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Motivational Interviewing in Health Care – Helping Patients Change Behavior

By
Stephen Rollnick, PhD
William R. Miller, PhD
Christopher C. Butler, MD

Course Description

Much of health care today involves helping patients manage conditions whose outcomes can be greatly influenced by lifestyle of behavior change. Written specifically for health care professionals, this concise book presents powerful tools to enhance communications with patients and guide them in making choices to improve their health, from weight loss, exercise, and smoking cessation, to medication adherence and safe sex practices. Engaging dialogues and vignettes bring to life the core skills of MI and show how to incorporate this brief evidence-based approach into any health care setting. Appendices include MI training resources and publications on specific medical conditions.

About Authors

Stephen Rollnick, PhD, is a clinical psychologist and Professor of Health Care Communication in the Department of Primary Care and Public Health at Cardiff University, Wales, United Kingdom. He practiced in a primary care setting for 16 years and then became a teacher and researcher on the subject of communication. Dr. Rollnick has written books on motivational interviewing and health behavior change and has a special interest in challenging consultations in health and social care. He has published widely in scientific journals and has taught practitioners and trainers in many countries throughout the world.

William R. Miller, PhD, is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico, where he joined the faculty in 1976. He served as Director of Clinical Training for UNM’s American Psychological Association-approved doctoral program in clinical psychology and as Codirector of UNM’s Center on Alcoholism, Substance Abuse, and Addictions (CASAA). Dr. Miller’s publications include 35 books and more than 200 articles and chapters. He introduced the concept of motivational interviewing in a 1983 article. The Institute for Scientific Information names him as one of the world’s most cited scientists.

Christopher C. Butler, MD, is Professor of Primary Care Medicine and head of the Department of Primary Care and Public Health at Cardiff University. He trained in medicine at the University of Cape Town and in clinical epidemiology at the University of Toronto. For his doctoral work, under the direction of Stephen Rollnick, he developed and evaluated behavior change counseling and conducted qualitative research into patients’ perceptions of advice against smoking from clinicians. Dr. Butler has published more than 70 papers, mainly on health behavior change and common infections. He has a general medical practice in a former coal-mining town in south Wales.

Learning Objectives

After completing this course you’ll be able to:

  1. List several health problems strongly linked to behavior and lifestyle.
  2. State how motivational interviewing works.
  3. List and describe the three “spirits” of motivational interviewing.
  4. Describe the acronym RULE.
  5. List and describe the three communication styles.
  6. List the three guiding styles of MI.
  7. List the three core communication skills.
  8. State the most common communication tools that practitioners use.
  9. Describe ambivalence.
  10. List examples of change talk: desire, ability and reasons.
  11. List examples of change talk: need, commitment, and taking steps.
  12. Describe the acronym DARN.
  13. Describe open and closed questions.
  14. List several purposes that open questions serve.
  15. Describe a Routine Assessment using a “Typical Day.” (Table 4.1).
  16. State the function of a good guide.
  17. Describe the “bubble sheet.”
  18. List the dual purpose of the ruler.
  19. State the two productive questions regarding change.
  20. State the purpose of a “key question” and give an example.
  21. List five reasons to improve your listening skills
  22. List three key situations for listening.
  23. State the two key signals that open the door to listening.
  24. State why silence is a good teacher.
  25. List four functions of a summary.
  26. State the three practical recommendations about questions while you are listening.
  27. State three effective and gentle ways of bringing listening to a close.
  28. List several steps for clarity regarding information giving and patient compliance
  29. Describe the four forces that block ability to absorb information you offer.
  30. List the methods of obtaining “permission to inform.”
  31. Describe how to offer choices.
  32. List the value of “check” in the chunk, check, chunk strategy of informing.
  33. Describe the Elicit-Provide-Elicit guideline of informing.
  34. List sample questions of how to assess commitment.
  35. List sample questions that elicit DARN statements.
  36. Define being “in the moment.”
  37. State the methods of guiding you will use as skill improves.
  38. List one of the origins of MI.
  39. State why a directing style is inappropriate for a patient in denial.
  40. Define aspirations for patient behavior change. (ABCs)
  41. Define “position of equipoise.”
  42. List several traps when wanting patients to change behavior.
  43. Describe agenda setting.
  44. State one way to get better at guiding.
  45. List briefly the 7 C’s of a Patient-Centered Model of Care.
  46. Discuss the “why” and “how” of patient health behavior change.
  47. According to Table 10.1, list the three traps to avoid when guiding groups.

Course Contents

Part I. Behavior Change and Motivational Interviewing

  1. Motivational Interviewing
  2. How Motivational Interviewing Fits into Health Care Practice

Part II. Core Skills of Motivational Interviewing

  1. Practicing Motivational Interviewing
  2. Asking
  3. Listening
  4. Informing

Part III. Putting It All Together

  1. Integrating the Skills
  2. Case Examples of a Guiding Style
  3. Getting Better at Guiding
  4. Beyond the Consultation