How do you have patient-centered conversations? Motivational Interviewing Basics

Summary

This video explains motivational interviewing (MI), a therapeutic approach designed to address ambivalence and increase motivation for change in patients, particularly in substance use treatment. The script highlights the five core principles of MI: expressing empathy, developing discrepancy, avoiding argument, dancing with discord, and supporting self-efficacy. It also introduces the OARS framework, consisting of open-ended questions, affirmations, reflective listening, and summaries, to foster meaningful conversations with patients. The goal is to engage patients in their own change process, increasing the likelihood of long-term recovery.

Takeaways

• 😀 Ambivalence is a natural contradiction where individuals recognize a problem but continue the behavior. Motivational interviewing targets this ambivalence to encourage change.
• 😀 Motivational interviewing (MI) is a therapeutic approach that works with patients to increase motivation and resolve ambivalence, focusing on their own reasons for change.
• 😀 The goal of MI is to avoid ‘sustained talk,’ which defends the status quo, and instead encourage ‘change talk’ where the patient argues for change.
• 😀 The first principle of MI is expressing empathy through reflective listening. This builds trust and provides an opportunity for patients to consider change.
• 😀 Developing discrepancy involves helping patients recognize the conflict between their current behavior (e.g., substance use) and their future goals or values.
• 😀 Avoiding direct confrontation or arguments is crucial. MI aims to prevent power struggles, as arguing can lead to sustained talk and resistance to change.
• 😀 ‘Dancing with discord’ means adjusting to the patient's sustained talk in a neutral, non-confrontational way, recognizing their disagreements without engaging in a power struggle.
• 😀 Supporting self-efficacy and optimism is key. MI emphasizes boosting a patient’s belief in their ability to change, as self-confidence plays a significant role in recovery.
• 😀 MI strategies include four core skills: Open-ended questions, Affirmations, Reflective listening, and Summaries (OARS), which help guide productive conversations about change.
• 😀 Open-ended questions promote dialogue and allow patients to express themselves, while affirmations build confidence, reflective listening deepens understanding, and summaries reinforce key points and change statements.

Q & A

What is ambivalence in the context of substance use?

Ambivalence is the inner conflict that arises when a person recognizes their substance use as a problem but continues using anyway. This internal contradiction can make it difficult to make a decision to change.

How does motivational interviewing help with ambivalence?

Motivational interviewing works by addressing and resolving ambivalence, guiding patients toward the motivation to change by exploring their own reasons for change, rather than pushing them into it.

What is the goal of motivational interviewing?

The goal of motivational interviewing is to enhance a patient's motivation to change by avoiding confrontational tactics and encouraging the patient to talk themselves into change, rather than having the provider do the convincing.

What is 'sustained talk' and how is it addressed in motivational interviewing?

Sustained talk is when a patient argues for the status quo and resists change. It is addressed by avoiding direct confrontation, shaming, or unsolicited advice, and instead working with the patient to explore their own reasons for change.

What does 'express empathy through reflective listening' mean?

Expressing empathy through reflective listening involves actively listening to the patient and reflecting back their feelings or thoughts in a way that shows understanding and acceptance, without necessarily agreeing with everything they say.

Why is 'developing discrepancy' important in motivational interviewing?

Developing discrepancy helps patients recognize the conflict between their current behavior and their future goals. This awareness can increase motivation to make changes and resolve the conflict between their desires and current actions.

What does 'dancing with discord' refer to in motivational interviewing?

'Dancing with discord' refers to adjusting to a patient's sustained talk or resistance without directly opposing it. It involves acknowledging the patient's feelings and perceptions in a neutral way, which prevents escalating arguments and helps maintain a cooperative atmosphere.

How does 'supporting self-efficacy' enhance the chances of recovery?

Supporting self-efficacy involves helping patients believe in their own ability to change. By recognizing and reinforcing their strengths, patients gain confidence in their capacity to make and sustain positive changes, which boosts their motivation for recovery.

What are the four core skills in motivational interviewing, and what do they involve?

The four core skills, known by the acronym OARS, are: 1) Open-ended questions, which encourage the patient to share more freely. 2) Affirmations, which build the patient's confidence by recognizing their strengths. 3) Reflective listening, where the provider actively listens and reflects back the patient's feelings. 4) Summaries, which help ensure understanding and reinforce key points in the conversation.

How does using open-ended questions benefit the conversation with patients?

Open-ended questions encourage the patient to provide more detailed responses and share their story, rather than limiting the conversation to yes or no answers. This fosters a deeper exploration of the patient's thoughts and feelings.