Motivational Interviewing - Health Counseling - Slides | HNFE 4644, Study notes of Public Health

Download Motivational Interviewing - Health Counseling - Slides | HNFE 4644 and more Study notes Public Health in PDF only on Docsity! MOTIVATIONAL INTERVIEWING Lecture 3 & 4 Chapters 1-4 Defining Motivational Interviewing (MI) MI is a effective evidence based approach to overcoming the ambivalence that keeps many people from making desired changes in their lives, even after seeking or being referred to professional treatment Pieces of the Puzzle Natural Change Positive change often occurs without formal treatment The stages and processes by which people change seem to be the same with or without treatment In this sense, treatment can be thought of as facilitating what is a natural process of change Pieces of the Puzzle Brief Intervention Effects Across behavior outcomes, settings and interventions even relatively brief interventions under certain conditions can trigger change. One or two sessions of counseling often yield much greater change in behavior than no counseling at all. Pieces of the Puzzle Dose Effects If a little counseling helps, then more is better? one might reason that the degree of change will be related to the amount (dose) of counseling a person receives. Evidence is inconsistent, many times brief or long term interventions have the same effect over the long haul Pieces of the Puzzle Waiting-Lists Effects Those who are waiting for ‘treatment’ often drift towards positive behavior change Pieces of the Puzzle Change-Talk Effects Most clinicians might agree that resistant people are less likely to change. Ask people how confident they are that they can succeed in making a particular change and there answer is a reasonably good predictor of what will happen. Give them a questionnaire at the outset of counseling asking about their level of readiness for change and their scores predict the amount of change at follow-up. Understanding Change What happens after formal interventions mirrors natural change (rather than being unique) The likelihood that change will occur is strongly influence by interpersonal interactions. When behavior change occurs much of it happens within the first few sessions, the total does of treatment does not make all that much difference The counselor is a significant determinant of treatment dropout, retention, adherence and outcome. People who believe that they are likely to change they do so. People whose counselors believe that they are likely to change do so. What peoples say about change is important. Able: Confidence to change Sometimes a person feels willing but not able to change. “I wish I could. . . “ Given sufficient importance, people find an avenue for change that they believe will work If a person becomes alarmed by a discrepancy but perceives no way to change instead of changing behavior people reduce their discomfort by shifting to defense mechanisms Ready: A matter of priorities One can be willing and able to change but not ready to do so. Like low importance, low readiness is also sometimes viewed as pathological. But relative priorities are part of normal human function and low readiness can be viewed not as character flaw but as information for next step I want to and I don’t want to AMBIVALENCE Social Context How Friends Make You Fat The Spread of Obesity in a Large Social Network Over 32 Years Nicholas A. Christakis, M.D., Ph.D., M.P.H., and James H. Fowler, Ph.D. New England Journal of Medicine Social Context Social and cultural factors affect people’s perceptions of their behavior evaluation of its costs and benefits Paradoxical Response Ambivalent people may not respond in a logical manner The theory of psychological reactance Secondary effects of a change within the person's social environment _ Facilitating Ghange Motivation is an Interpersonal Process Righting reflex Motivation is the product of interaction between people This is departure from popular notion that motivation is internal Developing Discrepancy Resolution of ambivalence It is discrepancy that underlies the perceived importance of change; no discrepancy, no motivation The larger the discrepancy, the greater the importance of change. There is obvious overlap between ambivalence and discrepancy. Without some discrepancy, there is no ambivalence Motivational Interviewing Definition: a client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Person focus does not focus on teaching new coping skills, reshaping cognitions or excavating the past Consciously directive Method of communication Focus on finding client’s intrinsic motivation for change Change consistent with individual value and beliefs MI with other treatments Fundamentally, MI is intended to instigate change Can be used in conjunction with many other methods or techniques May be used as Prelude Permeating style Fall-back option _ Practice of Ml 4 General Principles of MI Express empathy Develop discrepancy Roll with resistance Support self-efficacy Summary: MI It is a collaborative, not a prescriptive, approach We believe that each person possesses a powerful potential for change. MI is about helping to free people from the ambivalence that entraps them in repetitive cycles of self-defeating or self-destructive behavior. MI is a skillful clinical method, not a set of techniques that can be easily learned. It is designed to resolved motivational issues that inhibit positive behavior change. Simpler techniques in the spirit of MI have been adapted for use where training and consultation time is more limited.