1. CRICOS Provider Code: 0113B MOTIVATIONAL INTERVIEWING AN EMPOWERMENT APPROACH Dr. Annette Dunham MAPS School of Psychology Deakin University annette.dunham@deakin.edu.au

2. CRICOS Provider Code: 0113B OVERVIEW  We will look at the principles and characteristics of Motivational Interviewing (MI) and discuss why MI is an empowerment approach.  We will look at two of the four key processes in MI:  Engaging  Focusing  Evoking  Planning With particular emphasis on the EVOKING phase  We will practice some motivational interviewing skills.

3. CRICOS Provider Code: 0113B “Health professionals should regularly advise obese patients about healthy living”. Dominion Post 09/06/14

4. CRICOS Provider Code: 0113B “ Experts are trained to deliver prescriptions and advice, and they often work harder than we do trying to help us. But the expert approach actually lets us off the hook, sending the subtle message: ‘You aren’t in charge…’ When patients leave the clinic or office, they can and do veto recommendations a health professional makes”. (Glasgow & Anderson, 1999, pp. 2090-2092)

5. CRICOS Provider Code: 0113B WHY DO WE NEED TO ENCOURAGE CLIENT SELF-MANAGEMENT & AUTONOMY? Burden of chronic disease Greater demands on health practitioners Need for models that empower clients to manage own condition Clients want to be autonomous

6. CRICOS Provider Code: 0113B THE ACTIVE SERVICE MODEL HTTP://WWW.BAYSIDE.VIC.GOV.AU/COMMUNITY_SERVICES/SMR_ASM.HTM HTTP://WWW.BAYSIDE.VIC.GOV.AU/COMMUNITY_SERVICES/SMR_ASM.HTM Supported by five key principles: 1.People want to remain autonomous 2.People have potential to improve their capacity 3.People's needs should be viewed in a holistic way 4.HACC services should be organised around the person and carer; 5.A person's needs are best met where there are strong partnerships and collaborative working relationships between the person, their carers and family, support workers and service providers

7. CRICOS Provider Code: 0113B USING A COACHING APPROACH MOORE & TSCHANNEN-MORAN (2010) Accept the client where they are today Guide clients towards building their self-efficacy Help clients define a meaningful purpose for health and wellbeing Ask clients to take charge –to take “the driver’s seat” in their own health management.

8. CRICOS Provider Code: 0113B COMPARING MODELS (ANDERSON & FUNNELL, 2005; BODENHEIMER ET AL., 2002)

9. CRICOS Provider Code: 0113B DEFINITION (1) Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change. (2) Motivational interviewing is a person- centred counselling style for addressing the common problem of ambivalence about change. Miller & Rollnick (2012, p.29)

10. CRICOS Provider Code: 0113B DEFINITION (3) Motivational interviewing is a collaborative goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. Miller & Rollnick (2012, p.29)

11. CRICOS Provider Code: 0113B WHY MOTIVATIONAL INTERVIEWING? Evidence basedRelatively brief interventionValid and reliable tools Complementary to other interventions and methods Skills can be applied by a wide range of health practitioners

12. CRICOS Provider Code: 0113B WHAT MAKES IT MOTIVATIONAL INTERVIEWING? 4 KEY PROCESSES MILLER & ROLLNICK (2012)

13. CRICOS Provider Code: 0113B THE “SPIRIT” OF MOTIVATIONAL INTERVIEWING MILLER & ROLLNICK (2012) Collaboration AcceptanceCompassion Evocation

14. CRICOS Provider Code: 0113B RESIST THE RIGHTING REFLEX MILLER & ROLLNICK (2012)

15. CRICOS Provider Code: 0113B FIVE QUESTIONS MILLER & ROLLNICK (2012, P.11) 1.“Why would you want to make this change?” 2.“How might you go about it in order to succeed?” 3.“What are the three best reasons for you to do it?” 4.“How important is it for you to make this change and why? 5.“So what do you think you’ll do?”

