1. Motivational Interviewing The Process of Change Gloria Sayler, Seattle, U.S. Communication Skills Teacher

2. Change Think about a pt who is trying to make a change Consider a change you tried to make What helped, what didnt?

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 behaviors 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 ?

10. Maintenance Keeping the change in behavior in place –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