College of Public Programs
SCHOOL OF SOCIAL WORK
Robin Bonifas, PhD, MSW
Assistant Professor
Motivational
Interviewing:
An Introduction©
Celina Castelli
Hope Carroll
Veronica Montana
Rebecca Villanueva
What Is Motivational
Interviewing (MI)?
• MI is a client centered, semi-directive method of engaging
individuals in treatment or behavioral change.
• MI aims to promote and increase motivation to change behaviors
by exploring and resolving any issues of ambivalence the client
may be experiencing.
• MI addresses the client at their current state of functioning while
addressing the varying levels of readiness for client change.
• MI is non-judgmental, non-confrontational and non-adversarial.
4 Principles of MI
1)
Express empathy by sharing an understanding with the client of their
current situation and/or perspective.
2)
Help clients to explore and identify the discrepancies between what
they wants in their lives compared to their life current situation.
3)
Understand that resistance and reluctance are a natural and not
pathological response to change for the client.
4)
Support self efficacy:
•
Embrace client autonomy.
•
Help clients transition towards successful change with confidence.
Goals of MI
• Establish rapport
• Elicit and begin change talk
• Five stages of change:
1. precontemplation
2. contemplation
3. preparation
4. action
5. maintenance
• Establish commitment language from the client
• Be motivational!
Who May Benefit from MI:
Health related behavior changes
• Examples: smoking, diet, exercise
Treatment/medication adherence
• Examples: medication routine, maintaining medical appointments, individual
and/or group counseling or support sessions
Substance and/or alcohol abuse
• Can be used in conjunction with the 12-step program or in lieu of 12-step
program.
Child welfare
• Working with the parents and/or external support systems
Emotional behavior control
• Example: anger management, processing, verbalizing
A Video Example:
• http://www.youtube.com/watch?v=dmrJJPCuTE
A Case Study:
Jim Hernandez
• Jim is a 68-year old, Hispanic male with type-2 diabetes that lives
independently and is retired. He is divorced with two adult children and has
had recent difficulty monitoring his health and diabetes routine, including his
medication management. He reports a lack of energy, increased fluid intake
and more frequent urination.
• PCP advised Jim to frequently check his blood pressure at home, eat more
low-fat foods and increase his physical activity.
• Jim voiced concerns about his ability to be able to maintain and follow these
recommendations and asked for a referral to speak to a counselor, therapist,
or social worker who could help motivate him to maintain his diabetes better
• During intake with social worker, Jim voiced ambivalence regarding changing
his behaviors using statements such as, “I know I need to change and I want to
change, but it’s so difficult to take that first step,” and “I am already so old,
why do I need to change?”
Jim Hernandez continued…
• How would motivational interviewing help Jim
and others in similar situations?
• What would be the first step to take as a social
worker?
• How would you begin motivational interviewing
with Jim?
• Any identifiable barriers to change?
What Does the Literature Say?
The article, Motivational Interviewing to Affect Behavioral Changes in Older Adults,
reviews and assesses research literature regarding the efficacy of motivational
interviewing with older adults who have serious health challenges. As a result of
motivational interviewing, a considerable improvement in physical activity, diet,
cholesterol, blood pressure, glycemic control and increased smoking cessation
was found.
It is very important to note that all persons who are considering a behavioral
change have an internal conflict as to the pros and cons of the change they will
possibly be making. The article discusses the role of the motivational therapist to
help the client overcome their internal conflicts so they can then recognize the
positive benefits of change.
The studies reviewed by this article also suggest that motivational interviewing is
acceptable to older adults, which in turn can generate change in various health
behaviors in a relatively short period of time. However, there were variations in
findings which could have been because of the differences in treatment.
Cummings, Cooper & Cassie (2009). Motivational interviewing to affect behavioral change in older adults.
Research on Social Work Practice, 19(2), 195-204.
Literature Continued…
Motivational Strategies with Alcohol-Involved Older Adults: Implications for Social
Work Practice explores problem drinking in older adults and barriers to them
receiving assistance by outlining practice strategies. According to this article,
motivational interviewing is made up of two phases. Phase One is where
motivational change is built and Phase Two is where commitment to change is
strengthened.
When treating alcoholism, it important to know that people will only change
when the costs of their actions begin to outweigh the benefits. Therefore,
motivational interviewers facilitate change by highlighting how the problem
behavior affects the client’s self-mage, perceptions and aspirations.
