Motivational Interviewing¶
Motivational Interviewing (MI) – Barrington Hwang, Jose Arriola Vigo
Background
- MI: an evidence-based form of non-judgmental, pt-centered counseling that elicits change in pt behavior by guiding pt through own motivations for change
- For inpatients, MI is most useful for encouraging medication compliance before discharge or substance use cessation
- Assumptions/principles:
- Pt is in state of ambivalence, whether outwardly expressed or not
- Ambivalence is expressed with conflict between multiple courses of action
- Pt may go between stages of change at any given time, some pts may benefit from explaining this model of behavior change
- Techniques to identify ambivalence:
- Focus on reasons to change ("why") as opposed to specific actions ("how")
- Express empathy: discussion about values, hopes, emotions, and goals surrounding behavior
- Empower self-efficacy: ask about other times they have made changes in life
- Develop discrepancy - between current and desired behavior
- Avoid argument and authoritarian mentality - consider "asking" for permission to give your own thoughts, don't "give advice"
- Defuse resistance to change - emphasize pt autonomy and reflect on resistance
Evaluation
- Stages of behavior change:
- Precontemplation - pt does not intend to change and has not taken action toward behavior change; could be related to demoralization from prior attempts
- Contemplation - pt intends to change, but has not taken action, usually related to awareness of risks vs benefits of change
- Preparation - pt intends to change, has taken steps to create plan and mental action, but no current physical action toward behavior change
- Action - pt intends to change, currently following through on plan
- Maintenance - pt intends to change, has changed, and is taking steps to prevent relapse
- Continuing the Conversation:
- May be effective to have SMART goal-setting if pt is in any stage except precontemplation: Specific, Measurable, Attainable, Realistic, Time-limited
- Pts may benefit from discussion on specific defense mechanisms
- "OARS" interviewing skills: Open-ended questions, Affirm, Reflect, Summarize
- Most effective in conjunction with other treatments, when pts are willing, and when pts express ideas for change themselves
- Least effective in group format and when pt feels change comes from authority
Last update:
2022-04-27 07:13:46