Mark DiFilippo, MA, EdS, LAC

Associate Director, Behavioral Health

February 26, 2013

Camden, NJ

We all want to help our patients to make improvements in their health and lifestyles, but it’s not as easy as it sounds . . .

Oftentimes, we and our patients are not on the same page regarding our relationship/goals . . . .

The individuals with whom we work are often distrusting of the healthcare system and its providers . . .

Using traditional models of communication, we don’t seem to have much success in affecting change . . . .

Individuals and groups tend to be resistant to change . . . .

Motivational Interviewing* (MI)

◦ *An admittedly poor and inaccurate moniker

A collaborative, goal-oriented method of communication with

particular attention paid to the language of change. A method

designed to strengthen an individual’s motivation for and

movement toward a specific goal by eliciting and exploring

the person’s own arguments for change

A person-centered counseling method for addressing the common problem of ambivalence about change

A method of talking with people through which they are celebrated as the “experts” in their own lives

A model of communication which provides for open dialogue and the clear establishment of the clinical relationship

…not a series of techniques … but a way of being with the person.

Evocation

Collaboration

Autonomy

Compassion

Engaging – The Relational Foundation

Focusing – Strategic Centering

Evoking – The Transition to MI

Planning – The Bridge to Change

Open-ended questions

Affirmations

Reflections

Summarize

DESIRE to change (want, like, wish . . )

ABILITY to change (can, could . . )

REASONS to change (if . . then)

NEED to change (need, have to, got to . .)

COMMITMENT (intention, decision)

ACTIVATION (ready, prepared, willing)

TAKING STEPS

Because MI honors the sovereignty, dignity and self-efficacy of the individual

Because it is congruent with the natural communication style of many of our staff

Because it is an evidence-based model for change

Because it works in moving patients towards goals

Because alternatives don’t seem to work (see next slide)

Staff Confronts Denial, Explains Reality,

Provides Information . . .

without securing client’s agreement or buy-in

Reports come back of

“non-compliance”

“Acting out”

“Covert Negativity”

Staff tries to “outmuscle”

“resistance” with punishment

and provides even more

reasons and demands for

change

Person

“RESISTS”

Staff Confronts, tries to

coerce compliance or

attempts to reason the client

into the right behavior

Person‟s “resistance”

increases or person

displays passive-

aggressive “compliance”

Person defends „staus quo‟,

asserts autonomy and

defends or excuses current

behavior

Staff asserts demands for positive

behavior change, and takes up the „need

to change‟ side . . .Client takes up the

„does not need to change side‟

Pilot implementation by staff-members familiar with MI

Books/videos read/watched by clinical staff

3 half-day trainings by MINT approved trainer

Ongoing training/MI support by Assoc. Director of Behavioral Health

Ongoing training by Assoc. Director for all new staff

Rollnick, S., Miller, W., & Butler, C. (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. NYC: Guilford Press.

Rollnick, S., & Miller, W. (2013). Motivational Interviewing, Third Edition: Helping People Change. NYC: Guilford Press.

MotivationalInterviewing.org

The Homepage of MINT – Motivational Interviewing Network of Trainers