Motivational Interviewing The Process of Change Gloria Sayler, Seattle, U.S. Communication Skills Teacher A presentation for Bradford VTS www.bradfordvts.co.uk

Change Think about a pt who is trying to make a change Consider a change you tried to make What helped, what didn’t?

Goals Integrating Motivational Interviewing with Stages of Change theory Understanding the process of behavior changes Decreasing frustration for both pt and provider Increasing effectiveness

Advice Giving Works about 25% of the time The key is timing – using it in a pt centered approach

The Nature of Change Change is rarely a discrete, single event Sometimes, after a crisis, a person will readily change

Stages of Change Precontemplation – Pt is not interested or is deeply ambivalent Contemplation – patient is considering a change Change usually involves loss – in spite of the perceived gain

What is your role Elicit, understand the behavior’s meaning How are they thinking about the benefits and difficulties of changing X

Preparation Preparing to make a change Experiment with small steps Elicit and provide information

Action Pt starts making the changes in behavior more consistently Encourage Anything else ? Starts getting exciting

Maintenance Keeping the change in behavior in place Encourage Occasional “slips” Discouragement Encourage Provide information

Dancing vs. Wrestling Eliminates persecutor /victim roles Enhances provider and pt empowerment/partnership

Elicit – Provide - Elicit What do they know/Want to know? What additional information can you provide? Generate options What do they /family/friends think about that? Goals – what do you think will work?

Provider Blocks Anxious for change we end up: Lecturing – Ask questions Cheerleading Acknowledging/eliciting

Patient Blocks What is going to happen when you leave? Resistance - argument: quick summary// Identify and use discrepancies Helplessness : Acknowledging challenges/empathy; Eliciting previous successes

Resources: Miller WR and Rollnick: articles and books “Stages of Change and 12 Problem Behaviors…” article Motivational Interviewing (book) – preparing people to change Prochaska, et al: articles and books Changing for Good