MI in Health Care

Motivation News

Published by Cathy Cole, MSSW, LCSW Motivational Interviewing Network of Trainers, Inc.

December 2009
http://www.cathycoletraining.com (MI training since 1995) We sit together~ My thoughts you reflect And hope springs forth Cole, 2007

Newsletter Feature Article MI in Health Care

Onsite Training Opportunities

Training Schedule for 2010: all trainings are now open for registration.

Make your plans to attend one of these trainings. All trainings take place in Carrboro, NC, a charming town adjacent to Chapel Hill, NC. The closest airport is Raleigh Durham. Workshop fees are $595.

Introduction to Motivational interviewing: limited to 15 February 27-March 1, 2010 July 31-August 2, 2010

Advanced MI Training: all practice, limited to 6 April 24- 26, 2010 November 6-8, 2010

CathyColeTraining, inc. provider # 1177, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program. CathyColeTraining ,inc maintains responsibility for the program.

Social workers participating in this course will receive clinical social work continuing education clock hours. Other professionals need to check with appropriate boards to determine acceptance of ASWB approved CE.

For more information on trainings, please see Workshops at http://www.cathycoletraining.com

About My Workshops: I have provided MI training since 1995, following my training with Drs. Miller and Rollnick. My teaching approach is very pragmatic, focusing on the core concepts of MI and allowing the learning to progress from direct practice.

I have elected to limit the size of my workshops in order to maximize the opportunity to provide learning that can both address the concepts and practice of Motivational Interviewing while at the same time assist in the application of MI to each participant's work setting.

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Newsletter

This letter may be forwarded to anyone you feel could benefit as long as it is forwarded in its entirety. Past newsletters available via web site http://www.cathycoletraining.com

Welcome to Motivation News, a newsletter devoted to clinical information on the use of a Motivational Interviewing (MI) approach to change. The authors of this approach, William Miller, PhD and Stephen Rollnick, PhD define MI as a 'client centered, directive method for enhancing an intrinsic motivation for change by exploring and resolving ambivalence". This collaborative approach to working with clients has wide application in mental health, the justice system, addictions, health care and health education. Information in this newsletter is taken from various source material from the Motivational Interviewing Network of Trainers and specifically from the book Motivational Interviewing, Preparing People for Change; Miller and Rollnick, 2nd edition, 2002, Guilford Press. Additional source material: Motivational Interviewing in the Treatment of Psychological Problems, ed. Arkowitz, Westra, Miller, and Rollnick, Guilford 2007; Motivational Interviewing In Health Care, Rollnick, Miller, and Butler, Guilford, 2007.

MI in Health Care

Motivational Interviewing is a very useful tool in health care conversations. Rather than think of how to apply MI, it might be more helpful to listen for MI moments. A MI moment occurs in many ways: when the patient is hearing some unexpected news, such as a new diagnosis or a need to change the way of managing a chronic illness. Dr. Rollnick suggests employing the RULE for MI moments and conversations. R for reflect; U for understand your client; L for listen toward the goal of understanding; and E for empower your client. Embedded in RULE are the methods of eliciting change talk, strengthening confidence and heightening commitment for change.

A MI conversation might sound this way: C is for Client, I for interviewer

I: 'Good morning Mrs. Jones; we have about 15 minutes together today and I'd like to focus on how you are doing with your diabetes unless there is something more pressing for you.' (agenda setting)

C: 'Um, let's talk about what you think is important.' (sounding and looking nervous)

I: 'You sound alarmed at my bringing this up. (complex reflection)

C: 'Well, you usually just say all is okay and today you did not start there.'

I: 'You are worried about what I might have to say.' (complex reflection)

C: 'Yes, what is happening?'

I: 'I do need to discuss making some changes and want to give you just a little information and then I'll get your response. Despite all the effort you have made to take the medication, eat right, exercise, it seems we still don't have your blood sugars in control and I think it is time to start insulin injections.'

C: 'Oh no! I was afraid of that!'

I: 'This is hard news for you to hear.' (reflection)

C: 'That is what happened to my dad and then he just went downhill after that.'

I: 'You are scared this is the direction things will go for you.' (reflection)

C: 'Yes'

I: 'I can't speak to what happened with your dad but I would like to give you more information about how I see your case.' (asking permission)

C: 'I need to know what you have to say.'

From here the MD would provide information pertinent to this patient in small amounts, stopping to make certain she understands, reflect when there is a reaction from the patient and continue the conversation to determine her willingness to make this change in management. The initial part of the conversation allowed for the client to be heard/understood, not just presented with the facts and new plan. Patients are much more likely to try a new treatment plan when they feel understood and the difficulty of facing a change is not devalued.

Keep practicing!