the consultation has
failed.
• Clients are either motivated to change or not.
• Now is the right time to consider change.
• A tough approach is always best.
• I’m the expert; he or she must follow my advice.
Cash
Register
Activity
ACTIVE LISTENING
CLIENT
What I say
2
PRACTITIONER
What I hear
1
3
What I mean
or feel
What I
understand
(Gordon 1970, Miller & Jackson 1985)
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Many statements can have multiple meanings,
and your challenge is to identify one meaning
that the client is trying to express
“I wish I were more sociable”
“I wish I were more sociable”
•“I feel lonely and I want to have more friends”
•“I get very nervous when I have to talk to
strangers”
•“I should spend more time getting to know people”
•“I would like to be popular”
•“I can’t think of anything to say when I’m with
people”
•“People don’t invite me to their parties”
Active Listening Activity
1
2
3
Not Ready Unsure Ready Trying Done
0 1 2 3 4 5 6 7 8 9 10
Precontemplation Contemplation Preparation Action Maintenance
Motivational Interviewing –Phase I
Motivational Interviewing –Phase II
Readiness Ruler adapted from Stoff et al 1995 & Thomas Gordon
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ASSESS IMPORTANCE,
CONFIDENCE AND READINESS
It seems that some people cannot
change and others do not want to.
Having agreed to talk about a
particular behavior there are a number
of directions one could take.
It has been found that the assessment
of “importance”and “confidence”is a
useful first step.
I
M
P
O
R
T
A
N
C
E
LOW IMPORTANCE
LOW CONFIDENCE
0
LOW IMPORTANCE
HIGH CONFIDENCE
0 10
HIGH IMPORTANCE
LOW CONFIDENCE
HIGH IMPORTANCE
HIGH CONFIDENCE
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C O N F I D E N C E
Negotiating a Change
Plan
1. Setting goals
2. Considering change options
3. Arriving at a plan
4. Eliciting commitment
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