motivational interviewing: the challenging patient & interactive case studies
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Motivational Interviewing: The Challenging Patient & Interactive Case Studies. Michael Vallis, PhD R Psych Psychologist and Lead, CH Behaviour Change Institute Associate Professor, Dalhousie University. 4th Annual Chronic Disease Self-Management Conference. Let ’ s Start With What We Know. - PowerPoint PPT PresentationTRANSCRIPT
Michael Vallis, PhD R Psych
Psychologist and Lead, CH Behaviour Change Institute
Associate Professor, Dalhousie University
Motivational Interviewing: The Challenging Patient & Interactive Case Studies
4th Annual Chronic Disease Self-Management Conference
Let’s Start With What We Know
• The strongest predictor of future behaviour is .............?
• PAST BEHAVIOUR!
• What does this say about the likelihood of behaviour change?
• NOT!
And, by the way, the strongest predictor of changed behaviour
is.........?
SELF-EFFICACYA person’s confidence to perform a specific behaviour in a specific context for a specific time period and in the face of specific barriers
Self-Management Support Skills
1. Relationship skills - establishing a change based relationship using motivational interviewing
2. Motivational skills - getting to the behaviour
3. Behaviour change skills - making sustainable changes
4. Emotion management skills - helping to maintain the behaviour
What Does Self-Management
Support Really Mean?• Fundamental change in the relationship between the individual and the HCP
• From
• Expert clinician with uninformed helpseeker
• “Let me tell you what you need to do”
• “Let me tell you what you need to know”
• To
• We both have a role to play
• “I understand that you will make your own decisions and I respect that. Can we have a conversation about your health”
Change-Based Relationships
• A helping alliance involves 3 components:
• Bond
• Task
• Goal
Motivational Interviewing
Ask questions, Minimize statements Express Empathy Take a curious, nonjudgmental stance Learn to sit with ambivalence
Avoid argument Roll with resistance Support Self-Efficacy
Determine Readiness• Is the behaviour (or lack of it) a problem for
you?• Does the behaviour (or lack of it) cause you
any distress?• Are you interested in changing your
behaviour?• Are you ready to do something to change
your behaviour now?
Getting to the BehaviourReadiness Assessment
Not ReadyReady
Go Right to BehaviourModification
Ambivalent
Understanding the behaviour
Personal meaning
Seriousness, personal responsibility, controllability, optimism
Expanding on readiness
Personal/meaningful reasons to change
Willingness to work hard - connect to principles
Delay of gratification
Barriers/TemptationsEspecially social, cultural and environmental
Decisional Balance
Self-Efficacy
Working With the Behaviour:
Behaviour ModificationGoal Setting
SMART GOALS
Specific, measurable, achievable, relevant, timely
Shaping
Importance of NEXT STEP
Stimulus control
Respecting the environment
Reinforcement Management
Maintaining Change:Emotion
Management• Your Task
• Identify
• Educate
• Recommend
• Support
Managing EmotionsDealing with unhealthy coping strategies
Recognize the value of unhealthy behaviour and focus on replacing the function
Stress ManagementPhysical dischargePhysical calmingExpress emotionsSeek social support
Referral for psychological intervention
•“I want to eat what I want, when I want”
•“I feel fine, I am sure if my diabetes was a problem I would feel sick?”
•“Everytime you follow advice new research gets released that says the old way was better”
CASES• 50 yo single female living with elderly mom
(depressed drinker), - diabetes COPD dysthymic - she is stuck - not moving
• 17 adolescent male - grass - referred from school - cocaine and alcohol - struggle to avoid situations -he’s becoming concerned
• 19 yo referred from probation (drinking/driving) - meets regularly - says wants to make changes (don’t believe him) - “are you here because of probation” - ambivalent but slippery
• 70 yo female - smoker (1ppd) - relapse when stressed - motivated - COPD, ca, diabetic and bipolar