16. CRICOS Provider Code: 0113B ENGAGING: OARS MILLER & ROLLNICK (2012) Open Questions Affirmation Reflection Summaries

17. CRICOS Provider Code: 0113B FOCUSING MILLER & ROLLNICK (2012) 1.“I know where we’re going, the focus is clear.” –Move to next steps: the evoking and planning processes 2.“There are several options - we need to decide.” –Work with client to identify possibilities and priorities –Agenda mapping may be useful with multi-issues 3.“The focus is unclear and we need to explore” –Use core skills to help client move from general to specific, e.g. OARS

18. CRICOS Provider Code: 0113B AGENDA MAPPING MILLER & ROLLNICK (2012) Improve my diet Lose weight Manage my medication Stop smoking Get more exercise Improve my mood Cut down drinking

19. CRICOS Provider Code: 0113B CHANGE AND SUSTAIN TALK MILLER & ROLLNICK (2012) Not Changing Benefits: SUSTAIN TALK Costs: CHANGE TALK Changing Benefits: CHANGE TALK Costs: SUSTAIN TALK

20. CRICOS Provider Code: 0113B EVOKING CHANGE TALK: DARN CATS MILLER & ROLLNICK (2012) Preparatory: Desire to change (want, like, wish…) Ability to change (can, could…) Reasons to change (If……then…….) Need to change (need, have to, got to…) Mobilising: Commitment (Intention, decision, promise) Activation (willing, ready, preparing) Taking Steps (doing)

21. CRICOS Provider Code: 0113B EVOKING CHANGE TALK MILLER & ROLLNICK (2012) Desire: “How would you like things to change?” “What do you hope our work will accomplish?” Ability: “How might you do it?” “How confident are you that you could…?” Reasons: “What might be the best reasons for…?” “What might be good about quitting?” Need: “How important is it that you change?” “What do you think has to change?”

22. CRICOS Provider Code: 0113B IMPORTANCE RULER: HOW IMPORTANT IS THE CHANGE? (1= NOT IMPORTANT; 10= EXTREMELY IMPORTANT) 12345678910 Evoking Change Talk Miller & Rollnick (2012)

23. CRICOS Provider Code: 0113B EVOKING: SNATCHING CHANGE TALK OUT OF THE JAWS OF AMBIVALENCE MILLER & ROLLNICK (2012) Change talk is often inter-twined with sustain talk… Show preferential reflection of change talk

24. CRICOS Provider Code: 0113B CHANGE TALK OUT OF AMBIVALENCE I really need to start having a regular walk to help maintain my weight, but I hate the thought of having to get up early to do it. 1.You really don’t want to be bothered getting up early. 2.You understand that you need to increase your exercise level to be healthy. 3.You don’t think that you could keep this exercise going.

25. CRICOS Provider Code: 0113B CONFIDENCE RULER: HOW CONFIDENT ARE YOU THAT YOU CAN MAKE THIS CHANGE? (1= NOT CONFIDENT AT ALL; 10 = EXTREMELY CONFIDENT) 12345678910 Evoking Confidence Miller & Rollnick (2012)

26. CRICOS Provider Code: 0113B RAISING CHALLENGES AND PROBLEMS MILLER & ROLLNICK (2012) “What might you do if…?” “How could you respond if…?” “What do you think would happen if…?”

27. CRICOS Provider Code: 0113B RECOGNISING READINESS MILLER & ROLLNICK (2012) Diminished sustain talk Resolve Increased change talk Questions about change Envisioning Taking steps Time for planning when: Sufficient engagement A clear shared change goal Sufficient client motivation for change

28. CRICOS Provider Code: 0113B EVOKING A CHANGE PLAN MILLER & ROLLNICK (2012) Setting goals Considering change options Arriving at a plan Strengthening confidence Eliciting confidence

29. CRICOS Provider Code: 0113B WHAT MAKES IT MOTIVATIONAL INTERVIEWING? 4 KEY PROCESSES MILLER & ROLLNICK (2012)

30. CRICOS Provider Code: 0113B REFERENCES Anderson, B., & Funnell, M. (2005).The Art of Empowerment (2 nd ed.). Alexandria, Virginia: American Diabetes Association. Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. Journal of the American Medical Association, 288:19, pp.2469-2475. Miller, W. & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3 rd ed.). New York, NY: Guildford Press Moore, M., & Tschannen-Moran, B. (2010). Coaching psychology manual. Philadelphia, PA: Lippincott, Williams & Wilkins.