Motivational Interviewing: Helping People Change Jerica Berge, Ph.D., MPH, LMFT Assistant Professor Department of Family Medicine and Community Health University of Minnesota

Disclosure Statement I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity.

Motivational Interviewing PREPARING PEOPLE FOR CHANGE

Ambivalence The Dilemma of Change

Ambivalence State of having simultaneous, conflicting feelings: Mixed Feelings Uncertainty Indecisiveness

Consequences of Ambivalence The result of being in a state of ambivalence can lead to avoidance or procrastination OR…to deliberate attempts to resolve the ambivalence that may result in success or failure

Ambivalence Ambivalence about proposed behavior change is NORMAL Direct persuasion or advice giving is NOT an effective method for resolving ambivalence for most patients

The Righting Reflex Our desire to keep people from going down the wrong path, and to set things aright

Righting Reflex vs. Ambivalence

Advice Regarding Health Behavior Change We like to give it We’ve been trained to give it It’s not very effective We do it anyway

=80XyNE89eCs Bad Example MI

“Motivation to change is not a personality trait, but is affected by interpersonal interaction” Miller & Rollnick, 1991

Express empathy Develop discrepancy Roll with resistance and avoid argumentation Support self-efficacy Four key principles

=URiKA7CKtfc Good Example of MI

What You Can’t Do with MI Ex. With a parent of a child who is overweight In one given interaction you probably CANNOT: Get the parent to totally change both the child’s eating AND exercise habits Get the parent to change both the home food environment AND physical activity environment

What You Can Do with MI You probably CAN: Assess readiness for change Engage with the parent so that she sees you as someone who would be willing to help if and when she wants help Use reflective listening to encourage the parent to consider even a small step toward change Plant the seed for behavior change by using the “confidence ruler” technique