Motivational Interviewing

=Executive Summary=
 * “Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.”
 * A principles of motivational interviewing is that the motivation to change is elicited from the client and not imposed from without. Direct persuasion is not an effective method for resolving ambivalence.

=Objectives=

Describe 3 aspects of motivational interviewing:

 * 1) Collaborative:
 * 2) *We have a baseline level of motivation and readiness to change, but this fluctuates with our interactions
 * 3) *Encouragement instead of prescribing or just going along with patient
 * 4) *“Resistance and ‘denial’ are seen not as client traits, but as … a cue that the therapist needs to modify motivational strategies.”
 * 5) Evocative (drawing out):
 * 6) *Resources + motivation for change presumed to reside within the patient
 * 7) *Focus on client’s reasons for change:
 * 8) *“Values and behaviors interact” (Rokeach’s value theory)
 * 9) *Example: threatening death from lung cancer less effective than learning about patient’s own reasons to stop smoking (family responsibility, etc.)
 * 10) *Connect what your patients care about with health care goals
 * 11) Autonomy: honoring independent choice
 * 12) *Acceptance that people can and do make choices about the course of their lives
 * 13) *Acknowledging the patient’s freedom NOT to change sometimes makes change possible

List the 4 guiding principles of motivational interviewing using RULE

 * Resist the Righting Reflex
 * “Status quo talk:” least desirable situation from the standpoint of evoking motivation = when provider advocates for change while patient argues against it
 * Understand
 * Listen
 * Empower your patient (to advocate for their own change)
 * “Change talk:” we become more committed to that which we voice (Bem’s self-perception theory)
 * Self-efficacy: a person must have hope they can change; person’s and provider’s expectations predict outcomes

Identify motivational interviewing strategies that form the acronym OARS

 * Open-ended questions: “what do you think about your current level of physical activity?”
 * Negative aspects: What makes you think you need to do something about ______?
 * Optimistic questions: When else in your life have you made a significant change like this?  How did you do it?  What personal strengths do you have that will help you succeed?
 * Intention to change: What do you think you might do? What would you be willing to try?
 * Affirmations:
 * Emphasize strength
 * Notice/appreciate positive action
 * Genuine
 * Express hope, caring, or support
 * Reflective statements
 * Statements, not questions
 * Restate what patient says and selectively reinforce change talk
 * Puts patient in a more active role when discussing behavior change
 * Example: PT: “I don’t have time to exercise.” Reflection: “You’re concerned about your lack of exercise.”
 * Summarize
 * Collect material that has been offered
 * Link something just said with something that was said earlier
 * Draw together what has happened and transition to a new task
 * Stop the “talkers”: give value to what you have heard: “we have talked about a lot of things today. If you had to pick one thing to work on, what would it be?”

=Links & References=