. download the MS Word Viewer free of charge, Wikipedia: Comparison of reference management software, Raise doubt and increase the patient’s perception of the risks and problems with their current behaviour. This can be followed by asking the patient to elaborate further on this discrepancy and then succinctly summarising this discrepancy and reflecting it back to the patient. PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). New York: The Guilford Press, 2008. AIDS Patient Care STDs 2009;23:423–31. Evoking: eliciting ‘change talk’ to support patient motivation. In: Miller WR, Rollnick S, editors. completion of recommended screening or diagnostic tests or specialist/allied health/psychologist referral. 0000010587 00000 n Motivational Interviewing Motivational interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. and check patient’s technique. Weigh up the pros and cons of change with the patient and work on helping them tip the balance by: Clear goal setting – help the patient to develop a realistic plan for making a change and to take steps toward change, Help the patient to identify and use strategies to prevent relapse, Help the patient renew the processes of contemplation and action without becoming stuck or demoralised, * Relapse is normalised in MI and is used as an opportunity to learn about how to maintain long term behaviour change in the future, Collaboration: a partnership between the patient and practitioner is formed. If you don't have anything you can download the MS Word Viewer free of charge. Provide harm reduction strategies. A brief guide to motivational interviewing: Year 3 motivational interviewing workshop. To open click on the link, your computer or device will try and open the file using compatible software. You may not remember all of the processes and techniques of MI, but if you incorporate the Spirit of MI in all of your interactions with youth, you would have gone a long way in making a difference. DiClemente CC, Velasquez M. Motivational interviewing and the stages of change. “Sometimes people are not motivated to achieve the goals we create for them regardless of what they have told us they want,” said Dr. Liz Barnett and Gary Gardia, the authors of the course. Ask your client to pinpoint, on a scale of 1 to 10, how motivated they are to end their drug use. New York: Pergamon, 1986. I want to go back to being healthy and strong, with enough energy to enjoy my friends and family’. 0000002156 00000 n 0000023860 00000 n Every care is Next, it is important to build the patient's confidence in their ability to change. I'm going to explain the basics of motivational interviewing for personal trainers. They would then work on resolving this ambivalence, by connecting the things the patient cares about with motivation for change. Motivation to change is elicited from the client, and is not imposed from outside forces. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own arguments for change 11 Motivational interviewing moves the practitioner to develop a paradigm shift, a new mindset, a new way of seeing change. The Techniques Of MI. In general practice, the particular difficulties associated with quick consultation times can present unique challenges in implementing MI. This article provides an overview of motivational interviewing. All rights reserved. ADefinition"of"Motivational"Interviewing" The!definition!of!Motivational!Interviewing!(MI)!has!evolved!and!been!refined!since!the!original! In general practice, possible applications include: Motivational interviewing is underpinned by a series of principles that emphasise a collaborative therapeutic relationship in which the autonomy of the patient is respected and the patient's intrinsic resources for change are elicited by the therapist. Miller WR, Rollnick S. Motivational Interviewing. The practitioner connects health behaviour change to the things the patient cares about, Education: the patient is presumed to lack the insight, knowledge or skills required to change. 0000034451 00000 n anything contained in this publication. For further information and online motivational interviewing training opportunities visit www.motivationalinterviewing.org. This can often have a paradoxical effect in practice, inadvertently reinforcing the argument to maintain the status quo. It has been shown to be effective in the primary care setting with smoking cessation, hazardous drinking, physical activity, nutrition and chronic disease. After reviewing all of this, what's the next step for you? Patient outcomes improve when they are an active collaborator in their treatment.17 Empowering patients involves exploring their own ideas about how they can make changes to improve their health and drawing on the patient's personal knowledge about what has succeeded in the past. These will have "DOC" in brackets along with the filesize of the download. RULE is a useful mnemonic to draw upon when implementing the spirit of MI in general practice. 1. Motivational Interviewing can be a great technique for personal trainers to use to understand and encourage clients to stick with fitness. Diane Jankowski RN BSN CCM . But I can give you an idea of what the evidence shows us and what other people have done in your situation'. Practitioners who undertake MI training will have an additional therapeutic tool to draw upon when encountering patient resistance to change and a proven method for dealing with a number of common presentations within general practice. This trap can be avoided by employing strategies to elicit 'change talk'.1 There are many strategies to elicit 'change talk', but the simplest and most direct way is to elicit a patient's intention to change by asking a series of targeted questions from the following four categories: Alternatively, if a practitioner is time poor, a quick method of drawing out 'change talk' is to use an 'importance ruler'. What would it take for you to go from ___ to (a higher number)?'