Excessive drinking in older adults is a greater problem than previously thought
and motivational interviewing has proven useful in assisting older adults to
change their behavior. In addition to motivational interviewing, social workers can
offer help by identifying people in need, locating services and gathering support
from family members and organizations.
Hanson, M., & Gutheil, I. A. (2004). Motivational strategies with alcohol-involved older adults: Implications for
social work practice. Social Work, 49(3), 364-372.
Literature Continued…
An overview and process evaluation of TeleWalk: a telephone-based counseling
intervention to encourage walking in older adults discusses the development and
participant evaluation of TeleWalk. Also, the benefits of a physically active lifestyle
for older adults is discussed in this article.
The participants were recruited through their general practitioner and randomly
chosen to receive either eight telephone counseling sessions and printed material
over three months or to participate in outcome assessments only. All the
respondents agreed that the counselors advice encouraged them to become
physically active and was processional, motivating and helpful.
•
Kolt, G. S., Oliver, M., Schofield, G. M., Kerse, N., Garrett, N., & Latham, N. K. (2006). An overview and process
evaluation of TeleWalk: A telephone-based counseling intervention to encourage walking in older adults.
Health Promotion International, 21(3), 201-208.
Literature Continued…
A Randomized Trial of Tailoring and Motivational Interviewing to Promote Fruit and
Vegetable Consumption for Cancer Prevention and Control discusses how
motivational interviewing can help facilitate healthful eating habits which can
lower the risk of chronic diseases and risk of cancer. In this article, a study was
done that tested two health communication interventions and their effectiveness
in increasing fruit and vegetable consumption and physical activity in older adults
with and without cancer. Tailored print communication and brief telephone-based
motivational interviewing were the two different communication interventions
that were tested.
A significant increase in fruit and vegetable consumption was found for the
combined intervention group while none of the interventions produced
statistically significant improvements in increased physical activity. In addition, an
intervention that combined both communication strategies was found to be most
cost-effective for those without cancer while the study did not compute costeffectiveness for those with cancer because of insufficient evidence of differential
intervention effectiveness.
Campbell, M. K., Carr, C., DeVellis, B., Switzer, B., Biddle, A., Amamoo, M. A., et al. (2009). A randomized trial
of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention
and control. Annals of Behavioral Medicine, 38(2), 71-85.
Literature Continued…
The article, Motivational interviewing to change quality of life for people with
chronic heart failure: A randomized controlled trial, covers a study that consisted
of patients with chronic heart failure who’s quality of life has been reduced
because of a their limited physical activity and lack of independence. In this study,
sixty older patients were given either standard care, motivational interviewing or
both.
The study showed motivational interviewing, which incorporated behavior
change principles to promote physical activity, is effective in improving different
aspects of quality of life of those with chronic heart failure. This study also
showed that motivational interviewing is a viable option compared to traditional
exercise programming.
At baseline, 98% of participants were in pre-contemplation or contemplation
to change their behavior towards increased physical activity. At the end of
the follow-up period, 48% had improved into the preparation stage of
increasing their physical activity and 13% were in the action stage of increased
physical activity.
Brodie, D. A., Inoue, A., & Shaw, D. G. (2008). Motivational interviewing to change quality of life for people
with chronic heart failure: A randomised controlled trial. International Journal of Nursing Studies, 45(4), 489500.
Quick References
•
Brodie, D. A., Inoue, A., & Shaw, D. G. (2008). Motivational interviewing to change
quality of life for people with chronic heart failure: A randomised controlled trial.
International Journal of Nursing Studies, 45(4), 489-500.
•
Campbell, M. K., Carr, C., DeVellis, B., Switzer, B., Biddle, A., Amamoo, M. A., et al.
(2009). A randomized trial of tailoring and motivational interviewing to promote fruit
and vegetable consumption for cancer prevention and control. Annals of Behavioral
Medicine, 38(2), 71-85.
•
Cummings, S.M., Cooper, R.L., & Cassie, K.M. Motivational interviewing to affect
behavioral change in older adults.(2009). Research on Social Work Practice, 19(2), 195204.
•
Hanson, M., & Gutheil, I. A. (2004). Motivational strategies with alcohol-involved older
adults: Implications for social work practice. Social Work, 49(3), 364-372.
•
Kolt, G. S., Oliver, M., Schofield, G. M., Kerse, N., Garrett, N., & Latham, N. K. (2006). An
overview and process evaluation of TeleWalk: A telephone-based counseling
intervention to encourage walking in older adults. Health Promotion International, 21(3),
201-208.