Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

What is your Motivation large version with activities

1433 save
by

Aaron Ladd

on 24 May 2018

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of What is your Motivation large version with activities

Why are we doing it?
I have no financial or other benefits associated with these companies while providing this presentation.
Acknowledgements and Disclosures
Rollnick, Miller and Butler. Motivational Interviewing in Healthcare. 2008.
“I tell them what to do, but they won’t do it.”
Do these sound familiar?
The “Light Bulb” Moment
Motivational Interviewing
Motivational interviewing is:
What is Motivational Interviewing?
“It’s my job just to give them the facts, and that’s all I can do.”
“ No one listens to the recommendation I give"
“Ahhh, they are ‘pre-contemplative’ so there is nothing I can do for them.”
Motivation is the art of getting people to do what you want them to do because they want to do it.

-Dwight D. Eisenhower
Motivational Interviewing
Collaborative
Goal-oriented
A method of communication
Particular attention is given to the language of change.
It is designed to strengthen an individual’s motivation
The goal is to elicit change, by exploring the person’s own arguments for change
First described in the 1980’s by William Miller and Stephen Rollnick, two psychologists who had experience in treating alcoholism
Motivational Interviewing
What is your level of familiarity with motivational interviewing?
Heard about it from courses or articles, but never taken a full course or training
Previous training, but not sure I remember much
Previous training, but didn’t really apply it to my practice
Previous training, and using it actively in my practice
TEACH PROJECT, Centre for Addiction and Mental Health (CAMH)
What is the evidence
Does it work?

There are over 3700 publications in peer reviewed literature citing the use of a motivational approach for a wide range of behavior changes, 500 clinical trials, and several meta analyses.
JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 65(11), 1232--1245 (2015)
Our Client Interactions
Following
Directing
Guiding
Simply listening
Teaching and providing information
Exploring and leading
Do you ever feel like this?
THIS IS OUR GOAL
Changing Your Words Can Change The World
WHAT IS YOUR MOTIVATION
Aaron Ladd BMR RRT FCSRT CRE CTE CTTS
THIS IS NOT OUR GOAL
D.A.R.E.S.
D
A
R
E
S
The 5 key elements of M.I.
Develop discrepancy
Avoid argumentation
Roll with resistance
Express empathy
Support self-efficacy
Miller, W.R. & Rollnick, S.(2002)
FOUNDATIONAL SKILLS
O
A
S
R
O.A.R.S.
Open-ended questions
Affirm
Reflective Listening
Summarize
Overcoming ambivalence
"A collaborative, person-centered
form of guiding to elicit and
strengthen motivation to change"

Adding content or meaning not explicitly expressed
Metaphor or simile (feels like a slippery slope)
Amplified (stronger in meaning than what the client says)
Continuing the paragraph (.....and that gets really frustrating)
Double-sided (reflect both sides of the ambivalence)
Reframing (putting something in a different light)
Verbalizing unspoken emotion
Emphasizing one side
Alluding to client's autonomy
Simple Reflections
Restate what the client said as a declarative statement
Steve Rollnick
Bill Miller
MI Authors
Miller, W.R. & Rollnick, S.(2002)
Complex Reflections
Motivational Interviewing (MI) is an evidence-based treatment that addresses ambivalence to change.

