Motivational Interviewing is a technique designed to help patients change a specific health behavior. These include reducing risky behavior, such as smoking, unhealthy eating habits, sexual habits or improving things such as exercise frequency or changing diet. William Miller is given credit as the first person to describe Motivational Interviewing as a counseling technique. The counselor participates in role-playing activities to improve their skills and develop better methods for interacting with patients.
Motivational Interviewing Explained
The focus is a patient-centered method that strives to help the patient arrive at the conclusion that they need to change a behavior. MotivationalInterview.Org defines Motivational Interviewing as “a collaborative, person centered form of guiding to elicit and strengthen motivation for change.” The process attempts to support change through the patient’s own values and concerns. This is in contrast to a more coercive method of change that imposes the change or belief on a patient.
Motivational Interviewing Assumptions
According to The National Institute on Alcohol Abuse and Alcoholism Motivational Interviewing assumes that, “a) the theory that most people move through a series of steps prior to changing their behavior; b) change comes from within rather than from without; c) confrontation and negative messages are ineffective; d) knowledge alone is not helpful; and e) reducing ambivalence is the key to change.” The counselors are guided by principles, such as acknowledge patient’s perspective, develop discrepancy between the patient’s actions and their values, understand that there will be resistance and use it as an indication to adjust the conversation, and always support the person’s ability to make the change. The patient must believe that you trust that they are able to make the change.
Slow Motion Session Role Play
In the Slow Motion Session Role Play, the instructor begins the exercise by separating the class into groups of four and distributes cards identifying different types of resistance a patient might exhibit. The cards describe behavior such as arguing, ignoring, denying or interrupting. The instructor would then give each group a scenario for the group to act out. In each group, two participants act as the counselors, one acts as the patient and the last participant observes the interaction. The participant acting as a patient is given a resistance card and must display the behavior. The counselor then performs a motivational interview with the patient. In between each sentence, the group pauses for the other person to think about what he will say. The goal of the exercise is to help the counselor learn to deal with conflict that happens during a session.
Rolling with Resistance Role Play
The key to dealing with resistance is not to regard the patient as being argumentative or defiant, but use it as an opportunity to adopt another perspective. Resistance indicates the patient sees the situation differently than the counselor. An exercise aimed to help councilors recognize and better understand this difference is called the Rolling with Resistance Role Play. The instructor gives one training participant a behavior that needs to be changed and a specific resistance to that change. The second training participant plays the counselor that is called on to respond to that resistance.
Responses to Resistence
The counselors are trained to respond to resistance using one of several learned techniques to help avoid confrontation and maintain meaningful dialogue. One effective technique is reflecting the resistance statement back to the patient. This can be done by simply restating the concern or exaggerating it, not to mock the patient, but help them see that the statement itself is weak. Another way to respond is to point out how the resistance is inconsistent with a belief or value that the patient expressed earlier. Another strategy is to agree in part with the resistance so they feel that they concerns are understood, but the slight difference allows the conversation to move forward. Reframing the concern is also an effective technique that takes the original concern and puts it in a positive light so the patient can take away a more positive meaning.
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