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Motivational Interviewing as a Clinical Tool to Improve Patient Outcomes

Presenter: Trisha Arnold, BS
Clinical Psychology Doctoral Trainee
Jackson State University
University of Mississippi Medical Center

(content from PowerPoint presentation)

 

Overview of Presentation

Objective 1: Review of Motivational Interviewing

  • Spirit of Motivational Interviewing
  • Eliciting Change Talk
  • Responding to Change Talk
  • Short Video Example of Motivational Interviewing in a Clinical Setting

Objective 2: Review Uses of Motivational Interviewing in Clinical Settings

  • Medication Adherence
  • Weight Loss

Objective 3: Implementing Motivational Interviewing

  • Open Discussion With Examples of Possible Uses of Motivational Interviewing
  • Interactive Exercise to Practice Motivational Interviewing Skills

 

What Is Motivational Interviewing?

  • A method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior
  • A goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence
  • Patient focused psychotherapy that seeks to resolve ambivalence about changing behavior.

Overall goal of MI is to elicit change using an individuals unique motivational reasoning

 

Characteristics of MI

  • Motivational interviewing relies upon identifying and mobilizing the client's intrinsic values to stimulate behavior change
  • Motivation to change is elicited from the client and not imposed
  • Motivational interviewing is designed to elicit, clarify, and resolve ambivalence and to perceive benefits and costs associated with it
  • Eliciting and reinforcing the client’s belief in ability to carry out and succeed in achieving a specific goal is essential
  • The therapeutic relationship is a partnership
  • Motivational interviewing is both a set of techniques and counselling style
  • Motivational interviewing is directive and client-centered

http://www.ghurani.com/

 

Effectiveness of Motivational Interviewing in Clinical Settings 

  • Promote Weight Reduction
  • Dietary Modification
  • Increase Exercise
  • Decrease Smoking
  • Increase Safer Sex Practices
  • Increase Contraception Use
  • Medication Adherence
  • Medical Appointment Adherence

 

How to Perform Motivational. Interviewing

  • Express Empathy and Avoid Discrepancies
  • Develop Discrepancies
  • Roll with Resistance and Provide Personalized Feedback
  • Support Self-Efficacy and Elicit Self-Motivation

 

4 Processes of Motivational Interviewing

  • Engaging: The process of establishing a mutually trusting and respectful helping relationship
  • Focusing: Focus on a particular agenda. Clarify the direction of conversation.
  • Evoking: Eliciting the client’s motivation for change.
  • Planning: Commitment and action plan.

 

Identify and Elicit Change Talk

  • Desire
  • Ability
  • Reason
  • Need

 

Responding to Change Talk

  • Open Ended Questions: Asking for elaboration or more detail
  • Affirming: Recognize what the person is saying about change talk in a positive manner.
  • Reflecting: Convey understanding with a simple or complex reflection
  • Summarizing: Collect and give back bouquets of change talk

 

Simple or Complex Reflections

  • Simple: reflecting back what the person said
  • Complex: reflecting back the meaning of what the person said or reflecting in a extreme version of what the person said (never, always, impossible)

 

Quote

"A simple reflection…is like an iceberg…it is limited to what shows above the water, the content that has actually been expressed, whereas a complex reflection makes a guess about that lies beneath the surface."

- Miller & Rollnick, M13, p. 58

 

Utilizing Rulers to Elicit Change Talk

Graph interpretation: https://www.guilford.com/add/miller11_old/change_r.pdf?t=1 

 

Stages of Change: Primary Tasks

Graph interpretation: https://web.archive.org/web/20160821233850/http://www.ghurani.com/fundamental-principles.html 

http://www.ghurani.com/

 

MI Spirit: The Essential Foundation

  • Partnership: You and the client are equal experts
  • Acceptance: Absolute worth, accurate empathy, autonomy support, affirmation
  • Compassion: Beneficence, caring, focus on the other
  • Evocation: The client's wisdom is most important

 

Example of an Ineffective Physician

 

Example of an Effective Physician

 

When Could MI Be Useful for You?

 

Practice (Grab a Partner!)

  • Listener only uses motions (Speaker tell about your favorite job)
  • Listener can give simple reflections (Speaker tell about why you chose your profession)
  • Listener can give complex reflections (Speaker discuss something you would like to change in your life)

 

Current Study Utilizing Motivational Interviewing: MI-Prep

  • "A Pilot Study Assessing a Single Motivational Interviewing Session to Improve Uptake of PrEP among Young black MSM"
  • Tests a single-session of motivational interviewing (MI) designed to promote the acceptance and use of PrEP
  • Target sample is high-risk young black men who have sex with men YBMSM
  • The goal is increase PrEP uptake and to identify and modify psychosocial and structural predictors of PrEP acceptance.

 

The One-hour Session Has 7 Objectives:

  1. Build a positive rapport with the participant.
  2. Use the "readiness ruler" to identify readiness to initiate PrEP.
  3. Identify motivations for declining PrEP.
  4. Discuss his perceptions of PrEP and ensure he has a thorough understanding of the purpose of PrEP medication.
  5. Elicit "change talk" using reflection and rolling with resistance techniques.
  6. Discuss potential benefits or barriers of initiating PrEP.
  7. Using the readiness ruler a second time to assess readiness at the end of the MI session.

 

Questions

 

Contact Information:

Trisha Arnold

tarnold@umc.edu 

(601) 815-4999 or (870) 750-0392