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