M is for Motivation....

Or more precisely Motivational Interviewing (MI).

MI can be defined as ‘a client centred, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence’.

This definition comes from Miller and Rollnick’s 2002 book, Preparing People for Change.

MI skills are important for Occupational Therapists (and of course other professionals) as a therapist with these skills can greatly increase the efficacy of their interventions with clients, particularly when working on any process of changing to develop health promoting habits and routines.

To use MI skills most effectively, it is important to understand the stages of the change process. A well known model is that of Prochaska & Norcross in their book Changing for Good (1994). They set out the following stages (imagine making a change such as trying to give up smoking and they will probably make sense):

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Termination

In understanding what point in the process someone is at, a skilled therapist can tailor thier MI skills in the most appropriate way. Of course, change is sometimes enforced, not chosen e.g. after illness of accident. The process of change does not happen in as neat and linear fashion as the model above might seem to suggest. Using the example of giving up smoking, it can often take several attempts and the stages need to be gone through more than once.

AS OTs, developing our MI skills can help us make the most effective use of our often limited time with clients, and to help them towards their goals more effectively.

Communication skills class

In the last two weeks we have begun studying motivational interviewing, this is an important skill in occupational therapy generally and is a key component of the Lifestyle Redesign approach.

The preparatory readings for class included:
(see Books tab at top of page for ful references)

Re interviews and interviewing generally- Chapters 6 & 7 of Adler & Elmhorst
Re Change Theory- Prochaska et al Changing for Good.
For a good introduction to motivational interviewing, the workbook by David B Rosengren and the book by Rollnick, Miller & Butler were suggested.

'Homework' from last week was to apply the idea of an 'intentional conversation' to a conversation in your own life where you would probably usually be expected to- or feel you were expected to- give advice or come up with solutions. It is a way of practicing listening skills and involves listening actively instead of jumping in with ideas and suggestions. Several class members shared their experiences, some found people elaborated more if allowed to speak uninterrupted, some reflected on how difficult it can be to just listen and not be busy planning what you are going to say next, some found they were still asked for advice. There is a reflective sheet to evaluate the experience in the workbook.

This week we moved on to look at the change process and how it fits with motivational interviewing. The book Changing for Good is based on research studies of people who made significant life changes without any support or professional help. It analyses their experiences to identify 6 stages of change:

• Precontemplation
• Contemplation
• Preparation

• Action
• Maintenance
• Termination

 

We also looked at self determination theory, important to understanding the impact of the external world on individuals undergoing or considering change.

Depending on the stage a person is at in the change process, intervention may be more or less successful- or even completely inappropriate at that time. Motivational interviewing techniques are based on 5 principles:

• expressing accurate empathy
• developing discrepancy
• avoiding argument
• 'rolling' with resistance
• supporting self-efficacy

Skilled use can help an individual begin or move through the change process. This does not happen in a linear fashion but is often cyclical, think of people who make several attempts to give up smoking before eventually succeeding. However at the 'precontemplation' stage the person is unaware of the need for and potential benefits of change, once they move to the 'contemplation' stage, however often they need to revisit it, they will never fully return to precontemplation. 'Termination' means that the issue is fully resolved e.g. no lingering desire for a cigarette. For some issues, especially highly addictive behaviours like smoking, termination may never fully be reached.

This is a very brief overview to illustrate the importance for OTs of understanding the change process, making an assessment of where a client is in that process and directing intervention accordingly to an individual's needs whether in a group or individual setting. This is one reason why even interventions that follow a clear 'programme' require a high level of skills from the OT to ensure flexibility and facilitate a successful outcome.