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. completion of recommended screening or diagnostic tests or specialist/allied health/psychologist referral. DiClemente CC, Velasquez M. Motivational interviewing and the stages of change. A brief guide to motivational interviewing: Year 3 motivational interviewing workshop. 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. DOC Some documents on this site are in Microsoft Word format. within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. In motivational interviewing, any patient statement about making a positive change is called ‘change talk’. 18,24 By encouraging patients to talk about their own reasons for change, clinicians have a pathway to strengthen and elicit … Motivational Interviewing is an effective strategy for fostering change and increasing life stability. 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 good for people who are too emotional to be motivated. What difficulties have resulted from your drinking? More If a practitioner feels that the patient needs health advice at this point in order to set appropriate goals, it is customary to ask permission before giving advice as this honours the patient's autonomy. 0000009790 00000 n 0000002258 00000 n Motivational interviewing requires four key communication skills that support and strengthen the process of eliciting change talk, also known as OARS: Open-ended questions; Affirming; Reflective listening; Summarizing; Open-ended questions in In what way does your weight concern you? 0000008212 00000 n Melanie A. A discussion of how continuing to drink (maintaining the status quo) will impact his future goals to travel in retirement or have a good relationship with his children may be the focus. Cooperman NA, Arnsten JH. Within MI, the therapist is viewed as a facilitator rather than expert, who adopts a nonconfrontational approach to guide the patient toward change. Treating addictive behaviours: processes of change. Jensen CD, Cushing CC, Aylward BS, Craig JT, Sorell DM, Steele RG. Influencing risk behavior of sexually transmitted infection clinic visitors: Efficacy of a new methodology of motivational preventive counseling. 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. For example, drinking may impact the patient's values about being a loving partner and father or being healthy and strong. ‘I want to manage my diabetes better’, the importance of change for the patient (willingness). This manual is divided into two parts. 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. Naar-King S, Wright K, Parsons J, et al. They would then work on resolving this ambivalence, by connecting the things the patient cares about with motivation for change. Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behaviour. 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’. 0000008986 00000 n In MI, the opposite approach is taken, where the patient's motivation is targeted by the practitioner. Ask your client to pinpoint, on a scale of 1 to 10, how motivated they are to end their drug use. Why are you at ____ and not zero? The practitioner would emphasise that the decision to change is 'up to him', however they would work with the patient to increase his confidence that he can change (self efficacy). Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. 2nd edn. taking medication as prescribed, eating more fresh fruit and vegetables), it can be frustrating and bewildering when this advice is ignored or contested. 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. On this scale, zero is not important at all and 10 is extremely important. It was really hard, but once I put my mind to something I usually stick at it’, ‘I never thought I would be living like this. 0000036942 00000 n Available at. 0000002726 00000 n PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). Evoking: eliciting ‘change talk’ to support patient motivation. The views expressed by the authors of articles in Australian Family Physician are their own and not The heart or spirit of MI can be denoted by the acronym CARE. What concerns does he have about the effects of his drinking? The overall spirit of MI has been described as collaborative, evocative and honouring of patient autonomy.1 Miller and Rollnick1 have commented that the use of MI strategies in the absence of the spirit of MI is ineffective. Highlighting this discrepancy is at the core of motivating people to change. Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. Diane Jankowski RN BSN CCM . Privacy | Terms of use, Facilitating behaviour change in the general practice setting, Incorporating therapy into general practice, Use and effectiveness in general practice, Results from a survey of general practice registrars. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. 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. Motivational Interviewing and Oral Health Communication: Case-based Studies Maureen George, PhD RN AE-C FAAN . 1. I want to go back to being healthy and strong, with enough energy to enjoy my friends and family’. Participants learn 14 different Motivational Interviewing techniques that can be used to help clients identify and overcome reluctance to discuss to achieve their goals. Motivational interviewing ( MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. If a practitioner has more time, four additional principles (Table 5) can be applied within a longer therapeutic intervention. Successful progression through these stages leads to action, where the necessary steps to achieve change are undertaken. AIDS Patient Care STDs 2005;19:31–9. To save the file right click or option-click the link and choose "Save As...". A general rule-of-thumb in MI is that equal amounts of time in a consultation should be spent listening and talking. Importantly, an authoritative or paternalistic therapeutic style may in fact deter change by increasing resistance.1. 0000004574 00000 n Motivational interviewing techniques: Facilitating behaviour change in the general practice setting. If you do not have it you can download Adobe Reader free of charge. Anger, sadness, or apathy are reasons why someone may not be motivated, and by addressing these, the person can be ready for a change. 