9. You would think that…..
having been disciplined twice for misconduct
would be enough to persuade a man to do anything
possible to protect his career and livelihood?
hangovers, damaged relationships, an auto crash,
and memory blackouts would be enough to
convince a woman to stop drinking
10. You would think that…..
very real threats of blindness, amputations and
the
kidney failure from diabetes would be enough to
motivate weight loss and glycemic control
11. You would think that…..
very real threats of blindness, amputations and
the
kidney failure from diabetes would be enough to
motivate weight loss and glycemic control
time spent in the dehumanizing privations of prison
would dissuade people from re-offending
15. Your role
You don’t have to make change happen
You can’t
You don’t have to come up with all the answers
You probably don’t have the best ones
You’re not wrestling with patients
You’re dancing
17. Consider yourself
Imagine something in your life that you’ve often
thought about changing, but haven't.
Imagine this:
You cant leave the room until you’ve made a
decision to change!
19. “After all, when you seek advice from
someone it’s certainly not because you
want them to give it. You just want them
to be there while you talk to yourself”.
Terry Pratchett, 1948 –
29. You: Would you mind if we talked about your smoking?
Patient: Well, OK
You: How do you really feel about it?
Pt: I’m trying to cut back, but I cant say its easy with my job, you
know its stressful driving that truck
You: Its not easy for you yet you’d like to smoke less
Pt: Oh if I could, definitely, I know its not good for my chest for a start
You: You can feel the effect for yourself and its not pleasant
Pt: That right, but its such a stress reliever its hard to let go
You: Its difficult for you to imagine being without smoking
Pt: yes, that’s exactly right, you got me.
You: I don’t want to give you a lecture or hassle you about this, but I’m
wondering what would be helpful for you?
Pt: I just don’t know Doc.
You: Tell me, deep down, how important is this for you right now?
Pt: I feel sick and I’m tired, and this smoking wears me down….
30. Recent Changes in MI
Motivational Interviewing: Helping People Change
(3rd edition). NY: Guilford, 2012.
Introduce compassion as a key element
From “behaviour change” to “any change”
Make it simpler & easier to apply in practice
Include planning for action
4 Processes – let’s look!
31. New Four Process Model
This is what happens in an effec.ve MI session
32. PLAN
If they want to, support
them to plan changes
EVOKE
Draw out their own good
reasons to change
FOCUS
Find a useful direction
ENGAGE
Settle into a helpful conversation
33. PLAN
If they want to, support
them to plan changes
EVOKE
Draw out their own good
reasons to change
FOCUS
Find a useful direction
ENGAGE
Settle into a helpful conversation
34. “Settle into a helpful conversation”
ENGAGE
1. Just be nice and friendly?
2. You can get better & better
3. A service-wide challenge
The 20% rule
35. PLAN
If they want to, support
them to plan changes
EVOKE
Draw out their own good
reasons to change
FOCUS
Find a useful direction
ENGAGE
Settle into a helpful conversation
36. “Find a useful direction”
FOCUS
1. Who’s direction?
2. Usually more than one direction
3. Agenda mapping as a skill
37. PLAN
If they want to, support
them to plan changes
EVOKE
Draw out their own good
reasons to change
FOCUS
Find a useful direction
ENGAGE
Settle into a helpful conversation
38. “Draw out their own good reasons to change”
EVOKE
1. Defining heart of MI
2. Ear for language: change talk
39. PLAN
If they want to, support
them to plan changes
EVOKE
Draw out their own good
reasons to change
FOCUS
Find a useful direction
ENGAGE
Settle into a helpful conversation
40. “If they want to, support them to plan
changes”
PLAN
1. Righting reflex & other familiar
challenges
2. Usually more than one possible plan
3. Path mapping as a skill
45. 1. Importance (Why?)
“Why should I?”
“I want to, but....”
“What will I gain/lose?”
2. Confidence (How?)
“Will I be able to ?”
“What skills do I need”
“Will I cope in situations x, y & z?”
47. Importance & Confidence Scaling
How important is it for you right now to quit
smoking?
On a scale from 0 - 10, if 0 was “not at all important” and 10 was
“very important”, what number would you give yourself?
1. Why are you at x and not at 1?
2. What would need to happen, for you to get from x to (higher
no.)?
3. How can I help you get from x to (higher no.)?
Understanding answers increases motivation to change in
active patient
48. Theory & Research
49. Theory
1. A linguis.c theory
your MI style – change talk – beaer outcome
2. Self‐determina.on theory (SDT)
3 needs – Autonomy, Competence & Relatedness
52. Biomedical Markers
MI Comp.
Blood Glucose (5) OR 1.12* 52% vs 48%
Blood Pressure (1) OR 1.65** 57% vs 43%
Cholesterol (3) OR 1.09* 51% vs 49%
Heart failure (1) OR 7.78** 75% vs 25%
Heart rate (1) OR 0.91 49% vs 51%
Body weight (11) OR 1.15** 52% vs 48%
Dental (caries) (2) OR 1.85** 58% vs 42%
HIV Viral Load (2) OR 2.06* 60% vs 40%
Death rate (2) OR 1.54 56% vs 44%
Mental health (5) OR 1.29** 54% vs 46%
53. Health behaviors
MI Comp.
Health behavior
Eating healthy (7) OR 1.08 51% vs 49%
Eating disorder (6) OR 0.79 47% vs 53%
Injury Prevention (1) OR 1.76* 57% vs 43%
Alcohol
Amount (11) OR 2.51** 62% vs 38%
Dangerous Use (3) OR 1.94** 59% vs 41%
Smoking
Abstinence (8) OR 1.25* 51% vs 49%
Marijuana
Amount (5) OR 3.08** 65% vs 35%
Abstinence (1) OR 1.99 60% vs 40%
54. MI Comp.
Adherence
Medication (6) OR 1.17 52% vs 48%
Diabetes (5) OR 2.36** 63% vs 37%
Exercise (4) OR 1.37** 52% vs 48%
General Health (3) OR 1.55 52% vs 48%
A.R.T. (1) OR 11.56 78% vs 22%
Engagement
Keep appts (6) OR 1.56** 57% vs 43%
56.
People are generally better persuaded by the
reasons which they have themselves discovered,
than by those which have come into the mind of
others.”
Blaise Pascal, Pensées, (1670)
