Saturday, October 8, 2011

Motivational Interviewing

This past Saturday I spent the day with colleagues at a workshop learning motivational interviewing (MI) and counseling skills. Drs. John S. Baer and Kevin King introduced the basics and coached us through group activities. In the medical field, motivational interviewing has been gaining popularity. The newest definition describes MI on three levels. I like the technical therapeutic definition which describes MI as 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.' It's a mouthful but paints a thorough picture of what this patient-centered counseling style entails.

The essence of motivational interviewing is best described by the acronym A.C.E. The 'A' is for honoring autonomy and recognizing the patient will make his or her own choices. The 'C' stands for collaboration. In MI it is important to not always act as the 'expert' but to instead build a non-authoritarian and non-judgemental partnership with the patient. Lastly, during the session you will evoke change by eliciting the client's ideas, desires, reasons and needs. In short, it is our job to support and assist the clients while they resolve their own issues.

We do this by incorporating the four fundamental processes.

1. Engaging:  This is a very important step and may have to be circled back to if the client shows signs of discord. OARS is a set of skills developed to help build relationships and fully understand the client's issue. 

  • Open-ended questions: Questions formed in a way that push the client to elaborate instead of answering yes or no. Helps the provider gain perspective.

  • Affirmations: Honoring and recognizing efforts, successes and intentions. Encourage clients by finding things they value about themselves. Remember, affirmations must be genuine to work.

  • Reflective listening: Using simple or complex reflections to help communicate understanding or empathy. This was a huge focus at the training because MI is basically built on these skills. It felt awkward at first, I was more worried about formulating a response than actually listening. Try using the suggested stems below.

  • "So you are saying..." "It sounds like..." "You are wondering if..."

  •  Summaries: Type of reflective listening used to change directions or ask a key question. Start by indicating you are about to summarize, be concise, note both sides of  ambivalence (if any) and end with an open question.

  • 2. Focusing: Strategically using information and advice to set an agenda.

    3. Evoking: Using questions, responses and summaries to elicit change talk.

    4. Planning: Requires some commitment from the client, then work with them to develop a plan for change.

    With all of its parts, it may seem a bit daunting. However, one of the benefits to learning such a comprehensive style, is that no matter the situation, you always have relevant material to apply. At first during the activities it felt a little uncomfortable and somewhat forced. I stumbled through reflections and fought my natural "righting" reflex, but in the end I found this workshop to be extremely helpful. Like any other skill, it doesn't always come natural. Yet as you begin to master the different elements of MI, it certainly becomes a huge asset. Not only is it useful in nutritional counseling but I believe it will be beneficial in most relationships (even marriages). :)

    To learn more about motivational interviewing, please check out these additional resources:

    Rollnick S, Miller, W.R., & Butler C. (2008). Motivational Interviewing in Health Care. New York: Guilford Press.
    Rosengren, D.R. (2009). Building Motivational Interviewing Skills: A Practicioner Workbook. New York: Guilford Press.
    Naar-King, S. & Suarez, M. (2011) Motivational Interviewing with Adolescents and Young Adults. New York: Guilford Press.

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