Motivational Interviewing Bambi A. Carkey DNP, PMHNP-BC, NPP Clinical Assistant Professor Director of Clinical Affairs SUNY Upstate Medical University College of Nursing June 5, 2015

History Motivational Interviewing has it’s roots in person –centered therapy. Expands on person –centered therapy by incorporating therapeutic goals about desired change into a methodology for intervention “Motivational Interviewing with Problem Drinkers” (Miller, 1983).

Motivational Interviewing (MI) A beginning definition “ Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change” (Rollnick & Miller, 2013

Philosophical Assumptions Relationship - Collaborative & Friendly Persuasion versus coercion Challenging versus argumentative Priority – Resolving Ambivalence Avoid prescribing methods / techniques Pt. is responsible for own progress Focus on self – efficacy Sobczak(2012)

Central Purpose Examination and Resolution of Ambivalence MI is intentionally directive

Key Points The overall style of MI is one of guiding , which lies between and incorporates elements of directing and following styles Ambivalence is a normal part of preparing for change and a place where a person can remain stuck . (Rollnick & Miller, 2013)

Key Points Attempting to influence change by arguing for change with a person who is ambivalent, brings about the person’s natural resistance. People are more likely to be persuaded toward change by hearing their words reflected by the therapist.

The Spirit of MI “If you treat an individual as he is, he will stay as he is, but if you treat him as if he were what he ought to be and could be, he will become what he ought to be and could be.” Johann Wolfgang von Goethe

The Aspects of the Spirit of MI Partnership Acceptance Compassion Evocation

Change Engaging – The process of establishing a relationship of mutual respect and positive regard Focusing – The process of discovering and maintaining direction Evoking – The process intended to help resolve ambivalence in the direction of change Planning – The process of planning behavioral change

Acceptance There are Four aspects of Acceptance Absolute Worth Autonomy Affirmation Accurate Empathy

The Spirit of MI: Partnership MI is a person –centered counseling style for addressing ambivalence about change MI is a collaborative process. It is done for and with someone, not on or to them MI is not a way of tricking people into changing; it is a way of activation their own motivation and resources for change (Rollnick & Miller, 2013)

Techniques of MI OARS Open –ended questions Affirmations Reflective Listening Summarize

Therapist Behaviors Reflective listening Expression of acceptance and affirmation Evoking the pt.’s self motivational statements Reinforcing the pt’s self motivational statements Assessing the pt’s readiness to change Affirming the pt’s freedom of choice Sobczak (2012)

Therapist Behavior Expression of empathy Support self efficacy Roll with resistance Develop discrepancy : Pt’s identification of where he/she is, and where he/she would like to be Sobczak(2012)

Examples:Clinical 10 yr. old obese child comes in with mother at well child visit 52 yr old male presents post MI, with a hx of smoking 1 ppd x 35yrs 46 yr old woman is referred by PCP for Alcohol abuse 43 yr ols male presents with newly diagnosed DM type I

Examples Reframing Reflective Listening Rolling with resistance Summarization

References Miller, R. and Rollnick,S.(2013). Motivational Interviewing: Helping People Change. New York: Guilford Press. Sobczak, J.(2012). Motivational Interviewing (2012). Powerpoint.

Questions