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

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

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

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

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

6. 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

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

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

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

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

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

12. 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?

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

14. 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

15. 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