Diane Jankowski RN BSN CCM . their values and goals), Can take the form of compliments or statements of appreciation and understanding, Helps build rapport and validate and support the patient during the process of change, Most effective when the patient’s strengths and efforts for change are noticed and affirmed, Involves rephrasing a statement to capture the implicit meaning and feeling of a patient’s statement, Encourages continual personal exploration and helps people understand their motivations more fully, Can be used to amplify or reinforce desire for change, Links discussions and ‘checks in’ with the patient, Ensure mutual understanding of the discussion so far, Point out discrepancies between the person’s current situation and future goals, Demonstrates listening and understand the patient’s perspective. Motivational interviewing is a counselling method that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy; and Empower the patient. • Motivational Interviewing Techniques: Facilitating change in the general practice setting • Talking Points – Discussing OUD with your patient (Appendix C) • Stages of Change and Associated Interventions (Appendix D) • SMART Recovery Change Plan Worksheet (Appendix E) • Addiction and Mental Health Resource List (Appendix F) I'm going to explain the basics of motivational interviewing for personal trainers. [email protected], © The Royal Australian College of General Practitioners 2016 However, research around behaviour change shows that motivation is a dynamic state that can be influenced, and that it fluctuates in response to a practitioner’s style. Motivational interviewing requires four key communication skills that support and strengthen the process of eliciting change talk, also known as OARS: Open-ended questions; Affirming; Reflective listening; Summarizing; Open-ended questions in Motivational interviewing, second edition: Preparing people for change. J Acquir Immune Defic Syndr 2006;41:44–52. Rollnick S, Miller WR, Butler CC. Successful progression through these stages leads to action, where the necessary steps to achieve change are undertaken. 0000002156 00000 n A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Hettema J, Steele J, Miller WR. In subsequent consultations, when these strategies don't work, it is easy to give up hope that he will change his drinking, characterise him as 'unmotivated' and drop the subject altogether. Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. You may not remember all of the processes and techniques of MI, but if you incorporate the Spirit of MI in all of your interactions with youth, you would have gone a long way in making a difference. Let's break the definition down to better understand the theoretical underpinnings of this approach. The practitioner connects health behaviour change to the things the patient cares about, Education: the patient is presumed to lack the insight, knowledge or skills required to change. Outline emergency management of an acute asthma attack. In MI, the opposite approach is taken, where the patient's motivation is targeted by the practitioner. I believe people know what’s best for them. Alcohol 2005;40:535–9. 41(9), Sept., 2012, pp 660-667. When have you made a significant change in your life before? within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. SPIRIT Of MOTIVATIONAL INTERVIEWING While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points: 1. Influencing risk behavior of sexually transmitted infection clinic visitors: Efficacy of a new methodology of motivational preventive counseling. For example, drinking may impact the patient's values about being a loving partner and father or being healthy and strong. Motivational interviewing ( MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. Files on the website can be opened or downloaded and saved to your computer or device. This involves goal setting and negotiating a 'change plan of action'. The Royal Australian College of General Practitioners. Motivational interviewing. Recommendations 0000008212 00000 n West D, Dilillo V, Bursac Z, Gore SA, Greene PG. Australian Family Physician, Vol. The Substance Use Motivation Ruler is an excellent tool derived from motivational interviewing. Motivational interviewing emphasises eliciting reasons for change from the patient, rather than advising them of the reasons why they should change their drinking. ADefinition"of"Motivational"Interviewing" The!definition!of!Motivational!Interviewing!(MI)!has!evolved!and!been!refined!since!the!original! A discussion of how continuing to drink (maintaining the status quo) will impact his future goals to travel in retirement or have a good relationship with his children may be the focus. Motivational Interviewing can be a great technique for personal trainers to use to understand and encourage clients to stick with fitness. Barriers to implementing MI in general practice include time pressures, the professional development required in order to master MI, difficulty in adopting the spirit of MI when practitioners embody an expert role, patients' overwhelming desire for 'quick fix' options to health issues and the brevity of consultation times. When these strategies don’t succeed, the practitioner may characterise the patient as ‘unmotivated’ or ‘lacking insight’. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own arguments for change 11 It is the patient's own reasons for change, rather than the practitioner's, that will ultimately result in behaviour change. Ann Rev Clin Psychol 2005;1:91–111. Motivational Interviewing and Oral Health Communication: Case-based Studies Maureen George, PhD RN AE-C FAAN . DiClemente CC, Velasquez M. Motivational interviewing and the stages of change. Helping patients change behavior. The core principle of the approach is negotiation rather than conflict. It has been shown to be effective in the primary care setting with smoking cessation, hazardous drinking, physical activity, nutrition and chronic disease. Participants learn 14 different Motivational Interviewing techniques that can be used to help clients identify and overcome reluctance to discuss to achieve their goals. 