S. Beth Martin presentation given at the 2012 South Carolina Home Visiting Summit

1. •
Motivational Interviewing:
Who’s Driving the Change?
Sara Beth Martin, RN, MPH
September 19, 2012

2. Objectives:
 Discuss the general principles of
Motivational Interviewing.
 Identify communication skills used in
Motivational Interviewing.
 Identify opportunities for the use of
Motivational Interviewing in home
visitation.

3. What is Motivational
Interviewing?
 “If you treat an individual as he is, he will stay
as he is, but if you treat him as if he were
what he ought to be and could be, he will
become what he ought to be and could be.” –
Johann Wolfgang Von Goethe
 http://www.youtube
.com/watch?v=cj1BDPBE6Wk&feature=player_
detailpage

4. Stages of Change
 Precontemplation
 Contemplation
 Preparation
 Action
 Maintenance
(Prochaska & DiClemente, 1984.)

5. The Four General Principles
of Motivational Interviewing
 Express empathy
 Develop discrepancy
 Roll with resistance
 Support self-efficacy

6. Express Empathy
 Empathy can be defined
as the capacity for
participation in
another’s feelings or
ideas
 Neutrality without
judgment or evaluation
 Truly hearing and
listening to what
another is saying

7. Develop Discrepancy
 Build discrepancy between
the way things currently are
and the way a client would
like things to be
 Helping the client determine
how important a change
could be (ie. Discprepancy
between current behavior and
important goals or values
held by client)
 Helpful tool: Decisional
balance worksheet

8. Roll With Resistance
 Rolling means
getting out of the
way and not
engaging in it
 Rather than arguing
against resistance,
rolling with it and it is
likely reduced

9. Support Self-Efficacy
 One’s belief in his or
her ability to carry
out a specific act or
behavior
 Critical in MI, as this
attitude can make or
break an effort for
change
 Assessment of
readiness to change

10. Personal Views on Change

11. Skills Used in Motivational
Interviewing
 Open-ended questions
 Affirmations
 Reflective listening
 Summarizing
 Eliciting change talk

12. Open-ended Questions
 Open vs. closed
 Allows client to take
control of the
direction of the reply
 Active participation
of client in
discussion
 Open and
collaborative tone

13. Affirmations
 Genuine, direct
statements of
support
 Usually directed at
something specific
and change-oriented
 Demonstrate
understanding and
appreciation

14. Reflective Listening
 Active listening and
expression of
empathy
 Reflecting the
essence of what
was said or what
you think was meant

15. Summarizing
 Communicates that
you have followed
what the client
shared
 Structure session
and keep on track
 Emphasize certain
elements of what
was said

16. Eliciting Change Talk
 Change talk is
statements in favor of
change
 Indicates a desire,
ability, reason, or need
for change
 Recognize and
emphasize these
statements and move
towards commitment

17. Behavioral Rehearsal
 “Motivation is a fire from within. If
someone else tries to light that fire
under you, chances are it will burn very
briefly.” Stephen R. Covey
 Let’s practice how to apply these skills
to our work in home visitation.

18. Behavior Rehearsal and
Debrief
 Debriefing Questions:
 How did it feel to be interviewed with these
techniques?
 What examples of the principles and
methods of MI were used?
 Which techniques seemed to work best?
What was the most challenging aspect?

19. Summary and Application
 Although these skills may appear simple, they
are not always easy to use.
 Mastery requires considerable practice.
 How might you incorporate these into your
practice to help move your families in the
direction of positive change?

20. References
 Boston University School of Public Health. Building Blocks to Peer Success:
Motivational Interviewing Skills, 2012. Web. 5 Aug 2012.
 Miller, William R and Rollnick, Stephen. Motivational Interviewing Preparing
People for Change. 2nd ed. New York: Guilford, 2002. Print.
 Miller, William R. "Motivational Interviewing William Miller Video Clip." 06 April
2009. Online video clip. YouTube. Accessed on 6 August 2012.
 NIDA-SAMHSA. Motivational Interviewing Assessment: Supervisory Tools for
Enhancing Proficiency, 2006. Web. 2 Aug 2012.
 Rollnick, Stephen, Miller, William R, and Butler, Christopher C. Motivational
Interviewing in Health Care. New York: Guilford, 2008. Print.
 United States Department of Agriculture. WIC Works Resource System:
Motivational Interviewing, 2012. Web. 6 Aug 2012.