{"id":1790,"date":"2016-02-01T08:29:00","date_gmt":"2016-02-01T16:29:00","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=1790"},"modified":"2016-01-25T16:31:21","modified_gmt":"2016-01-26T00:31:21","slug":"motivational-interviewing","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=1790","title":{"rendered":"Motivational Interviewing"},"content":{"rendered":"

Definition of Motivational Interviewing (MI):<\/strong> Patient-centered communication style for eliciting behavior change by helping patients explore and resolve ambivalence.<\/p>\n

Indications for Use:<\/strong> There\u2019s NEVER a bad time. But most useful when you sense that YOU have a greater motivation for change than the PATIENT does her\/himself.<\/p>\n

Basic Principles of Motivational Interviewing:<\/strong><\/p>\n

    \n
  1. Don\u2019t tell patients what to do<\/li>\n
  2. Listen instead<\/li>\n
  3. Let the patient tell you<\/em> they need to change<\/li>\n
  4. Help patients choose to change. If contrast between two choices is brought out, patients feel an urge to resolve the conflict by making a choice<\/li>\n
  5. Help patients feel confident before they try to change<\/li>\n
  6. Treat ambivalence around tough choices as normal<\/li>\n<\/ol>\n

    Four Goals in using Motivational Interviewing for identifying and suggesting treatment for substance use problems:<\/strong><\/p>\n

    (This example features using MI in a potential problem drinking situation but could apply to the misuse or overuse of any substance.)<\/p>\n

      \n
    1. Get permission to begin a conversation with patient after conducting a screening:<\/strong><\/li>\n<\/ol>\n

      DON\u2019T TELL: It looks like you have a drinking problem.<\/p>\n

      This is heard as, \u201cYou\u2019re a drunk and aren\u2019t you ashamed!\u201d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/em><\/p>\n

      ASK: \u201cIs it okay if I give you feedback on the screening we just did about your alcohol use?\u201d<\/p>\n

      If YES: give feedback in neutral, generalized way, for example, say, \u201cThe guidelines indicate that more than ___ drinks per day or ___ drinks per week can indicate problem drinking for (insert patient\u2019s gender). Your answers indicate you may fall into that range.\u201d \u00a0<\/em><\/p>\n

      If NO: \u201cI understand. This is something that is difficult for most of my patients. Can you share why it may be difficult for you?\u201d\u00a0 Engage in empathetic listening. Then summarize what you\u2019ve heard and ask, \u201cAm I hearing you correctly.\u201d<\/em><\/p>\n

        \n
      1. Develop discrepancy between the patient\u2019s goals or values and their current behavior.<\/strong><\/li>\n<\/ol>\n

        \u201cWhat are some of the things you like about drinking?\u201d<\/p>\n

        \u201cAre there any concerns you\u2019ve had about your drinking?\u201d<\/p>\n

        \u201cTell me about a time that your drinking had a negative effect on your health or job or family life.\u201d<\/p>\n

        \u201cDoes this match up with how you want to take care of yourself?<\/p>\n

        \u201cDoes this match up with how you make other decisions in your life?\u201d<\/p>\n

        \u201cIt sounds like there are some reasons to make changes but you also don\u2019t want to give up something you enjoy? This is entirely normal.\u201d<\/p>\n

        Again, just listen and then summarize as in the prior step.<\/em><\/p>\n

          \n
        1. Avoid argument or direct confrontation and adjust to resistance rather than opposing it directly.<\/strong><\/li>\n<\/ol>\n

          \u201cNot everyone is able to face making changes in long term habits.\u201d<\/p>\n

          \u201cIt\u2019s pretty normal to have mixed feelings about changing long term habits that we\u2019ve enjoyed, even though they affect our health.\u201d<\/p>\n

          \u201cSome people try a few AA meetings or just a first appointment with the County Substance Abuse program to see if one of them is right for them.\u201d<\/p>\n

          Give suggestions in a generalized, non-judgmental, off-hand manner.<\/em><\/p>\n

          \u201cCan I give you this resource information in case you would like help in making changes later on?\u201d<\/p>\n

          Hand them written information on local Treatment Resources such as County SUD program phone number or AA hotline number, and\/or handout on effects of problem drinking on health. <\/em><\/p>\n

          For free copies including shipping and handling, of <\/em>RETHINKING DRINKING: Alcohol and Your Health<\/em><\/a> in English or Spanish go to: <\/em>http:\/\/pubs.niaaa.nih.gov\/publications\/RethinkingDrinking\/OrderPage.htm<\/em><\/a>)<\/em><\/p>\n

            \n
          1. Support self-efficacy and optimism.<\/strong><\/li>\n<\/ol>\n

            \u201cNot everyone is able to be as open as you have been today.\u201d<\/p>\n

            \u201cNot everyone is willing to do the screening, much less discuss the results.\u201d<\/p>\n

            \u201cEven if you\u2019re not ready to make changes now, I can always help you when you are ready.\u201d<\/p>\n

            \u201cConfidence in making tough choices comes over time and with talking things out with trusted friends or family.\u201d<\/p>\n

            \u201cI know you care about your health and have the ability to make good choices by the fact that you came in for this appointment today.\u201d<\/p>\n

            Always end discussion on this upbeat, confidence-building note<\/em>.<\/p>\n

            Karen Stephen, Ph.D., Mental Health Clinical Director<\/p>\n","protected":false},"excerpt":{"rendered":"

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