“Motivational interviewing is a brief, focused, client-centered, collaborative practice approach designed to elicit behavioral changes by helping alcohol and drug involved clients (and their partners) identify, explore, and resolve ambivalence”
The therapeutic relationship is more of a partership or companionship then expert and recipient. The couseler that ues MI forcus on the client expereinces. They use these experiences to teach rather then directly teaching or advising. MI allows the pt to experience the ambivalence that they are feeling.
When a peron uses MI, they listen for what they call "DANCR steps" 1. Desire to change : I want to change 2. Ability to change: I could 3. Need to change: I must 4. Commitment to change: I promise to 5. Reasonns to change: becasue
steps: these are behavior steps, NOT the target behavior but steps that create the target behavior or desired change ( ie. I read the pamplet about treatment, I drove by the facility)
Using motivational interviewing techniques is used to help the client go through the stages of change. The initial phases of motivational interviewing, when clients are in the pre-contemplation stage, the clinician uses the clients own words to highlight the costs off the problem behavior and the benefits of changing the behavior. Motivational interviewing allows the client to see strengths they currently have, supports, barriers they may see, and encouraging the person to make the change. There are five interview strategies used in motivational interviewing: 1. Reflective listening or paraphase: Lets the pt know you are listening: "You're feeling" Sounds like you, It seems you, So you have been... If I heard you correctly 2. Open ended questions: this assist to learn the details how the client has the healthy riskey behavior part of their lives: "your partner has some concerns, but you tell me how you see things "What have you noticed about your _______(behavior) in the last year "@What have you liked ot enjoy about______ (behavior) 3. Affirmation (validation): THis should be something postive that refers to an aspect of the client that would last across time or situations: ie smart, resourceful, patient, strong or slso fo effort: I appreciarte you beig here today 4. Summarization: Ask where the healthy risk behavior fits in wth lifestyle, health or stress: 1. On a scale on 1-10 with 10 mbeign th most concerned, How concern are you now anout yout _____ certain behavior 2. So______(rsik behavior) helps you unwind at the end of the day. What else does it help with
The first four are considered to be nondirective intervention skills. These skills provide an opportunity for the clinician to establish rapport with the client. This is essential to assure success with any intervention.
The fifth interview strategy that is involved in motivational interviewing is eliciting self-motivational statements. “Self motivational statements are remarks that made by clients that generally fall into four categories: 1. Recognition that a current behavior or its consequences are problematic. 2. Expressions of concern about the current situation. 3. Indications of an intention or desire to change. 4. Words of hope and optimism about change.”
Some ways that clinicians can elicit self-motivational statements by asking question such as: If you continue to drink as you have, what do you think will happen to your health? In what ways does alcohol have a negative impact on your job? Finances? Relationships, etc? Asking about impacts about relationships is essential for the patient to clearly see the effects of their habit of themselves and others. “Spousal influence is an important factor in older adults’ drinking. Thus, involving clients’ families can increase the success of motivational interviewing.
Some of the questions OF MI are similiar to what other type of therapy? What populations might MI not work as well? What restrictions if any would your find in using MI in your work enviroment? Drawbacks of MI?
MI is one of my favorite techniques to use with my clients. MI is extremely useful when working with individuals with chemical dependency issues. I find it helpful with people of all ages and it is also useful with family members. Many of those in treatment at my agency are there because of legal involvement so MI is used to try to get the pt. to identify the problems they have in their life as a result of using D/A.
I think that my agency does a good job at identifying where the pt. is in regards to their desire to change. Our assessment process asks some questions to help the assessor identify the stage they are in. I don’t think, however, that we do such a good job at continuing with MI to help move people along in the different stages of change.
MI, in my view, is so helpful because you as the clinician are able to use the pt. own words and ask more questions and challenge their thinking with their own words. Pointing out the contradictions in the pts. thinking is the main objective of the clinician and it is so rewarding to see the pt. have a “light bulb” moment while using MI. I also think that MI can be used in brief and/or longer term treatment which is another benefit of this technique.
MI approach seems to be similar to strength-based approach. Rather attempting to solve the client problems or suggesting solutions to the client, the therapist focuses on the client’s strengths. I think this approach will work well in any situation because it is less threatening to the client in terms of making a change. But I am not sure this approach would work well with clients who are severely addicted or having mental health issues. I can’t think of MI’s drawbacks at the moment but I will keep thinking.
Tara, Thanks for your input and emphasizing how much legal implications impact your clients motivation to change their behavior.
Tim, I am wondering why your not sure this approach may not work well with "severely" addicted clients? Can we qualify the level of someones addiction and if so are there and dangers to doing so?
I admire the fact that Motivational Interviewing allows for acceptance of the "Middle Ground" with changing behavior and that is it allows for "Ambivalence" Ambivalence isn't perceived as failure or a weakness. If the average addicttion takes 7 X's to end, there is going to be inherit ambivalence and so "called failure in that process.
But, our black and white society doesn't easily allow for failure or for someone to be on the fence about change behavior because there are some legitmate pleasurable things concerning this behavior they want to change
I like what Derek said about ambivalence. I think that we have to remember that in many ways people think that their addiction and/or MH issues are who they are. I think many people have developed a sense of self and in some ways are afraid of what they may become without their addiction or by treating their MH issues. Ambivalence is an importsnt factor because when we think of individuals as part of a greater system, we have to help people see that they are 1) part of a greater system and 2) that they can change the way in which they particpate within these systems. MI is beneficial because it empowers people to change at their own pace or to not change at all.
Tara, I think changing at your own pace is the key. I think when people are shamed, pressured, coerced into change, there may be some interim change but it is short lived and high risk for relapse. I think the cognitive part of really understand there individual thought process and motivations for change is huge.
