AN INTRODUCTION TO MOTIVATIONAL INTERVIEWING Derek McLaughlin
OVERVIEW • Welcome introduction and warm up • What are your learning needs • Exercise one • Theory of Motivational Interviewing • Exercise two • The actual process of Motivational Interviewing • Exercise three • Review and evaluation
PASCAL’S PENSEES “People are generally better persuaded by the reasons which they have themselves discovered, than by those which have come into the minds of others.” (17th Century)
OR ANOTHER VIEW • “…still the man hears what he wants to hear and disregards the rest” (The Boxer, Simon and Garfunkel, 1970).
EXERCISE ONE • Break into pairs • One person plays role of occupational health nurse of a large company the other person plays the role of an employee of the company who smokes • The scenario-the company has decided to ‘help’ smokers to stop smoking via the occupational health nurse • The employee who smokes does not want to stop • The nurse must stop this person from smoking • Rollnick, S
MOTIVATION Motivation should not be thought of as a personality trait rather as a state of readiness or eagerness to change, which may fluctuate from one time or situation to another This state is one that can be influenced Miller & Rollnick (1991)
STAGES OF CHANGE • Pre-contemplation • Contemplation • Determination • Action • Maintenance • Relapse • Changed lifestyle • Prochaska & DiClemente (1983)
CYCLE OF CHANGE T i m e X X X
EXERCISE TWO • Favourite Teacher – What made them an effective educator? • Least Favourite Teacher – What was it about this person that left this impression with you?
DEFINITION Motivational Interviewing is a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. From Rollnick S. & Miller, W.R. (1995) What is Motivational Interviewing? Behavioural and Cognitive Psychotherapy, 23,325-334
Good Practice The principles - Express Empathy Develop Discrepancy Roll with Resistance Support Self-efficacy
TWO VITAL ELEMENTS • Behavioural change • Ambivalence
EXERCISE THREE • Break into pairs • One person in the role of the nurse the other person attending about their use of cigarettes • This time using a motivational interviewing approach the nurse will discuss with the person their use of cigarettes
EARLY STRATEGIES Agenda Setting medication poor housing stress pain family
EARLY STRATEGIES Readiness Ruler Scaling questions 1 - 10 to assess Importance and Confidence
IS MOTIVATIONAL INTERVIEWING FOR YOU? • People have the right to live their lives in their own way, providing they do not infringe the rights of others. • It is rarely clear cut what someone ought or ought not to do. • Responsibility for changes lies with the person. • Health is not everyone’s top priority. • People often do know what would be best for them.
IS MOTIVATIONAL INTERVIEWING FOR YOU? • Professional are not failures just because they can not persuade people to change. • Motivation is not an all or nothing concept, it is on a continuum and is subject to change. • Change is a process not an event. • Successful change occurs only when a person has made up their mind that it is what they really want. • Mason (2006) Dual Diagnosis Nursing p 254.
AN INTRODUCTION TO MOTIVATIONAL INTERVIEWING Derek McLaughlin DF.McLaughlin@ulster.ac.uk