Evidence-based practice refers to the use of research and scientific studies as a base for determining the best practices in a field. The basic premise of the movement is to provide transparency and to assure the public that techniques and procedures will provide the best possible interventions or treatments.
Open Questions
Open questions should be used often in conversation but not exclusively
Of course, when asking open questions, you must be willing to listen to the person’s response.
Open questions invite others to “tell their story” in their own words without leading them in a specific direction.
Open them up!
Open questions are the opposite of closed questions. Closed questions typically elicit a limited response such as “yes” or “no.”
Affirmations
EXAMPLES
What do you want to do next?
Help me understand ___?
How would you like things to be different?
When would you be most likely to___?
What do you think you will lose if you give up ___?
What have you tried before to make a change?
Statements and gestures
To be effective, affirmations must be genuine and congruent.
Affirmations build confidence in one’s ability to change.
I appreciate that you are willing to meet with me today.
You are clearly a very resourceful person.
You handled yourself really well in that situation.
That’s a good suggestion.
If I were in your shoes, I don’t know if I could have managed nearly so well.
I’ve enjoyed talking with you today.
Examples of affirming statements
Summary
Change Talk
Desire
Ability
Reason
Need
I want
I wish
I would like to
I could
I can
I might
It's possible
Family
Health
Job
Consequences
I don't want to lose my.....
If I don't....
I have to
I really don't want to
I won't
I'll try
Faith
Partner
Evocation
Reinforce Change Talk
Evoking Change Talk
Recognize Change Talk
Use Change Rulers
Summarize
Ask What Else?
Don't Reinforce Sustain Talk
C A T
Commitment
Activation
Taking Steps
I will
I'm going to
I plan to
I'm almost ready
I checked it out
I tried to
I'm tired of living like this
It's time
I'm thinking about it
I can if I make up my mind
D.A.R.N.
Preparatory
Implementing
References
Borrelli, B., McQuaid, E.L., Becker, B., Hammond, K., Papandonatos, G., Fritz, G., & Abrams, D. (2002). Motivating parents of kids with asthma to quit smoking: the PAQS project. Health Education Research, 17(5), 659-69 pp.

Erickson, S.J., Gerstle, M., & Feldstein, S.W. (2005). Brief interventions and motivational interviewing with children, adolescents, and their parents in pediatric health care settings: a review. Archives of Pediatrics and Adolescent Medicine, 159(12), 1173-80 pp.

Halterman, J.S., Riekert, K., Bayer, A., Fagnano, M., Tremblay, P., Blaakman, S., & Borrelli, B. (2011). A pilot study to enhance preventive asthma care among urban adolescents with asthma. The Journal of Asthma, 48(5), 523-30 pp.

Knight, K.M., McGowan, L., Dickens, C., & Bundy, C. (2006). A systematic review of motivational interviewing in physical health care settings. British Journal of Health Psychology, 11(Pt 2), 319-32 pp.

Lozano, P., McPhillips, H.A., Hartzler, B., Robertson, A.S., Runkle, C., Scholz, K.A., Stout, J.W., & Kieckhefer GM. (2010). Randomized trial of teaching brief motivational interviewing to pediatric trainees to promote healthy behaviors in families. Archives of Pediatrics and Adolescent Medicine, 164(6), 561-6 pp.

Powell, C. & Brazier, A. (2004). Psychological approaches to the management of respiratory symptoms in children and adolescents. Paediatric Respiratory Reviews. 5(3), 214-24 pp.

Riekert, K.A., Borrelli, B., Bilderback, A., & Rand, C.S. (2011). The development of a motivational interviewing intervention to promote medication adherence among inner-city, African-American adolescents with asthma. Patient Education and Counseling. 82(1), 117-22 pp.

Seid, M., D'Amico, E.J., Varni, J.W., Munafo, J.K., Britto, M.T., Kercsmar, C.M., Drotar, D., King, E.C., & Darbie, L. (2011). The In Vivo Adherence Intervention For at Risk Adolescents With Asthma: Report of a Randomized Pilot Trial. Journal of Pediatric Psychology, Online, Dec, 1-14 pp.

Weinstein, A.G. (2011). The potential of asthma adherence management to enhance asthma guidelines. Annals of Allergy, Asthma and Immunology, 106(4):283-91 pp.
"In the end it is your choice – where would you like to go from here?"
THE SPIRIT OF MI
Partnership
Acceptance
Evocation
Compassion
"I’m interested in your ideas on how you want to tackle this."
"What do you know about the link between smoking and asthma?"
"I can understand that must make you feel upset and we will work together to get through this."
Self-managing
Self-prioritizing
Self-directed
Autonomy
working jointly with others
a process
goals are shared and realized together
TEACH PROJECT, Centre for Addiction and Mental Health (CAMH)
TEACH PROJECT, Centre for Addiction and Mental Health (CAMH)
Collaboration
Evocation
From the Latin "to call forth"
Elicitation of what is already present
Using their pre-discovered knowledge
TEACH PROJECT, Centre for Addiction and Mental Health (CAMH)
IF THIS IS YOU.... YOU ARE DOING IT WRONG!!!
Compassion
Understanding how another may be feeling
Recognizing and sharing the same emotions
Not necessarily having personally experienced, yet allowing to project on your consciousness
Empathy
TEACH PROJECT, Centre for Addiction and Mental Health (CAMH)
Promote client’s welfare first