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. Motivational interviewing, second edition: 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. If you could do anything, what would you change? AIDS Patient Care STDs 2009;23:423–31. This can often have a paradoxical effect in practice, inadvertently reinforcing the argument to maintain the status quo. 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. AIDS Educ Prev 2006;18:1–11. These will have "DOC" in brackets along with the filesize of the download. 23 The research and proposition behind motivational interviewing is that this method promotes change talk, and strengthens self-efficacy and behavioural intention. The practitioner tells the patient what to do, Honouring a patient’s autonomy: although the practitioner informs and advises their patient, they acknowledge the patient’s right and freedom not to change. Patients benefit from this relationship the most when the practitioner also embodies hope that change is possible. To view these documents you will need software that can read Microsoft Word format. 0000035172 00000 n It has been shown to be effective in the primary care setting with smoking cessation, hazardous drinking, physical activity, nutrition and chronic disease. Files on the website can be opened or downloaded and saved to your computer or device. In: Miller WR, Rollnick S, editors. The Royal Australian College of General Practitioners. inaccuracies contained therein or for the consequences of any action taken by any person as a result of substance abuse, weight management). 5 Principles of Motivational Interviewing. taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or In subsequent consultations, when these strategies don't work, it is easy to give up hope that he will change his drinking, characterise him as 'unmotivated' and drop the subject altogether. If you don't have anything you can download the MS Word Viewer free of charge. Ambivalence is particularly evident in situations where there is conflict between an immediate reward and longer term adverse consequences (eg. Motivational Interviewing has been used successfully in primary care for the brief intervention phase of addiction treatment (D’amico, 2018, VanBuskirk & Wetherell, 2014) and provides an effective means for motivating patients to use other substance use therapies (Frost, 2018; Luty, 2018). Do smart mothers make better diagnoses than poor doctors? Family members, friends and peers of those with co-occurring mental disorders can use the motivational interviewing technique outside of Motivational interviewing in practice requires clinicians to suppress the initial righting reflex so that they can explore the patient's motivations for change. 0000035281 00000 n 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. necessarily those of the publisher or the editorial staff, and must not be quoted as such. However, research around behaviour change shows that motivation is a dynamic state that can be influenced, and that it fluctuates in response to a practitioner’s style. What would be different in your life if you lost weight? 0000032159 00000 n Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. 0000011372 00000 n The apparent 'lack of motivation' evident in the patient would be constructed as 'unresolved ambivalence' within an MI framework. 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. How did you do it? Outline emergency management of an acute asthma attack. ‘It’s up to you’, Authority: the practitioner instructs the patient to make changes, * A general rule-of-thumb in MI practice is to ask an open-ended question, followed by 2–3 reflections, ‘I guess, if I’m honest, if I keep drinking, I am worried my family are going to stop forgiving me for my behaviour’, ‘If I lose weight, at least I won’t have to wake up feeling guilty every morning that I am not taking care of myself’, ‘I did stop smoking a few years ago for a year and I felt so much healthier. ADefinition"of"Motivational"Interviewing" The!definition!of!Motivational!Interviewing!(MI)!has!evolved!and!been!refined!since!the!original! A male patient, 52 years of age, who drinks heavily and has expressed the desire to reduce drinking, but continues to drink heavily. On the other hand, the pros for adopting an MI approach with patients who are resistant to change are compelling. SAMPLE MOTIVATIONAL INTERVIEWING SESSION SCRIPT HANDOUT Ensure that the Readiness Ruler is administered just before the session, ideally by someone other than you. Bendigo CHS Men’s Health ClinicImproving access to primary care, January/February - Teaching in general practice, Australian Family Physician (incorporating Annals of General Practice) Volume 41, No.9, September 2012 Pages 660-667. Focusing: identifying a target for change that is to be the primary subject of discussion in therapy. 0000003393 00000 n 0000037295 00000 n smoking, overeating, heavy drinking) or adopting healthy or safe behaviours (eg. Clinical Tips: Motivational Interviewing Motivational interviewing is a person-centred counselling style that addresses ambivalence about change. 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. 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'. 0000012820 00000 n This will get you to understand how you … J Nerv Ment Dis 1999;187:630–5. 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 Using the spirit of MI, the practitioner avoids an authoritarian stance, and respects the autonomy of the patient by accepting he has the responsibility to change his drinking – or not. hŞb```b``ñb`e``½Ê È€ ‚l@ÈÂÀñÄSà` p0l»Ô¸ø€Ä/™r1|%ì�Øô˜¬':Ì3p‰P8 Å6�é~ã+†‡ÒL;Ä®ğ»°ob®l|}àCf‚¹†l¯k0s*ã‡ïŠÌ*¤V&±}a®fpäj±ŒP²àùÁ~ŸycãU†¿R,OHiğ`»Å|‡ñ£àƒÜ.RIlÁ̳ï5. What would it take for you to go from ___ to (a higher number)?'. 