FROM “ NO I WON’T”
TO “YES I DID!”
Using Motivational Interviewing to Promote
Engagement in Occupation
Objectives
■ Participants will define motivational interviewing (MI).
■ Participants will relate the use of MI to the practice of
occupational therapy (OT), including core values and
practices, and relation to occupation.
■ Participants will identify populations that may benefit from
the use of MI in OT.
■ Participants will demonstrate the four core skills of MI.
Population/Setting and OT Focus
■ Chronic pain, return to work
■ Hand therapy, home program
■ Diabetes, healthy cooking
■ Spinal cord injury, pressure
relief
■ Fall risk, remove clutter
■ Hypertension, medication
management
■ Post-stroke, stress
management
■ Parents of children with
disabilities, use of assistive
tech
WHAT DO THESE
SCENARIOS HAVE IN
COMMON?
Discussion
■ Question 1: What barriers
does your population likely
encounter that limits
performance of the
identified occupation?
■ Question 2: Considering
these barriers, if someone
told a client how to improve
in this area, what might the
client say in response?
■ Chronic pain, return to work
■ Hand therapy, home program
■ Diabetes, healthy cooking
■ Spinal cord injury, pressure
relief
■ Fall risk, remove clutter
■ Hypertension, medication
management
■ Post-stroke, stress
management
■ Parents of children with
disabilities, use of assistive
tech
Imagine that your client says…
■ … “I want to go back to work, but I’m not sure how
to manage the pain and get my work done.”
■ … “All of you therapists come in here and tell me to
clean my house. It’s cleaner than it’s ever been! I
just need to be more careful when I walk.”
■ … “It’s time for me to cook my own meals. Eating
out is expensive, and it’s not good for my health.”
Learn to cook
Return to work
Move newspapers
Where do you want YOUR client to be?
Question 3
■ Relate the client
quotes from
Question 2 to these
steps/stages.
■ Where is your
imagined client
right now?
HOW CAN YOU HELP
THEM GET TO
“YES I DID”?
Client Interactions
How Would You Respond?
■ … “I want to go back to work, but I’m not sure how
to manage the pain and get my work done.”
■ … “All of you therapists come in here and tell me to
clean my house. It’s cleaner than it’s ever been! I
just need to be more careful when I walk.”
■ … “It’s time for me to cook my own meals. Eating
out is expensive, and it’s not good for my health.”
“Traditional approaches to treating individuals
…might include educating them about their
condition, giving recommendations on how to
prevent and recover from the injury, and
instructing them on home exercises and activity
modifications. With my client, these approaches
initially led to resistance and little compliance.”
(Bracken, 2017, p. 20)
Ambivalence and Influencing Change
Make a Change
Stay the Same
Stages of Change (Prochaska & DiClemente, 1984)
Precontempation
“I won’t do it.”
"I can't do it."
Contemplation
"I want to do it."
"How do I do it?"
Preparation
"I'll try to do it."
"I can do it."
"I will do it."
Action
"I'm doing it!"
Maintenance
"Yes, I did it!"
"I'm still doing it!"
Motivation
■ Movement toward change
■ Occurs when ambivalence is resolved
■ Results from interactions
– Does NOT reside within clients
(Miller & Rollnick, 2012)
Motivational Interviewing (MI)
“Motivational interviewing (MI) is a
collaborative, goal-oriented style of
communication…designed to strengthen
personal motivation for and commitment to
a specific goal by eliciting the person’s
reasons for change within an atmosphere of
acceptance and compassion.”
(Miller & Rollnick, 2012, p. 29)
Motivational Interviewing (MI)
In other words...
A way to talk with people about change.
MI’s Relationship to OT
■ Therapeutic use of self
■ OT’s values
– Client-centered
– Considers client’s contexts;
values and beliefs;
personal goals
■ Motivation affects
participation and occupational
performance
By U.S. Navy photo by Mass Communication Specialist 3rd Class
Jake Berenguer [Public domain], via Wikimedia Commons
WHAT SPECIFIC
SKILLS DOES MI
INVOLVE?
Core Skills of MI
■Open-Ended Questions
■Affirmations
■Reflections
■Summaries
Open-Ended Questions
■Get more information
■Avoid assumptions
■Provide clarification
■Not inquisition
Affirmations
■Client strengths
■Genuine statements
■“You”
■Choose specific behaviors
Reflections
■ Check your understanding
■ Processing time
■ Capture positives
■ Reinforce change talk
■ Reflections as statements
– Avoid “It sounds like…”
– Don’t ask questions
■ Incorrect reflections are OK!
Summaries
■ Use “and”, avoid “but”
■ Clarification
■ Change talk
■ Be concise
■ Change the path
Back to Occupation…
Some Possible Responses
Client Says…
The OT Might Say…
■
“I want to go back to work, but I’m not
sure how to manage the pain and get
my work done.”
■
“Getting back to work and doing your job
well is really important to you.”
■
All of you therapists come in here and
tell me to clean my house. It’s cleaner
than it’s ever been! I just need to be
more careful when I walk.”
■
“You’ve worked hard to pick things up
so that you don’t trip, so it’s frustrating
to be told that you should do more
cleaning. It seems like there must be a
different approach to keep you safe.”
■
“It’s time for me to cook my own meals.
Eating out is expensive, and it’s not
good for my health.”
■
“What steps do you think you might take
to begin cooking meals for yourself?”
Supporting Evidence
Return to work with chronic pain:
Thompson, 2013
Healthy cooking with diabetes:
Mann, Javaherian-Dysinger, & Hewitt, 2013
Social participation with Vets with PTSD:
Beauchesne & Jacques, 2015
Instead of this…
■ Occupation-Based?
■ Client-Centered?
■ Self-Motivated?
….Let’s aim for this…
“Your purpose is to understand the life
before you, to see the world through
this person’s eyes rather than
superimposing your vision.”
(Miller & Rollnick, 2012, p. 16)
References
■ Beauchesne, J. & Jacques, C. (2015). From combat to compassion: Enabling
change in Veterans. Occupational Therapy Now, 17(5), 26.
■ Blanche, E. I., Fogelberg, D., Diaz, J., Carlson, M., & Clark, F. (2011). Manualization
of occupational therapy interventions: Illustrations from the pressure ulcer
prevention research program. American Journal of Occupational Therapy, 65, 711719.
■ Bracken, A. (2017, May 8). Engaging challenging clients through Motivational
Interviewing. OT Practice, 20-22.
■ Hildebrand, M. (2015). Effectiveness of interventions for adults with psychological
or emotional impairment after stroke: An evidence-based review. American Journal
of Occupational Therapy, 69(1), 1-8.
References
■ Mann, D. P., Javaherian-Dysinger, H., & Hewitt, L. (2013, September 23). Ounce of
prevention: Using the power of lifestyle to improve health outcomes. OT Practice,
16-21.
■ Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change
(3rd ed.). New York, NY: Guilford Press.
■ Schwartz, J. K., Grogan, K. A., Mutch, M. J., Nowicki, E. B., Seidel, E. A., Woelfel, S. A.,
& Smith. R. O. (2017). Intervention to improve medication management: Qualitative
outcomes from a Phase I randomized controlled trial. American Journal of
Occupational Therapy, 71(6), 1-10.
■ Thompson, B. (2013). Are you ready? Readiness to return to work for people living
with chronic pain. Occupational Therapy Now, 14(5), 13-15.
Questions?