2.Motivational Interviewing: Setting the scene

Summary

In 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

00:00

😀 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.

05:01

🤔 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.

Keywords

💡Motivational Interviewing

Motivational Interviewing is a counseling method that helps individuals resolve their ambivalence about behavior change. It is goal-directed and client-centered, aiming to elicit behavior change by exploring and resolving ambivalence. In the script, the concept is central to the discussion on how clinicians can facilitate health behavior changes in their clients by evoking their own motivations and concerns.

💡Clinical Psychologist

A clinical psychologist is a licensed professional who provides psychological assessments, diagnoses, and treatments for mental health disorders. In the video, Stan Steinle identifies himself as a clinical psychologist, indicating his expertise in the field and his interest in motivational interviewing as a tool for helping clients make positive changes.

💡Ambivalence

Ambivalence refers to the state of having mixed feelings or contradictory ideas about something. In the context of the video, it is the internal conflict clients face when considering a change in behavior. The script illustrates this through the patient's conflicting feelings about exercising and spending time with family.

💡Behavior Change

Behavior change involves modifying one's actions or habits, often in response to new information or a desire to improve health outcomes. The video emphasizes the importance of clinicians helping clients navigate this process, particularly in relation to lifestyle choices and treatment adherence.

💡Lifestyle Choices

Lifestyle choices are decisions individuals make about their daily habits and routines, such as diet, exercise, and sleep. The script highlights these choices as significant contributors to health outcomes, and how they can be a point of discussion in motivational interviewing.

💡Treatment Adherence

Treatment adherence refers to the extent to which patients follow medical advice or prescribed treatments. In the script, it is mentioned as a critical factor in health outcomes, and a potential area for improvement through motivational interviewing.

💡Communication Skills

Communication skills are the abilities to effectively convey information, ideas, and emotions. The video discusses the importance of these skills in the context of motivational interviewing, where clinicians must reflect, empathize, and evoke change from clients.

💡Writing Reflex

The 'writing reflex' is a term used in the script to describe the automatic tendency of clinicians to provide solutions or advice to their clients. It is contrasted with the approach of motivational interviewing, which seeks to evoke self-motivation for change from the client rather than imposing solutions.

💡Resistance

Resistance in the context of the video refers to the client's opposition to change or the act of arguing against the reasons for change presented by the clinician. The script illustrates how traditional confrontational approaches can increase resistance, which is counterproductive to the goal of behavior change.

💡Empathy

Empathy is the ability to understand and share the feelings of another. In motivational interviewing, as discussed in the script, clinicians are encouraged to listen with empathy to the client's concerns and motivations, fostering a supportive environment for change.

💡Optimism

Optimism is a positive outlook or expectation of success. The script suggests that nurturing optimism is a key aspect of motivational interviewing, as it can help clients see the possibility of change and improve their willingness to engage in it.

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