0000006990 00000 n Diabetes Care 2007;30:1081–7. Gives the practitioner the opportunity to learn more about what the patient cares about (eg. This article provides an overview of motivational interviewing. Next, it is important to build the patient's confidence in their ability to change. After reviewing all of this, what's the next step for you? On this scale, zero is not confident at all and 10 is extremely confident. Every care is It is not intended to be used as a stand-alone treatment for substance use disorders, but rather specifically for working with ambivalence about change. 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! Hettema J, Steele J, Miller WR. A truly collaborative therapeutic relationship is a powerful motivator. Motivational interviewing for improving adherence to antiretroviral medications. 0000005892 00000 n Motivation to change is elicited from the client, and is not imposed from outside forces. and check patient’s technique. Motivational interviewing is practiced by licensed therapists and substance-abuse counselors. The practitioner would therefore work on understanding this ambivalence, by exploring the pros and cons of continuing to drink alcohol. 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. The core principle of the approach is negotiation rather than conflict. Perform PEFR. J Consult Clin Psychol 2011;79:433–40. The effectiveness of motivational interviewing delivered by youth workers in reducing drinking, cigarette and cannabis smoking among young people: quasi-experimental pilot study. 0000005251 00000 n Complete a GP management plan with a patient with asthma Complete/review Asthma Cycle of Motivational interviewing. The content of any advertising or promotional material contained Motivational interviewing includes a range of techniques to help people make changes in their behaviour. Provide harm reduction strategies. New York: The Guilford Press, 2002. Motivational interviewing in health care. Motivational Interviewing (MI) is a style of counseling that mental health professionals use to encourage productive verbal sessions with patients who are afflicted with multiple, or co-occurring, disorders. trailer <<76AA3C09CA52434BAA9CE1A20B7CA63E>]/Prev 995627>> startxref 0 %%EOF 263 0 obj <>stream A is for aphorismDo smart mothers make better diagnoses than poor doctors? 0000014236 00000 n 41(9), Sept., 2012, pp 660-667. A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. %PDF-1.4 %âãÏÓ 0000004688 00000 n motivational interviewing such as motivational enhancement theory (a time-limited four session approach) and health coaching.7 Motivational interviewing techniques are also widely applied as part of telephone care management initiatives, some forms of counselling and some types of … J Acquir Immune Defic Syndr 2006;41:44–52. Preparing people for change. Although paradoxical, the MI approach is effective at engaging apparently 'unmotivated' individuals and when considered in the context of standard practice can be a powerful engagement strategy (Case study, Table 2). Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. In Phase I, four early methods represented by the acronym OARS (Table 3) constitute the basic skills of MI. 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. is published by The Royal Australian College of General Practitioners, Motivational Interviewing Motivational interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. 0000007561 00000 n Motivational interviewing (MI) is an effective counselling method that enhances motivation through the resolution of ambivalence. New York: The Guilford Press, 2008. All rights reserved. 0000004800 00000 n Where would you be on this scale? Let's break the definition down to better understand the theoretical underpinnings of this approach. Example: 'If you can think of a scale from zero to 10 of how important it is for you to lose weight. The Substance Use Motivation Ruler is an excellent tool derived from motivational interviewing. The Techniques Of MI. 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. When patients receive compelling advice to adopt a healthier lifestyle by cutting back or ceasing harmful behaviours (eg. OARS is a set of communication techniques that achieve two basic goals in patient care – building rapport and understanding the problem. 0000032286 00000 n 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 conclusions may naturally lead the practitioner to adopt a paternalistic therapeutic style and warn the patient of the risks to his health. 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). It sounds like things can't stay the same as they are. When have you made a significant change in your life before? This involves goal setting and negotiating a 'change plan of action'. 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. What would it take for you to go from ___ to (a higher number)?'. whether change is an immediate priority (readiness). 229 0 obj <> endobj xref 229 35 0000000016 00000 n Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. Motivational Interviewing: An Appropriate Model for Engaging Clients with Drug Abuse Problems in the Probation Service Sheena Norton* Summary: Motivational Interviewing (MI), initially developed to assist those with alcohol addiction issues (Miller, 1983), is also a useful strategy in probation work with 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. Anything, what 's the next step for you paternalistic therapeutic style may in fact deter change by clients. Derived from motivational interviewing: twenty-five years of empirical studies on the other hand, the importance change... 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' evident in the patient 's confidence in their behaviour, pp 660-667 do not it. Or spirit of MI can be applied within a longer therapeutic intervention C, Brownell C Tollefson... In MI, the opposite approach is negotiation rather than the practitioner also embodies hope that change possible... ( eg efficient ways to help patients develop internal motivation to change in... Goal setting and negotiating a 'change plan ' together and 10 is extremely confident for Substance. You to lose weight in part by clinical psychologists William R. Miller and Stephen Rollnick the. People know what ’ s best for them 23 the research and behind... What the evidence shows us and what other people have done in your situation ' imposed outside...