Motivational

Interviewing: An

Introduction©

Celina CastelliHope Carroll

Veronica MontanaRebecca Villanueva

Robin Bonifas, PhD, MSWAssistant Professor

College of Public ProgramsSCHOOL OF SOCIAL WORK

What Is Motivational Interviewing (MI)?

• MI is a client centered, semi-directive method of engaging individuals in treatment or behavioral change.

• MI aims to promote and increase motivation to change behaviors by exploring and resolving any issues of ambivalence the client may be experiencing.

• MI addresses the client at their current state of functioning while addressing the varying levels of readiness for client change.

• MI is non-judgmental, non-confrontational and non-adversarial.

4 Principles of MI

1) Express empathy by sharing an understanding with the client of their current situation and/or perspective.

2) Help clients to explore and identify the discrepancies between what they wants in their lives compared to their life current situation.

3) Understand that resistance and reluctance are a natural and not pathological response to change for the client.

4) Support self efficacy:• Embrace client autonomy.• Help clients transition towards successful change

with confidence.

Goals of MI

• Establish rapport

• Elicit and begin change talk• Five stages of change:

1. precontemplation2. contemplation3. preparation4. action5. maintenance

• Establish commitment language from the client

• Be motivational!

Who May Benefit from MI:

Health related behavior changes• Examples: smoking, diet, exercise

Treatment/medication adherence• Examples: medication routine, maintaining medical

appointments, individual and/or group counseling or support sessions

Substance and/or alcohol abuse• Can be used in conjunction with the 12-step program or

in lieu of 12-step program.

Child welfare• Working with the parents and/or external support

systems

Emotional behavior control• Example: anger management, processing, verbalizing

A Video Example:

• http://www.youtube.com/watch?v=dm-rJJPCuTE

A Case Study:Jim Hernandez

• Jim is a 68-year old, Hispanic male with type-2 diabetes that lives independently and is retired. He is divorced with two adult children and has had recent difficulty monitoring his health and diabetes routine, including his medication management. He reports a lack of energy, increased fluid intake and more frequent urination.

• PCP advised Jim to frequently check his blood pressure at home, eat more low-fat foods and increase his physical activity.

• Jim voiced concerns about his ability to be able to maintain and follow these recommendations and asked for a referral to speak to a counselor, therapist, or social worker who could help motivate him to maintain his diabetes better

• During intake with social worker, Jim voiced ambivalence regarding changing his behaviors using statements such as, “I know I need to change and I want to change, but it’s so difficult to take that first step,” and “I am already so old, why do I need to change?”

Jim Hernandez continued…

• How would motivational interviewing help Jim and others in similar situations?

• What would be the first step to take as a social worker?

• How would you begin motivational interviewing with Jim?

• Any identifiable barriers to change?

What Does the Literature Say?

The article, Motivational Interviewing to Affect Behavioral Changes in Older Adults, reviews and assesses research literature regarding the efficacy of motivational interviewing with older adults who have serious health challenges. As a result of motivational interviewing, a considerable improvement in physical activity, diet, cholesterol, blood pressure, glycemic control and increased smoking cessation was found.

It is very important to note that all persons who are considering a behavioral change have an internal conflict as to the pros and cons of the change they will possibly be making. The article discusses the role of the motivational therapist to help the client overcome their internal conflicts so they can then recognize the positive benefits of change.

The studies reviewed by this article also suggest that motivational interviewing is acceptable to older adults, which in turn can generate change in various health behaviors in a relatively short period of time. However, there were variations in findings which could have been because of the differences in treatment.

Cummings, Cooper & Cassie (2009). Motivational interviewing to affect behavioral change in older adults. Research on Social Work Practice, 19(2), 195-204.

Literature Continued…

Motivational Strategies with Alcohol-Involved Older Adults: Implications for Social Work Practice explores problem drinking in older adults and barriers to them receiving assistance by outlining practice strategies. According to this article, motivational interviewing is made up of two phases. Phase One is where motivational change is built and Phase Two is where commitment to change is strengthened.

When treating alcoholism, it important to know that people will only change when the costs of their actions begin to outweigh the benefits. Therefore, motivational interviewers facilitate change by highlighting how the problem behavior affects the client’s self-mage, perceptions and aspirations.