. This manual is divided into two parts. These were:1, Using MI techniques, the practitioner can tailor motivational strategies to the individual's stage of change according to the Prochaska and DiClemente model (Table 1).1,2. What do you think you might do? Motivational Interviewing is an effective strategy for fostering change and increasing life stability. DOC Some documents on this site are in Microsoft Word format. West D, Dilillo V, Bursac Z, Gore SA, Greene PG. Where would you be on this scale? The core principle of the approach is negotiation rather than conflict. Opening Statement • I’m not here to preach to you or tell you what you “should” do; how would I know, it’s your life and not mine! One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks. Volume 41, No.9, September 2012 Pages 660-667. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual; they are stuck between simultaneously wanting to change and not wanting to change. J Consult Clin Psychol 2003;71:843–61. AIDS Educ Prev 2006;18:1–11. What would be different in your life if you lost weight? How would you like your health to be in 5 years time? It grew out of the Prochaska and DiClemente model described above2 and Miller and Rollnick's1 work in the field of addiction medicine, which drew on the phrase 'ready, willing and able' to outline three critical components of motivation. Describe motivational interviewing in the office setting and its role in behavior change D iscuss motivational interviewing strategies best suited to primary care practice R ecognize when motivational inter-viewing might be applicable A pply motivational interviewing strategies in a variety of circumstances. MP3 Most web browsers will play the MP3 audio within the browser, Your comment is being submitted, please wait, Mental health nurses in general practiceA personal perspective, Psychological encounters in general practice, Motivational interviewing techniquesFacilitating behaviour change in the general practice setting, Cognitive behaviour therapyIncorporating therapy into general practice, Acceptance and commitment therapyPathways for general practitioners, Problem solving therapyUse and effectiveness in general practice, Early and tight glycaemic controlThe key to managing type 2 diabetes, Cutaneous plaque in a diabetic patientA case study, Managing undernutrition in the elderlyPrevention is better than cure, Using a mobile phone application in youth mental healthAn evaluation study, Changes in the demography of Australia and therefore general practice patient populations, Assessing pathology training needsResults from a survey of general practice registrars, Problem gamblingAetiology, identification and management. J Acquir Immune Defic Syndr 2006;41:44–52. For example, drinking may impact the patient's values about being a loving partner and father or being healthy and strong. Motivational interviewing is a set of patient-centered communication techniques—focused on being empathetic, nonjudgmental, and supportive—which helps individuals express their own reasons for change and take responsibility for their own behavior. 0000006605 00000 n 100 Wellington Parade, East Melbourne, Victoria 3002, Australia In Phase I, four early methods represented by the acronym OARS (Table 3) constitute the basic skills of MI. Evocation: the evocation of the patient’s own motivation. Fisher J, Fisher W, Cornman D, Amico R, Bryan A, Friedland G. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behaviour among HIV-infected patients. In motivational interviewing, any patient statement about making a positive change is called ‘change talk’. within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. In keeping with the spirit of MI, a simple phrase reminding the patient of their autonomy is useful, 'You are the expert on you, so I'm not sure I am the best person to judge what will work for you. Motivational interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. afp@racgp.org.au, © The Royal Australian College of General Practitioners 2016 their values and goals), Can take the form of compliments or statements of appreciation and understanding, Helps build rapport and validate and support the patient during the process of change, Most effective when the patient’s strengths and efforts for change are noticed and affirmed, Involves rephrasing a statement to capture the implicit meaning and feeling of a patient’s statement, Encourages continual personal exploration and helps people understand their motivations more fully, Can be used to amplify or reinforce desire for change, Links discussions and ‘checks in’ with the patient, Ensure mutual understanding of the discussion so far, Point out discrepancies between the person’s current situation and future goals, Demonstrates listening and understand the patient’s perspective. Do smart mothers make better diagnoses than poor doctors? Anger, sadness, or apathy are reasons why someone may not be motivated, and by addressing these, the person can be ready for a change. On this scale, zero is not important at all and 10 is extremely important. What strengths do you have that would help you make a change? A truly collaborative therapeutic relationship is a powerful motivator. Successful progression through these stages leads to action, where the necessary steps to achieve change are undertaken. Ann Rev Clin Psychol 2005;1:91–111. This involves goal setting and negotiating a 'change plan of action'. Motivational interviewing improves weight loss in women with type 2 diabetes. This interview style is very gentle and empathetic. Initially defined in 1983 by William Miller, motivational interviewing is used as a form of therapy to help treat people dealing with addictions, including drug and alcohol. Gold, DO, FAAP, is an Motivational interviewing. Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. 2nd edn. 0000006990 00000 n Res Soc Work Pract 2010;20:137–60. Hettema J, Steele J, Miller WR. taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. Miller and Rollnick17have attempted to simplify the practice of MI for health care settings by developing four guiding principles, represented by the acronym RULE: The righting reflex describes the tendency of health professionals to advise patients about the right path for good health. 0000008212 00000 n Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management. The practitioner acknowledges the patient’s expertise about themselves, Confrontation: the practitioner assumes the patient has an impaired perspective and consequently imposes the need for ‘insight’. More What worries you about your blood pressure? Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behaviour. Motivational interviewing is good for people who are too emotional to be motivated. Gray E, McCambridge J, Strang J. Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. 229 0 obj <> endobj xref 229 35 0000000016 00000 n Complete a GP management plan with a patient with asthma Complete/review Asthma Cycle of Influencing risk behavior of sexually transmitted infection clinic visitors: Efficacy of a new methodology of motivational preventive counseling. 0000036942 00000 n Motivational interviewing in practice requires clinicians to suppress the initial righting reflex so that they can explore the patient's motivations for change. This change process is modelled in five parts as a progression from an initial precontemplative stage, where the individual is not considering change; to a contemplative stage, where the individual is actively ambivalent about change; to preparation, where the individual begins to plan and commit to change. Healthy choices: Motivational enhancement therapy for health risk behaviours in HIV-positive youth. 0000032159 00000 n J Consult Clin Psychol 2011;79:433–40. If you could do anything, what would you change? Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. To open a PDF file you will need compatible software such as Adobe Reader. 23 The research and proposition behind motivational interviewing is that this method promotes change talk, and strengthens self-efficacy and behavioural intention. The Royal Australian College of General Practitioners. A natural response for a practitioner who encounters such opposition (termed ‘resistance’ in the psychological literature) is to reiterate health advice with greater authority or to adopt a more coercive style in order to educate the patient about the imminent health risks if they don’t change. 0000004111 00000 n You may receive an invite to complete the AFP Online Video Interview as part of our recruitment process and this is designed to assist us to understand more about you and your motivation and interest in applying for a Police or Protective Service Officer role. When patients receive compelling advice to adopt a healthier lifestyle by cutting back or ceasing harmful behaviours (eg. If successful, action leads to the final stage, maintenance, where the person works to maintain and sustain long term change.3 Relapse is considered an important stage in the change process and is used as an opportunity to learn about sustaining maintenance in the future. A is for aphorismDo smart mothers make better diagnoses than poor doctors? Recommendations Follow the prompts to chose a location. Example: 'If you can think of a scale from zero to 10 of how confident you are that you can cut back the amount you are drinking. The practitioner would therefore work on understanding this ambivalence, by exploring the pros and cons of continuing to drink alcohol. SPIRIT Of MOTIVATIONAL INTERVIEWING While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points: 1. The heart or spirit of MI can be denoted by the acronym CARE. For example, the patient who presents with serious health problems as a result of heavy drinking, who shows genuine concern about the impact of alcohol on his health, and in spite of advice from his practitioner to cut back his drinking, continues to drink at harmful levels, embodies this phenomenon. Adapted from CCNC Motivational Interviewing Resource Guide, Community Care of North Carolina. 0000012820 00000 n The Four Processes of MI. What difficulties have resulted from your drinking? Preparing people for change. Motivational interviewing is a counselling method that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy; and Empower the patient. 2. Helping patients change behavior. These conclusions may naturally lead the practitioner to adopt a paternalistic therapeutic style and warn the patient of the risks to his health. In what ways do you want your life to be different in 5 years? Recent meta-analyses show that MI is equivalent to or better than other treatments such as cognitive behavioural therapy (CBT) or pharmacotherapy, and superior to placebo and nontreatment controls for decreasing alcohol and drug use in adults4–6 and adolescents.7 Motivational interviewing has also been shown to be efficacious in a number of other health conditions, such as smoking cessation,8 reducing sexual risk behaviours,9–11 improving adherence to treatment and medication,12 as well as diabetes management.13 In addition, studies support the applicability of MI to HIV care, such as improving adherence to antiretroviral therapy14,15 and the reduction of substance use among HIV positive men and women.15 As such, MI is an important therapeutic technique that has wide applicability within healthcare settings in motivating people to change. Motivational interviewing, second edition: Preparing people for change. 0000036639 00000 n Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. 0000004364 00000 n AIDS Patient Care STDs 2005;19:31–9. 5 Principles of Motivational Interviewing. whether change is an immediate priority (readiness). The seminal text on motivational interviewing (Motivational Interviewing: Preparing People for Change) by Miller & Rollnick defines the theory as a "client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" (1). Diabetes Care 2007;30:1081–7. Examples of key questions to build a 'change plan' include: It is common for patients to ask for answers or 'quick fixes' during Phase II. If you do not have it you can download Adobe Reader free of charge. 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Be the primary subject of discussion in therapy status quo interventions for adolescent Substance use behavior:! Of motivation, ambivalence and resistance cannabis smoking among young people: quasi-experimental pilot study drinking, and... Encourage clients to stick with fitness ceasing harmful behaviours ( eg Preparing people for,... Patient would be different in your situation ' meta-analysis of motivational interviewing interventions for adolescent Substance use motivation Ruler an... Significant health risks that this method promotes change talk, and is not important at all and 10 extremely. Adopting healthy or safe behaviours ( eg the opportunity to learn more about what the patient 's about. In Phase I, four early methods represented by the practitioner also embodies hope that change elicited.