2.Motivational Interviewing: Setting the scene
Summary
TLDRIn this video, Stan Steinle, a clinical psychologist, discusses the concept and importance of motivational interviewing. He explains how clinicians can effectively help patients make beneficial lifestyle changes to improve their health and quality of life. Steinle highlights the challenges of patient resistance and the role of clinician communication in fostering change. Through an example interaction, he illustrates common pitfalls and emphasizes the need for empathetic, client-centered approaches that encourage patients to advocate for their own change, thereby enhancing treatment adherence and health outcomes.
Takeaways
- 😀 Motivational interviewing is a method used by clinicians to help people make positive changes in their lives to improve health and quality of life.
- 🔍 The script highlights the challenges clinicians face in helping patients make lifestyle changes and adhere to treatment recommendations, which are significant contributors to health outcomes.
- 👥 Communication with patients is crucial and can influence their decisions and ability to make and sustain behavioral changes.
- 🚫 The traditional clinician-patient interaction can sometimes lead to arguments against change, which can evoke resistance and reduce the likelihood of change.
- 🤔 The concept of 'ambivalence' is key; patients often feel two ways about making changes, seeing both benefits and drawbacks.
- 💡 Clinicians should aim to evoke the patient's own motivations and concerns rather than imposing their views, which is a central element of motivational interviewing.
- 🌟 Empathy and active listening are essential in motivational interviewing, allowing the clinician to understand the patient's perspective and experiences.
- 🛡 Minimizing resistance is a goal of motivational interviewing, as it helps to create an environment where change is more likely to occur.
- 🌱 The approach nurtures hope and optimism, creating a sense that positive change is possible for the patient.
- 🎯 Motivational interviewing is goal-directed, aiming for specific behavioral changes, but it is also client-centered, focusing on the patient's own goals and choices.
- 🧘♂️ It involves helping patients explore and resolve their ambivalence, enabling them to make personal choices that they are more likely to follow through on.
Q & A
What is the main focus of Stan's discussion in the script?
-Stan's main focus is on motivational interviewing, its application in clinical practice, and how it can be useful for clinicians to help their clients and patients make positive changes in their lives.
What is motivational interviewing according to the script?
-Motivational interviewing is a goal-directed, client-centered approach that aims to help individuals work towards change and healthy behavioral changes by exploring and resolving their ambivalence.
Why is helping people make lifestyle changes considered challenging in clinical practice?
-It is challenging because people often have ambivalent feelings about changing their behaviors, and clinicians need to navigate these feelings without creating resistance or arguments against change.
What are the two largest contributors to people's health outcomes mentioned in the script?
-The two largest contributors to people's health outcomes are their lifestyle choices and their adherence to treatment recommendations.
What is the 'writing reflex' as described in the script?
-The 'writing reflex' refers to the clinician's instinct to fix things for the patient, which can lead to confrontation with the patient's ambivalence and potentially increase resistance to change.
How can clinicians reduce resistance to change when working with clients?
-Clinicians can reduce resistance by using motivational interviewing techniques, which include evoking the client's own concerns and motivations, listening with empathy, and nurturing hope and optimism.
What is the importance of communication in helping patients make decisions about their health?
-Effective communication is crucial as it influences the choices patients make and their ability to sustain behavioral changes, which in turn affects their health outcomes.
What is the role of a clinician in motivational interviewing?
-The clinician's role is to facilitate the client's exploration of their ambivalence, evoke their own arguments for change, and support them in making personal choices that lead to behavior change.
Why is it counterproductive for clinicians to argue for change with their clients?
-Arguing for change can evoke more arguments against change from the client, increasing their resistance and making them less likely to make the desired changes.
How does the script illustrate the interaction between a clinician and a patient using motivational interviewing?
-The script provides an example of a conversation where the clinician uses reflections and logical arguments to guide the patient, but also highlights the importance of not creating an argumentative dynamic that could hinder change.
What is the significance of the patient's ambivalence in motivational interviewing?
-Ambivalence is a natural part of the change process, and recognizing and exploring it is key to helping the client resolve their mixed feelings and make an informed decision about change.
Outlines
😀 Introduction to Motivational Interviewing
Stan Steinle, a clinical psychologist, introduces the concept of motivational interviewing, a method aimed at helping people make positive changes in their lives to improve health and quality of life. He emphasizes the challenges clinicians face in motivating patients to adopt healthier lifestyles and adhere to treatment recommendations. The script describes a typical interaction between a clinician and a patient, highlighting the resistance the patient shows to change. The key takeaway is the importance of effective communication in facilitating change and the clinician's role in preparing patients for it.
