Jarred Munro: Clinical Psychologist SRS 0.5 FTE Solutions Health Psychology 0.5 FTE MOTIVATIONAL INTERVIEWING(MI)

By the end of this session you will: Understand the ideals of Motivational Interviewing. Understand the difference between Motivational Interviewing and Motivational Interventions. Weigh up if further MI training is useful to your work. Objectives

Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Who am I? Clinical Psychologist 10 years experience on Ward 2 SPH/ Ward A SRS Interest in Adjustment to Disability, Chronic Pain and Behavioural Medicine as well as traditional mental health. Acceptance and Commitment (ACT) Therapist 3

What is MI? A) an intervention designed to motivate unmotivated patients? B) a school of psychotherapy? C) a therapeutic stance to help resolve ambivalence? 4

What is MI? A skilful style of communication conducted for the purpose of eliciting from patients their own good motivations for making behaviour changes in the interests of their health. 5

Mystery of MI? “People don’t bring a lack of motivation they bring ambivalence” Working through ambivalence is a central goal of MI  Aim to evoke a patient’s arguments for change/ self motivational statements 6

Ambivalence A state of mind in which a person has coexisting but conflicting feelings about something “I want to but I don’t want to” It is normal, acceptable, understandable! Caught in this- not poorly motivated 7

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MI example…. Consider yourself… Pick one of these behavioural change options Make healthier food choices Reduce alcohol consumption Engage in regular exercise Stop smoking 9

MI example…. Why would you want to make this change? What are the three best reasons for you to do it? How important is it for you to make this change? So what do you think you’ll do? What you have changed in the past that you can relate to this issue? What may happen if things continue as they are(status quo)? If you were 100% successful in making the changes you want, what would be different? What are the worst things that might happen if you don’t make this change? What are the best things that might happen if you do make this change? 10

MI example…. On a scale where one is not really important at all, and ten is extremely important, how important is it to you to change? How much do you want to? How confident you are that you could? How committed are you to _________? What do you want in life? What values are most important to you? How does this behaviour sit into your value system? 11

MI example…. Perhaps______ is so important that you don’t want to give it up, no matter what the cost? 12

What is MI? 3 CORE Tenets Collaboration – dual expertise between pt and therapist Evocation – key focus to elicit reasons, abilities and methods for change Autonomy – emphasis that the individual is ultimately responsible for making his or her own choice for change and carrying out this change. 13

Spirit of MI Collaboration vs Confrontation Counselling involves a partnerships that honours the client’s experience and perspectives. The counsellor provides an atmosphere that is conducive rather than coercive VS Counselling involves overriding the client’s impaired perspectives by imposing awareness and acceptance of “reality” that the client cannot see or will not admit. 14

Spirit of MI Evocation vs Education The resources and motivation for change are presumed to reside within the client. Intrinsic motivation for change is enhanced by drawing on the client’s own perceptions, goals and values. VS The client is presumed to lack key knowledge, insight, and/or skills that are necessary to change to occur. The counsellor seeks to address these deficits by providing the requisite enlightenment. 15

Spirit of MI Autonomy vs Authority The counsellor affirms the client’s right and capacity for self- direction and facilitates informed choices. VS The counsellor tells the client what he or she must do. 16

Reasons people struggle for motivation in post acute rehab? Current and prior coping strategies Personality characteristics Social support & social isolation Medical management Level of impairment Rehabilitation process and progress Substance abuse Psychiatric history Dysphasia/Dysarthria 17

How could MI help in Stroke Rehab? What are the behaviours we want to change? Who’s problem is it? 18

Therapist role in change talk? Research has shown that therapist behaviour influences treatment outcome. Empathy is key 19

My 2 cents on Motivating Stroke Patients Organisational metaphor Values 20

Goal Setting informed by MI Collaborative, patient, centered goal setting. 21

Motivation for OT vs Physio example Why are Stroke Patients seemingly more motivated to attend PT sessions than OT sessions? 22

Questions? Do you see a role for MI in your unit? 23