Motivational Interviewing Flashcards
Barriers to Change.
Social – social norms, secondary gain
Spiritual – suffering/deserved
Psychological – depressed/anxious
Biology – exercise hurts
Stages of Change
What is a closed question?
Have you been taking your medication?
How much do you drink every day?
Where does it hurt?
The patient’s expectation is that after you ask these questions, you will have an answer.
What is an open question?
What do you do about missing doses of your medication?
What sort of things do you do when you get together with your friends?
What does drinking look like for you?
What do you do when this hurts?
If you decided to exercise more, what kinds of exercise might work best for you?
These are better questions for motivational interviewing.
Examples of how to Ask: Direct, Guide, Follow
How many times has that happened? (direct)
What kind of change makes sense to you? (guide)
Tell me from the beginning about how your pain developed. (follow)
Why is a typical day assessment useful?
Good way to gather a lot of information
Develops rapport
Unhealthy behaviors tend to cluster in individuals
Chance to ask ‘how do you feel about… smoking, drinking, lack of exercise…
What are questions to elicit change talk?
Desire: Do you want, like, hope..?
Ability: Is it possible, what could you do? How would you do that?
Reasons: What would the benefits be for you?Why would you make this change?
These are examples of…
What are the benefits and drawbacks to the proposed plan for change?
It sounds like you don’t like….What would you like? Because…? How would that feel?
What can the medication do for you?
What worries you most about surgery?
What problems have you had with exercise in the past?
QUESTIONS TO INITIATE CONVERSATIONS ABOUT CHANGE
What are some important aspects of listening?
Eye contact
Reflect what you hear every 1-2 minutes
First part of the consultation most important
Silence is OK.
How difficult, I’m sorry – can be enough
Be honest with your time limitations
If you feel stuck, the patient probably does too. Listen for tone in voice.
Resistant patient: “If I take all those medications I will be over medicated”.
What’s your reflective statement?
Response: “It sounds like you’re worried that taking too many medications might harm you.”
Reflective listening = understating an emotion
Change Talk examples:
Desire:
Ability:
Reasons:
Need:
Commitment:
Taking steps:
Desire: I want to, I would like to, I wish…
Ability: I could, I can, I might be able to…
Reasons: I would probably feel better if…
Need: I ought to, I have to, I really should
Commitment: I am going to, I will, I intend to..
Taking steps: I actually went out and…
This week I started….
Reasons for a patient not being able to listen?
Bewildered Overwhelmed High emotion Mood Distractions White coat syndrome Want’s to look good for you
Explain ambivalence and it’s resistance to change.
Most people want to feel healthier AND
Feel uncomfortable with change
Patients usually know good reasons for change AND They enjoy the status quo
So, they anticipate the downside of change
How do you deal with resistance?
AVOID ARGUING OR LECTURING
REFLECT, OFFER EMPATHY
ENCOURAGE THE PATIENT TO COME UP WITH A NEW PERSPECTIVE – A NEW WAY TO SOLVE THE PROBLEM*
ASK WHAT HAS WORKED IN THE PAST
“On a scale of 1 to 10 how - resistant are you to …. - optimistic are you about… - hopeful… - worried… What would have to happen to change this level?
According to Blaise Pascal, people are persuaded by reasons they discovered or those of someone else?
Reasons they themselves have discovered.
Basic Principles: Don't confront.. Don't lecture.. Don't encourage authority.. Instead, do this.
COLLABORATE (NOT CONFRONT)
EVOKE (NOT LECTURE)
ENCOURAGE AUTONOMY (NOT AUTHORITY)
ELICIT VALUES, FEARS, HOPES, AND EXPECTATIONS, FEELINGS