🤔 The Challenge of Ambivalence in Change
This paragraph delves into the concept of ambivalence, where patients often feel conflicted about making changes due to the perceived benefits and drawbacks. The 'writing reflex' of clinicians, a tendency to want to fix things for the patient, is contrasted with the patient's ambivalence, which can lead to confrontation and resistance to change. The paragraph stresses the importance of clinicians evoking the patient's own motivations and concerns rather than imposing change. The goal is to minimize resistance and nurture hope and optimism, leading to the development of motivational interviewing as an approach that is goal-directed, client-centered, and focused on resolving ambivalence.
Mindmap
Keywords
💡Motivational Interviewing
💡Clinical Psychologist
💡Ambivalence
💡Behavior Change
💡Lifestyle Choices
💡Treatment Adherence
💡Communication Skills
💡Writing Reflex
💡Resistance
💡Empathy
💡Optimism
Highlights
Introduction to motivational interviewing by a clinical psychologist named Stan Steinle.
Motivational interviewing as a method to help clients make changes to improve health and quality of life.
The privileged position of clinicians in helping people make life changes.
Challenges in helping clients make lifestyle changes and adhere to treatment recommendations.
Importance of lifestyle choices and treatment adherence in health outcomes.
The role of communication in facilitating behavioral changes in clients.
Demonstration of a clinician-patient interaction highlighting communication strategies.
The 'yes, but' argument pattern in clinician-patient conversations.
Clinician's 'writing reflex' and its potential to evoke resistance to change in clients.
The concept of ambivalence as a key dilemma in the change process for clients.
The importance of evoking arguments for change from the client rather than the clinician.
The role of empathy and minimizing resistance in motivational interviewing.
Nurturing hope and optimism as part of the motivational interviewing process.
Definition and core principles of motivational interviewing.
Motivational interviewing as a goal-directed, client-centered approach to elicit behavior change.
Exploring and resolving ambivalence as a strategy in motivational interviewing.
Transcripts
[Music]
well hello everyone um my name's Stan
steinle uh I'm a clinical psychologist
uh just in private practice but one of
my areas of interest is this topic of
motivational interviewing so hopefully
for the for the next little while we'll
have a bit of a chat about um
motivational interviewing and perhaps
how it might be um useful for you uh in
some of the work that you do with your
clients and
patients I suppose just to to set the
scene one of the the most satisfying
things I think about our work as
clinicians um is helping people to make
changes to their lives which um actually
uh helps to improve their health and
perhaps improve their quality of life in
fact it's quite a privileged position I
think in many ways for us to to be able
to to have that sort of involvement in
in people's lives on the other hand I
think one of the most challenging things
about our work as clinicians and um is
in fact helping people make changes to
their lives one of the most challenging
things is what to do to actually help
people to make decisions about their
lifestyle and their behaviors that does
uh help them to improve their health and
their quality of life it's it's
important because um two of the largest
contributors to People's Health outcomes
and and perhaps to their poor health is
in fact their lifestyle choices um and
secondly their choices around whether
they adhere to and follow through with
different treatment uh recommendations
as well so lifestyle behaviors and
treatment adherence are are two of the
big contributors to to People's Health
outcomes the way we communicate with
patients is also then very important in
terms of the choices that that people
make and their ability to to make and
sustain those behavioral changes so
today we'll be a bit about that notion
of how we communicate with our clients
or
patients in fact we hold a very unique
position I think and and and a unique um
sort of opportunity to uh work with
people in a way that prepares them for
change what I'd like to do first of all
though is just to um just to show you an
example of an interaction between a
clinician and a patient have a think
about it as I as I talk through it
because there's some things that that
the interaction actually kind of
demonstrates in the way that that um
that clinicians and patients can can uh
can work together so looking at your BMI
and your consistently high blood
pressure readings now's a good time for
you to start exercising and losing some
weight yeah um you know I get up early
with the kids and I'm at work till 7 or
8:00 p.m. so I don't have a lot of time
during the day I understand time is
scarce but this is very serious there's
a high risk association between high
blood pressure and risk of stroke yeah
I've heard that but I feel guilty
spending time on myself when I should be
spending it with the family I know it's
hard to juggle everything but if you
don't spend the time now working on your
health you're not going to be there long
term for your family yeah but I've never
been a good
exerciser and I've never really enjoyed
it you know I'd rather read and relax
with a couple of good Reds that's the
best end of day for me okay it's
important to relax at the end of the day
but keep in mind alcohol can increase
your blood pressure as well so you may
need to watch how much you drink as well
yeah you know I've heard that so what's
happening in that sort of interaction
what we see there is a concerned
clinician you know here is a a clinician
who really would like to help the person