Excessive drinking in older adults is a greater problem than previously thought and motivational interviewing has proven useful in assisting older adults to change their behavior. In addition to motivational interviewing, social workers can offer help by identifying people in need, locating services and gathering support from family members and organizations.

Hanson, M., & Gutheil, I. A. (2004). Motivational strategies with alcohol-involved older adults:

Implications for social work practice. Social Work, 49(3), 364-372.

Literature Continued…

An overview and process evaluation of TeleWalk: a telephone-based counseling intervention to encourage walking in older adults discusses the development and participant evaluation of TeleWalk. Also, the benefits of a physically active lifestyle for older adults is discussed in this article.

The participants were recruited through their general practitioner and randomly chosen to receive either eight telephone counseling sessions and printed material over three months or to participate in outcome assessments only. All the respondents agreed that the counselors advice encouraged them to become physically active and was processional, motivating and helpful.

• Kolt, G. S., Oliver, M., Schofield, G. M., Kerse, N., Garrett, N., & Latham, N. K. (2006). An overview and process evaluation of TeleWalk: A telephone-based counseling intervention to encourage walking in older adults. Health Promotion International, 21(3), 201-208.

Literature Continued…

A Randomized Trial of Tailoring and Motivational Interviewing to Promote Fruit and Vegetable Consumption for Cancer Prevention and Control discusses how motivational interviewing can help facilitate healthful eating habits which can lower the risk of chronic diseases and risk of cancer. In this article, a study was done that tested two health communication interventions and their effectiveness in increasing fruit and vegetable consumption and physical activity in older adults with and without cancer. Tailored print communication and brief telephone-based motivational interviewing were the two different communication interventions that were tested.

A significant increase in fruit and vegetable consumption was found for the combined intervention group while none of the interventions produced statistically significant improvements in increased physical activity. In addition, an intervention that combined both communication strategies was found to be most cost-effective for those without cancer while the study did not compute cost-effectiveness for those with cancer because of insufficient evidence of differential intervention effectiveness.

Campbell, M. K., Carr, C., DeVellis, B., Switzer, B., Biddle, A., Amamoo, M. A., et al. (2009). A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Annals of Behavioral Medicine, 38(2), 71-85.

Literature Continued…

The article, Motivational interviewing to change quality of life for people with chronic heart failure: A randomized controlled trial, covers a study that consisted of patients with chronic heart failure who’s quality of life has been reduced because of a their limited physical activity and lack of independence. In this study, sixty older patients were given either standard care, motivational interviewing or both.

The study showed motivational interviewing, which incorporated behavior change principles to promote physical activity, is effective in improving different aspects of quality of life of those with chronic heart failure. This study also showed that motivational interviewing is a viable option compared to traditional exercise programming.

At baseline, 98% of participants were in pre-contemplation or contemplation to change their behavior towards increased physical activity. At the end of the follow-up period, 48% had improved into the preparation stage of increasing their physical activity and 13% were in the action stage of increased physical activity.

Brodie, D. A., Inoue, A., & Shaw, D. G. (2008). Motivational interviewing to change quality of life for people with chronic heart failure: A randomised controlled trial. International Journal of Nursing Studies, 45(4), 489-500.

Quick References• Brodie, D. A., Inoue, A., & Shaw, D. G. (2008). Motivational

interviewing to change quality of life for people with chronic heart failure: A randomised controlled trial. International Journal of Nursing Studies, 45(4), 489-500.

• Campbell, M. K., Carr, C., DeVellis, B., Switzer, B., Biddle, A., Amamoo, M. A., et al. (2009). A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Annals of Behavioral Medicine, 38(2), 71-85.

• Cummings, S.M., Cooper, R.L., & Cassie, K.M. Motivational interviewing to affect behavioral change in older adults.(2009). Research on Social Work Practice, 19(2), 195-204.

• Hanson, M., & Gutheil, I. A. (2004). Motivational strategies with alcohol-involved older adults: Implications for social work practice. Social Work, 49(3), 364-372.

• Kolt, G. S., Oliver, M., Schofield, G. M., Kerse, N., Garrett, N., & Latham, N. K. (2006). An overview and process evaluation of TeleWalk: A telephone-based counseling intervention to encourage walking in older adults. Health Promotion International, 21(3), 201-208.