Focusing on
their
needs
Response that motivates someone to help
EMOTION

Duncker's Candle Problem
The Solution

One was told they were being monitored for comparison
One group was told that if they performed quickly they would be rewarded.
Taking one step further
They found that the incentivised group took nearly three and a half minutes longer to complete the exercise than the group who were not offered an incentive.
The Carrot and the Stick Don’t work!!
Getting you folks to do the candle test…
“People are generally better persuaded by the reasons they have themselves discovered, than by those which have come into the mind of others.”
Pascal, 17th Century
The TRUTH!!!!
They split into two groups
Which group was faster?
“People are generally better persuaded by the reasons they have themselves discovered, than by those which have come into the mind of others.”
Pascal, 17th Century
The TRUTH!!!!
Has anyone heard of Duncker’s candle problem? A study was conducted a few decades ago which analysed what happens when people are given conceptual challenges and offered rewards for finding a solution quickly. The exercise presented to the participants was the “candle problem”.

The test presents the participant with the following task: how to fix a lit candle on a wall in a way so the candle wax won't drip onto the table below.[3] To do so, one may only use the following along with the candle: a book of matches,a box of thumbtacks
Most patients are ambivalent about unhealthy behaviors
The Righting Reflex
We see this an unhealthy/risky behavior, and our natural instinct is to point it out & advise change.
The patient’s natural response is to defend the opposite (no change) side of the ambivalence coin.
Refers to the tendency of practitioners to try to actively fix their client’s problems, thereby reducing the likelihood of client change.
HOW?

1. Asking evocative questions

2. Using the Importance Ruler

3. Exploring the Decisional Balance

4. Elaborating

5. Querying extremes

6. Looking back

7. Looking forward

8. Exploring goals and values
Angry, agitated and overwhelmed
Oppositional
Discounting
Defensive
Justifying
Not listened to or understood
Disengaged and helpless
How your clients repond to you FIXING THEM!
Behavior change is not easy

Behavior change is not an event, but rather a process.No one can be forced to change, but we can help people discover why they want to change

Before you jump into talking about a specific behaviour it is essential to ask for permission.



Asking Permission

Motivational interviewing is a tools we can apply to identify what the client is ambivalent about, and help the client to discover potential solutions

Overcoming Ambivalence

Open questions are hard to answer
Let's try one:
Did you have a good relationship with your father?
Tell me about the relationship you have with your father?
Recognizing client strengths
acknowledge behaviors that lead in the direction of positive change
no matter how big or small.
It is very easy to confuse praise with affirmation. Affirmation is not telling someone that they did a good job, it is recognizing effort. Affirmation is far more about the attempt and less about the result.

Affirmation is NOT praise!

The concept of Reflective Listening is to provide a focus for the conversation. The goal is to direct or steer the conversation to positive aspects.

During our conversations with clients there are a great many things said, our goal is to identify statements of strength, desire, or ability.

Reflective listening is a tool used to demonstrate our understanding of what is being said, and to direct a conversation to focus on the positive. It is also a good way to help us to listen
Reflective Listening
Activity -Developing Empathy
ACTIVITY: Your Mentor
There are many ways to ask, but it is essential that we do.
Summary can be used throughout a conversation but are particularly helpful at transition points

after the person has spoken about a particular topic,
After the client recounts a personal experience
when the encounter is nearing an end.
Summarizing helps to ensure that there is clear communication between the speaker and listener.


Also, it can provide a stepping stone towards change.
Summary
Summary is also a good way to end a conversation when the visit is completed.

Summary
Activity 8
QUESTIONS????
THE CHINESE BAMBOO TREE
Drop by drop is the water pot filled. Likewise, the wise man, gathering it little by little, fills himself with good. Buddha
Activity: Asking for permission
Activity: Building on their knowledge
Activity: Open questions
Activity: Affirmations
Activity: Reflections
Acitivity: Bring it all together
Full transcript