Motivational Interviewing for Behavior Change March 13, 2015 Pam Pietruszewski, MA Integrated Health Consultant National Council for Behavioral Health

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My own motivation level: A.Is always rock bottom low B.Goes up and down depending on the day, circumstances, etc. C.Is always sky high Polling question #1

Motivational interviewing is a collaborative, person-centered, guiding method designed to elicit and strengthen motivation for change. Miller & Rollnick, 2012

Miller & Rollnick, 2009 MI is not…. A way of tricking people into doing what you want them to do A specific technique Problem solving or skill building Just client-centered therapy Easy to apply A remedy for every clinical challenge

What do we know with reasonable confidence about MI? MI improves treatment retention, adherence, and outcomes across a range of behaviors Outcomes vary widely across providers, programs, and research sites MI skill is reliably measurable and predicts better outcomes MI generalizes fairly well across cultures Therapeutic relationship matters

The Continuum Directing Guiding Following Behavioral Therapy Cognitive Therapy Reality Therapy Motivational Interviewing Solution-focused therapy Psychodynamic psychotherapy Client-centered therapy Informing Asking Listening

4 Fundamental Processes Engaging Focusing Evoking Planning 13

Engaging Focusing Evoking Planning

MI Spirit Partnership Evocation Compassion Acceptance

MI Spirit Partnership Evocation Compassion Acceptance

Evocation

Autonomy

Engaging Focusing Evoking Planning

Open-ended inquiry Not fact-finding Not yes/no or brief answer Not fact-finding Not yes/no or brief answer 20 Anticipate response Ask for examples & elaboration How…What…Tell me… Anticipate response Ask for examples & elaboration How…What…Tell me… Tell me about the role smoking has in your life. How are you taking your medication?

Polling question #2 Which of the following is the an example of open- ended inquiry? A.How many cigarettes do you smoke per day? B.What concerns you about your smoking? C.Do you want to quit smoking? D.I really recommend you quit all tobacco use. Ok?

Affirmations Supportive, encouraging statements Genuine, direct reinforcements Demonstrate understanding You are very committed to your grandchildren. You’ve found creative ways to fit in exercise.

Engaging Focusing Evoking Planning

Sustain Talk Change Talk Ambivalence

Amount of change talk is more predictive than amount of readiness. PreparatoryCommitment Desire - Ability - Reasons - Need - Commitment - Action - Taking Steps

Darren When the doctor said I had high blood pressure, I couldn’t believe it! I want to feel better but I’m not quitting smoking. Can’t I just cut out fried foods or something else? I’ve dieted before, so I can do it again.

You want to feel better. You’re surprised by the results. While you don’t want to quit smoking, you are open to making some changes. Reflections When the doctor said I had high blood pressure, I couldn’t believe it! I want to feel better but I’m not quitting smoking. Can’t I just cut out fried foods or something else? I’ve dieted before, so I can do it again.

Polling question #3 “I don’t have time for patches and pills and support groups. My wife nags me about it and I know I have to do it at some point. I just don’t want to deal with it right now.” Which reflection best elicits change talk? A.You know you need to make some changes. B.You are a busy man. C.Your wife is a nag.

Engaging Focusing Evoking Planning

Is your client with you?

What would be good about…? What else have you been thinking about? How might you make the best of it? What keeps you going? What could you do differently? So where does this leave you now? What is your next step?

Decisional Balance Tool Good Not so good No change Change

Engaging Focusing Evoking Planning

People often say that motivation doesn’t last. Well, neither does bathing – that’s why we recommend it daily. – Zig Ziglar

How do clinicians best learn MI? “One-shot” trainings don’t create competence (Miller & Mount, 2001; Walters et al., 2005) Workshops + feedback + coaching most likely combination to significantly and substantially change patient’s change talk (Miller, 2013)

Questions?

MI Training Opportunities Pam Pietruszewski: Dawn Tenia: Introduction (1-2 hrs) Strategies for Behavior Change (4-8 hrs) Building Competency Workshop (Two days) Proficiency through Coaching & Feedback

Upcoming Webinars April 7 th, 2:00-3:30pm – Tobacco Cessation May (exact date TBD) – Alcohol & SBIRT

Register at Exclusive GTAC discount! Enter: GTAC200