Chet Fox MD Cheryl Aspy PhD Brian Manning MPH Janet Ann McAndrews BS Motivational Interviewing Creating Patient Centered Health Behavior Change Chet Fox MD Cheryl Aspy PhD Brian Manning MPH Janet Ann McAndrews BS “God thinks he is a doctor joke”

What is Motivational Interviewing “MI works by activating patients own motivation for change and adherence to treatment” Rollnick S, Miller W , Butler C, Motivational Interviewing in Health Care p. 5

Key Elements Promote desire to change Promote confidence change is possible

Seven Principles Motivation to change is elicited from the client, and not imposed from without It is the patient’s task, not the clinician’s, to resolve his or her ambivalence Direct persuasion is not an effective method for resolving ambivalence. The counseling style is a quiet and eliciting one

Seven Principles (Con’t) The clinician is directive in helping the client to examine and resolve ambivalence Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction The therapeutic relationship is more like a partnership or companionship than expert/recipient roles. . http://www.motivationalinterview.org/clinical/whatismi.html

From Priest to Partner PRIEST DOCTOR Wears Collar Speaks Latin Expert: tells person what to do Has confessional Parishioner admits sins Gives penance Wears white coat Speaks Latin Expert: tells person what to do Has confidential exam room Patient confesses what they did not do Gives pills

How I got started AI M-HI The story of Larry

Notable Quotes “ It is less frightening to come to you, I feel more like you are my friend” “I don’t feel like I am going to the Principal’s office anymore”

Goal Setting Areas Nutrition Activity Emotional Well Being Need to be Specific What the patient wants to do (desire) What the patient feels they can do (confidence) Remember baby steps, we always want a positive result.

Remember Yoda “Try not. Do or do not, there is no try.” -- Yoda

DEMONSTRATION

Workshop Assignment One Pair up Alternate being Doctor and patient Set actual goals for yourself in the areas of nutrition, activity and emotional well being If you need help, ask one of the 3 of us, Brian, Janet or myself Take 10 minutes each, then we will reconvene

Workshop Assignment Two Break up into 3 groups Take 30 minutes How did you feel about the process How did you feel about the interaction Do you feel you can incorporate this in your practice What could you easily do What are some of the barriers

Debrief (Whole Group) Each group reports what it found If you are willing to give us your e-mail address, we will survey you in a couple of months to see how this has worked in your practice