and and to prevent um bad things
happening to that person and the
clinician is showing good skills there
there's good communication skills good
good um uh kind of reflections of some
of the harder bits that the patient is
experiencing and the clinician in
amongst that is offering logic IAL
Arguments for change they're presenting
the reasons that the person should
change um the only problem is the
patient is arguing back the patient is
arguing against change there's it's
becoming this interaction between the
two whereby um the clinician on the one
hand is is trying to put all of those
good Arguments for why the client should
change out there and the the client is
arguing against those reasons is putting
all the reasons why they can't or
shouldn't or won't change they've there
a little bit of a of an interaction that
we often see in that situation where
each person is kind of starting their
sentence with yes but maybe you should
make this change yeah but I can't
because of this yeah but maybe you
should because of this yeah but I can't
because of this and that yes but sort of
tennis in a way is actually creating um
an argument it's friendly and nice and
pleasant but nevertheless it's an
argument and the the client is arguing
against change the really important
thing for us as clinicians to stop and
consider as well though is that there's
something in what the clinician or we as
clinicians are doing that's actually
evoking that from the client and that's
really important because we know that um
the more that we evoke arguments against
change from the client the less likely
that they actually will change so in an
interaction like that the the clinician
and the clinician's behaviors are
actually reducing the likelihood of of
the client actually making any of the
changes that that ultimately might be
important for them so I suppose the the
the question is is you know really
what's at play here and and the thing
that we have to remember when we're
working with people who are um
considering change or perhaps feel two
ways about some sort of behavior is is
we need to remember that ambivalence is
the key dilemma that they face they feel
two ways about it there are good things
and not so good things about any given
Behavior whether it's something like um
you know exercise or you know or or
perhaps smoking or or whatever whatever
the behavior might be for anyone
individual they feel ambivalent about it
because there's some things they like
about it and some things they don't
about it and the the difficulty is that
um while the client might be feeling or
patient might be feeling ambivalent on
the other side we have clinicians who
often experience what we call the
writing reflex the writing reflex is
this notion whereby um the clinician you
know wants to make things right for the
person you know wants to fix things what
can see in the future there's some sort
of um you know perhaps bad outcome or or
some you know consequence for them and
wants to set that a right the problem is
that where on the one hand we have the
the client with ambivalence and on the
other hand we have the uh clinician with
the writing uh reflex a confrontation
occurs between those two the ambivalence
and the writing re reflex confront each
other and in the end uh what that
actually can do is to make the person
more resistant to change and less likely
to change so faced with this dilemma
faced with this notion that we're
wanting to help people to make changes
um to improve their their health and
their quality of life but also this
notion that um you know that we're
really wanting to avoid those arguments
whereby the uh the client becomes more
and more resistant of change there would
they developed some early Concepts and
probably the first one is is a really
important take-home message from all of
this and and that is that um we're
really wanting the client rather than
the clinician to be making the arguments
for change that's a fundamental kind of
element of of what we're now trying to
do when when working with our with our
clients our role is actually much more
just about evoking from the clients
their own concerns and and their own
motivations um rather than trying to
tell them what to do or persuade them
about what to do we're trying to evoke
it from them and have them argue for
change themselves as well as that we we
want to do that um in a way where we
listen with empathy have have an
empathic kind of ear to to what the
client has having to say we want to
minimize resistance we want to to to
work with people in a way where they um
uh are arguing less and less against
change or resisting change in that way
and we're wanting to nurture hope and
optimism we want to create a sense of of
optimism um that things can change for
them so out of those early Concepts I
guess was developed this uh approach
called motivational interviewing um
motivational interviewing I I guess if
we're thinking of a definition
motivational interviewing is goal
directed in that it is about trying to
work towards change and work towards um
you know uh healthy behavioral changes
but it's also client centered in that
while there are these goals and we're
working towards something we're wanting
to do it in a way whereby you know we're
evoking that from the clients it's it's
evoking their choices and their
strategies and their goals we do those
things in order to elicit some sort of
behavior change for the client um by
helping them to explore and resolve
ambivalence so while ambivalence is
there and and is something that we're
not wanting to to sort of argue against
we recognize that it's there and we try
to explore it and ultimately resolve it
for the person so they're able to make
their own personal choice
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