From Course Objectives

Contents 1 Executive Summary 2 Objectives 2.1 Describe 3 aspects of motivational interviewing: 2.2 List the 4 guiding principles of motivational interviewing using RULE 2.3 Identify motivational interviewing strategies that form the acronym OARS 3 Links & References

Executive Summary

• “Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.” ^[1]
• 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:
   • We have a baseline level of motivation and readiness to change, but this fluctuates with our interactions
   • Encouragement instead of prescribing or just going along with patient
   • “Resistance and ‘denial’ are seen not as client traits, but as … a cue that the therapist needs to modify motivational strategies.”
2. Evocative (drawing out):
   • Resources + motivation for change presumed to reside within the patient
   • Focus on client’s reasons for change:
   • “Values and behaviors interact” (Rokeach’s value theory)
   • Example: threatening death from lung cancer less effective than learning about patient’s own reasons to stop smoking (family responsibility, etc.)
   • Connect what your patients care about with health care goals
3. Autonomy: honoring independent choice
   • Acceptance that people can and do make choices about the course of their lives
   • 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

1. ↑ Stephen Rollnick, Ph.D., & William R. Miller, Ph.D., "What is MI?", Motivational Interviewing: Resources for clinicians