Intro to Motivational Interviewing

1. Intro to Motivational Interviewing The UBC department of obstetrics & gynaecology Leadership training program October 25, 2018

2. Learning Objectives Familiarize the concept of motivational interviewing Discuss basic MI techniques Application of the technique to enhance communication

3. Intention for the Session My hope is to evoke a curiosity that might interest you to want to learn more about this topic.

4. What is Motivational Interviewing(MI)? “Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion” (Miller & Rollnick, 2013)

5. Strengthening Motivation…

6. Video

7. The Quality of the Relationship Matters • An estimated 70-80% of medical litigation involves communication and relationship-based challenges Sources of dissatisfaction • Lack of preparation for meetings • Giving the impression of having very little time • Showing little regard for patient/family’s views (Lussier & Richard, 2005)

8. The Quality of the Relationship Matters Trust, interaction and empathy have a positive influence on the patient-physician relationship (Lan & Yan, 2017) Patients attesting to good communication with their physician are more likely to be… Satisfied with their care Share important information for accurate diagnosis Follow advice Follow prescribed treatment (Ha & Longnecker, 2010)

9. Sustain Talk • Represents the other side of a person’s ambivalence • Resistance to the change that is being contemplated • As the helper, arguing against this resistance is counterproductive - reinforcement of the status quo (Miller & Rose, 2009)

10. Sustain Talk Examples “I don’t want to quit smoking, I enjoy it” “It’s too much trouble” “It sounds like a lot of work that I don’t have time for” “I don’t have the energy to invest in this project” “It’s a bit of a setback, but I’m fine with it for now”

11. Change Talk • “Change talk is any self-expressed language that is an argument for change”(Miller & Rollnick, 2013) • Many different forms of change talk (6 forms!)

12. Change Talk Examples “I don’t know what to do, but something has to change” “I want to play outside with my grandkids more” “I wish I could lose some weight” “This pain keeps me from playing the piano”

13. Commitment Language & Its Importance • Studies suggest that commitment language is predictive of subsequent behaviour change (Amrhein et al., 2003) Possible reasons why: • The public consequences of making verbal commitments • The rewards of fulfilling the change • The costs of failing to meet the commitment (Festinger, 1957; Kulik & Carlino, 1987)

14. Partner Up! Client: Choose something that you have been thinking about changing, should change, or want/need to change, but haven’t done yet. Helper: Tell the client how much they need to make this change • Give them a list of reasons to pursue the change • Emphasize the importance of changing • Tell them how to do it • Assure the client that they can change & that they need to get on with it.

15. Stay in the Same Role with Your Partner Client: Choose something that you have been thinking about changing, should change, or want/need to change, but haven’t done Helper: Gives no advice, listen attentively and may choose to ask questions such as: • Why would you want to make this change? • How might you go about it in order to succeed? • What are the three best reasons for you to do it? • How important is it for you to make this change, and why? (Miller & Rollnick, 2013)

16. Let’s Reflect “A [person] who is active in the consultation, thinking aloud about the why and how of change, is more likely to do something about this afterwards” (Miller & Butler, 2008)

17. Why is Change SO difficult? Ambivalence • Uncomfortable • Precontemplation • Simultaneous conflicting motivations “When ambivalence is present individuals normally express pro-change and counter change arguments” – (Miller & Rollnick, 2013) So you stay in the same spot because making a move is far too frightening!

18. Tips for the helper- Open Ended Questions Tips to elicit change talk “Why might you want to make this change?” “How important is it to you to make this change?” “What might it take for you to make a decision to ___” “What do you think will happen if nothing changes?” To test level of commitment to change “So where do we go from here?” “What would be a first step?” “What, if anything, do you plan to do?” (Urquhart & Jasiura, 2016)

19. Tips for the helper – Fighting the Righting Reflex A helper’s natural tendency is to elaborate about the ‘good side’ of the argument ie) why change is good, how you should do it The individual has probably heard the ‘positive’ argument before from a voice within or someone else (Miller & Rollnick, 2013) So what happens afterwards? More Resistance!

20. 4 Steps to Motivational Interviewing

21. Engaging “Engaging is the process of establishing a mutually trusting and respectful relationship” (Miller & Rollnick, 2014) OARS Open ended questions Affirmations Reflective listening Summarize

22. Focusing “Finding one or more specific goals that provide direction for the consultation” (Miller & Rollnick, 2014) • Focus can arise from: client/context/helper 3 types of focus: • Directing – Make a recommendation & check in with client • Following – “What would you like to talk about today?” • Guiding – collaborative search for direction, negotiation

23. Evoking: Sustain Talk vs. Change Talk “Evoking involves eliciting the client’s own motivations for change and lies at the heart of MI” (Miller & Rollnick, 2013) • Identify Sustain talk versus Change talk • Resolve ambivalence so there is direction for change by using open-ended questions Eg) “Tell me about a time when you succeeded at something you were unsure you could achieve?” “What do you think might happen if you don’t make this change?”

24. Planning “You pull together all of the person’s own desire, ability, reasons and need, revving the engine of change and then get out of the way by asking a key question” (Miller & Rollnick, 2013) • Construct change plan • Do not get ahead of the client • Ask a key question ”So where does this all leave you?” “I wonder what you might decide to do”

25. Let’s Sum Up the Process: Vacay for Two? ENGAGING: Shall we travel together ? FOCUSING: Where to? EVOKING: Whether or not we should go and Why PLANNING: How and When? (Miller & Rollnick, 2013)

26. Interested in MI?

27. Motivational Interviewing Course Change Talk Associates Introductory & Advanced MI Courses https://changetalk.ca/ Cristine Urquhart (604) 716 - 6685

29. References Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner Journal, 10(1), 38-43. Lan YL, Yan YH. The Impact of Trust, Interaction, and Empathy in Doctor-Patient Relationship on Patient Satisfaction. J Nurs Health Stud. 2017, 2:2. Lussier, M. T., & Richard, C. (2005). Doctor-patient communication: complaints and legal actions. Canadian family physician Medecin de famillecanadien, 51(1), 37-39. Miller, W. R., & Rollnick, S. (2013). Applications of motivational interviewing. Miller, W. R., & Rollnick, S. (2014). The effectiveness and ineffectiveness of complex behavioral interventions: impact of treatment fidelity. Contemporary clinical trials, 37(2), 234-241.