0000004364 00000 n Motivational interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. ‘I want to manage my diabetes better’, the importance of change for the patient (willingness). In: Miller WR, Heather N, editors. This will get you to understand how you … 0000004688 00000 n Provide harm reduction strategies. The practitioner acknowledges the patient’s expertise about themselves, Confrontation: the practitioner assumes the patient has an impaired perspective and consequently imposes the need for ‘insight’. What difficulties have resulted from your drinking? Ambivalence is particularly evident in situations where there is conflict between an immediate reward and longer term adverse consequences (eg. Motivational Interviewing Motivational interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. Their transtheoretical model of behaviour change (the 'Stages of Change') describes readiness to change as a dynamic process, in which the pros and cons of changing generates ambivalence. 0000004111 00000 n DOC Some documents on this site are in Microsoft Word format. On the other hand, the pros for adopting an MI approach with patients who are resistant to change are compelling. If a practitioner has more time, four additional principles (Table 5) can be applied within a longer therapeutic intervention. Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. Melanie A. The seminal text on motivational interviewing (Motivational Interviewing: Preparing People for Change) by Miller & Rollnick defines the theory as a "client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" (1). They would then work on resolving this ambivalence, by connecting the things the patient cares about with motivation for change. Miller and Rollnick17have attempted to simplify the practice of MI for health care settings by developing four guiding principles, represented by the acronym RULE: The righting reflex describes the tendency of health professionals to advise patients about the right path for good health. To open click on the link, your computer or device will try and open the file using compatible software. But I can give you an idea of what the evidence shows us and what other people have done in your situation'. Gray E, McCambridge J, Strang J. Where would you be on this scale? What do you think you might do? Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management. If you could do anything, what would you change? Examples of key questions to build a 'change plan' include: It is common for patients to ask for answers or 'quick fixes' during Phase II. These files will have "PDF" in brackets along with the filesize of the download. For further information and online motivational interviewing training opportunities visit www.motivationalinterviewing.org. Motivation to change is elicited from the client, and is not imposed from outside forces. Focusing: identifying a target for change that is to be the primary subject of discussion in therapy. PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). Motivational interviewing (MI) is an effective counselling method that enhances motivation through the resolution of ambivalence. The heart or spirit of MI can be denoted by the acronym CARE. Motivational Interviewing: An Appropriate Model for Engaging Clients with Drug Abuse Problems in the Probation Service Sheena Norton* Summary: Motivational Interviewing (MI), initially developed to assist those with alcohol addiction issues (Miller, 1983), is also a useful strategy in probation work with Bendigo CHS Men’s Health ClinicImproving access to primary care, January/February - Teaching in general practice, Australian Family Physician (incorporating Annals of General Practice) In Phase I, four early methods represented by the acronym OARS (Table 3) constitute the basic skills of MI. What would it take for you to go from ___ to (a higher number)?'. Privacy | Terms of use, Facilitating behaviour change in the general practice setting, Incorporating therapy into general practice, Use and effectiveness in general practice, Results from a survey of general practice registrars. This involves focusing on the patient's strengths and past experiences of success. inaccuracies contained therein or for the consequences of any action taken by any person as a result of Motivational interviewing includes a range of techniques to help people make changes in their behaviour. 0000003393 00000 n Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behaviour. 0000005892 00000 n Treating addictive behaviours: processes of change. The Techniques Of MI. Motivational interviewing is important as it helps the patient identify the thoughts and feelings that cause them to continue “unhealthy” behaviours and help her to develop new thought patterns to aid in behaviour change ("Motivational Interviewing: A Tool for Behaviour Change", 2020). Employ motivational interviewing techniques for a patient who smokes and discuss non-pharmacological and pharmacological methods of quitting. is published by The Royal Australian College of General Practitioners, taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or Motivational Interviewing (MI) is a style of counseling that mental health professionals use to encourage productive verbal sessions with patients who are afflicted with multiple, or co-occurring, disorders. 0000000996 00000 n In keeping with the spirit of MI, a simple phrase reminding the patient of their autonomy is useful, 'You are the expert on you, so I'm not sure I am the best person to judge what will work for you. Prochaska J, DiClemente C. Towards a comprehensive model of change. Family members, friends and peers of those with co-occurring mental disorders can use the motivational interviewing technique outside of Joint decision making occurs. Evoking: eliciting ‘change talk’ to support patient motivation. J Nerv Ment Dis 1999;187:630–5. smoking, overeating, heavy drinking) or adopting healthy or safe behaviours (eg. necessarily those of the publisher or the editorial staff, and must not be quoted as such. Using the spirit of MI, the practitioner avoids an authoritarian stance, and respects the autonomy of the patient by accepting he has the responsibility to change his drinking – or not. This trap can be avoided by employing strategies to elicit 'change talk'.1 There are many strategies to elicit 'change talk', but the simplest and most direct way is to elicit a patient's intention to change by asking a series of targeted questions from the following four categories: Alternatively, if a practitioner is time poor, a quick method of drawing out 'change talk' is to use an 'importance ruler'. Latchford, G. (2010). 0000007561 00000 n 0000012112 00000 n On this scale, zero is not important at all and 10 is extremely important. 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