Motivational Interviewing
in the Primary Care Setting
Presented by: Jonathan Betlinski, MD
Date: 12/17/2015
Disclosures and Learning Objectives
Learning Objectives:
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Know the 6 Stages of Change
Know the 1 goal of Motivational Interviewing
Know the 3 parts of the Spirit of MI
Know the 4 principles of MI
Know the 4 core communication skills of MI
Disclosures: Dr. Jonathan Betlinski has nothing to disclose except his
profound gratitude to the late Jon Emerson, LCSW, for his mentoring in
teaching this topic. Some of these slides are from a lecture of his.
Motivational Interviewing in Primary Care
• Review the history of MI
• Review the basic elements of MI
• Discuss the impact of MI in the Primary
Care Setting
• Discuss clinical scenarios in which MI may
be helpful
• Reveal next topic
Motivational Interviewing: History
Originally developed for use in Addiction
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First described in 1983 article
Miller and Rollnick published 2nd Edition in 2002
By 2013, more than 3,000 formally trained
More than 3 million clients in 47 languages
Number of studies doubles every 3 years
Now listed in SAMHSA’s NREPP
http://legacy.nreppadmin.net/ViewIntervention.aspx?id=346
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759607/pdf/nihms146933.pdf
Motivational Interviewing: Current Uses
Sexual Health
Dietary Change
Weight Loss
Voice Therapy
Gambling
Promote Physical Activity
Medication Adherence
Fibromyalgia
Diabetes
Chronic Leg Ulceration
Criminal Justice
Stroke Rehabilitation
Chronic Pain
Self-Care
Domestic Violence
Mental Health
http://integratedrecovery.org/wp-content/uploads/2012/07/MI-in-Primary-Care-Settings.pdf
Stages of Change
The Transtheoretical Model posits a series
of steps to adopting healthy behaviors
1.
2.
3.
4.
5.
6.
Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse
www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf
Stages of Change
http://www.socialwork.career/2013/02/motivationalinterviewing-client_20.html
Motivational Interviewing: Definition
Motivational interviewing is
“a directive, client-centered counseling
style for eliciting behavior change by
helping clients to explore and resolve
ambivalence.”
--Rollnick & Miller (1995)
Emerson
Motivational Interviewing: Definition
Motivational interviewing is
“a client-centered, directive method for
enhancing intrinsic motivation to change
by exploring and resolving ambivalence.”
--Miller and Rollnick (2002)
http://integratedrecovery.org/wp-content/uploads/2012/07/MI-in-Primary-Care-Settings.pdf
Motivational Interviewing: Definition
Motivational interviewing is
“a person-centered method of guiding to
elicit and strengthen personal motivation
for change.”
--Miller and Rollnick (2009)
http://integratedrecovery.org/wp-content/uploads/2012/07/MI-in-Primary-Care-Settings.pdf
Motivational Interviewing: Goal
The Goal of MI is simple:
Behavior Change
Commitment
Not
Capitulation
http://integratedrecovery.org/wp-content/uploads/2012/07/MI-in-Primary-Care-Settings.pdf
Motivational Interviewing: The Spirit
Collaboration (not confrontation)
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Counselor is a partner, not an authority
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Motivation for change is elicited, not imposed
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Task is to help client articulate and resolve ambivalence
Evocation (not imposition)
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Draw knowledge out rather than imparting it
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The patient is the expert in their own lives
Autonomy (not authority)
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Responsibility for change belongs to client
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The client presents the arguments for change
http://www.ytporegon.org/content/spirit-motivational-interviewing
Motivational Interviewing: The Principles
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Express Empathy
Develop Discrepancy
Roll with Resistance
Support Self-Efficacy
http://integratedrecovery.org/wp-content/uploads/2012/07/MI-in-Primary-Care-Settings.pdf
Express Empathy
• Accepting the person, their
situation, their point of view
• Respecting their explanations
• Reflective, nonjudgmental listening
• Avoiding criticism and blaming
• Support self-esteem
Emerson
Develop Discrepancy
• Identify problematic behavior
• Remind of goals and values
• Ask for help in understanding –
Columbo
• Be sincerely curious
• Use “so”, “if” reflectively
• Let client make the argument for
change
Emerson
Roll with Resistance
• Argument breeds defensiveness
• Go with the direction of the client’s
argument
• Suggest new perspectives, but don’t
insist on them
• “Take what you want, leave the
rest”
Emerson
Roll with Resistance
Argument breeds defensiveness
Go with the direction of the client’s
argument
Suggest new perspectives, but don’t
insist on them
“Take what you want, leave the rest”
“Yes….and”
Emerson
Support Self-Efficacy
Believe in the client’s capability
Explore strengths
Highlight positive exceptions
Emphasize small steps – realistic
hope
• Maintain confidence and optimism
• Anticipate a different future
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Emerson
Motivational Interviewing: Core Skills
Core MI Communication Skills – OARS
• Asking Open-ended Questions
• Making well-timed Affirmations
• Making frequent Reflective Listening
Statements
• Using Summaries to communicate
understanding
http://www.ytporegon.org/sites/default/files/fileattachments/HelpDocForOARSYTPWebPage_0.pdf
http://integratedrecovery.org/wp-content/uploads/2012/07/MI-in-Primary-Care-Settings.pdf
Motivational Interviewing: Inconsistent Items
MI Inconsistent Items
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Unsolicited Advice, Direction-Giving or Feedback
Emphasis on Abstinence Only
Direct Confrontation of Client
Emphasis on Powerlessness and Loss of Control
Asserting Authority
Closed-Ended Questions
http://www.drugabuse.gov/blending-initiative/motivational-interviewing-assessment
http://www.jdcap.org/SiteCollectionDocuments/Probation%20Supervision%20Self%20Assessment%20Form.pdf
Summary
• Motivational Interviewing is an effective
way to elicit healthy behavior change
• The Spirit of MI is one of Collaboration,
Evocation and Autonomy
• The Principles of MI include Expressing
Empathy, Developing Discrepancy,
Rolling with Resistance, and Supporting
Self-Efficacy
• Remember to use your OARS skills
The End!
PTSD
in the
Primary
Care
Setting
01/07/15
http://news.nationalgeographic.com/2015/12/151216-anwr-highest-peak-mt-isto-fodar-remote-sensing/