I also think that it is imperative that clinicians are patient, non judgemental and that they educate others around the change process during this time of ambivalence because other providers will be so quick to throw a label on your clients and it is our duty to protect their dignity and opportunity to succeed
Tara, I think your clinical setting really lends for MI to be successful. For the LICSW exam Team, With regard to ACUTE Medical Settings MI isn't highly regard as the primary modality of choice. I am thinking probably because you don't have the enough time to thoughtfully address ambivalence/Resistance and carry out a treatment plan. Nevertheless, I do think it has it's place and I want to discuss that with you. But, I want you to remember for the LICSW Exam and application questions about theoretical modalities, average length of treatment sessions and clinical settings are going to be important variables that require congruency. For example, brief Therapy, on average is 4 to 6 weeks or sessions may not necessarily be a good match for a contextual questioning where the clinician may need long period of time to explore someones childhood abuse experiences related to PTSD
Team, thank you for such a thoughtful discussion! Tim, I had the same reservations as you regarding MI being effective with those "severely addicted" or perhaps longer term uses. My reservation comes in part from reading Beautiful Boy and reading about the amount of manipulation the son uses in order to continue as he wishes while appeasing those around him who want to see improvement. Of course, this is just one book and I have limited experience with CD, so I look forward to learning more from all of you.
I had a very recent experience with a client who I think MI would have been incredibly useful for and I wish I had a better understanding of the critical components of the theory prior to my visiting her. In this case, the patient was not described by the medical team as an "addict" but had a history of illicit substance abuse during her pregnancy and tested positive following the birth of her baby. When I questioned the patient, she said that she had stopped but that people were using around her and she ingested the substance second-handedly. During the course of our meeting, the patient insisted that she was done with drugs and was excited to be a new mom (MI's need to change/reason to change). My concern was more about the people around her and how she was going to ensure that she would continue to be strong enough to insist that they not do drugs around the baby. I asked her what her plan was to discuss this situation with those individuals and she said that she plans to talk to them (MI's desire to change) and will insist that they go somewhere else if they try to use drugs at her home. Due to mandated reporting laws, I reported this case to CPS and discussed this with the patient in a follow up meeting. Despite the grave news for most patients, this patient seemed to receive this news as further motivation that she not use again and that it was up to her to ensure that those around her not use either. (as a background note, the patient had asked if this would likely trigger an investigation and due to the type of substance and lack of other reports, I told her that it was unlikely, but that I could not be sure if there were other reports made unbeknownst to me.)
Hi Team, Great topic! Thanks for the valuable insight. I get kind of excited about MI, as I did when I first disovered the principles of the Rogerian approach. It seems that many of its principles have become part of what we naturally do as counselors. Derek, I am looking forward to a discussion of how to use MI in medical settings, where we may have only one interaction. I have found that it "feels" good to support self-efficacy and to apply some of the directive approaches like "agreeing with a twist," but we have no way of knowing the outcome when we don't see a patient again.
I have been watching a training video made my Miller and Rollnick that some of you may have seen. In it Miller talks about 6 commonalities in brief interventions that he found to be consistent with MI. He uses the acronym FRAMES to stand for Feedback - the sharing of test results and such; Resonsibility - the idea that the decision to change lies with the client; Advice - the directive nature of these interventions; Menu of options - the idea of providing a range of responses to a maladaptive behavior; Empathy; and Self Efficacy - developing clients belief in their ability to change.
He shows how even a single brief session can contain all these elements. I am trying to imprint this acronym and its contents in my mind as I approach patients in the ER.
I really enjoy the concept and practice of MI. While I find that it was more appropriate in the CD setting, I also find myself using it in the acute setting (in the ER and the hospital). Of course, in the ER and hospital, it is much more brief and limited. When I think back to pt's I have worked with in the hospital and the MI approach that has been useful, I think of those pt's that come in with comorbidities that may be linked to unhealthy behaviors/choices and addictions. I see pt's coming in through the revolving door all the time. Despite the fact that they have end stage liver disease, they continue to drink on a daily basis, or despite their end stage COPD,on home O2- they continue to smoke daily. In these cases, MI comes in handy, but it is knowing how to effectively engage the pt in MI type of conversation and assessment that is key, as time is limited.Another example I can think of is working with pt's who have had multiple admits, yet despite the fact that home is not a safe option for them to d/c to, they continue to refuse SNF, HH etc.... having dialect w/ these pt's re: their ambilvalence towards going to a SNF, or allowing for home services is important and I think our word choices and questions we choose to engage them in can sometimes allow for them to really think about the consequences their choices have had on their current situation (medical and psycho-social). It is during these times, where I am able to briefly pull out the MI that I am able to see the pt's decide to try another option such as SNF or HH (this does not work all the time, but if I am going to have success, I automatically go to the MI mindset).
I think people have ambivalence for many reasons. One obvious one, is that they are scared to change. I think we can all recall a time in our life where we were scared of a change...... I know I can. ANother reason is that maybe they have never had/don't know how to access the support they need to make the change. The central purpose of the MI framework is to help the pt (always being pt centered in this approach) to empower themselves through resolution of their ambivalence. I can think back to many pt's where this has worked (mostly through my work as a CDP, but also in brief ways like a pt finally agreeing to go to a SNF after talking through why they have not gone in the past, and how making the choices they have has also not worked in the past). I can also think back to ways in which this has not worked. So I think it is all about meeting the pt's where they are at. For some pt's, this is exactly what they may need to make that next step towards recovery/change. For others, they may not be at a point (maybe they have not reliazed their losses, are still in denial etc..) where this will be beneficial for them. I think that the principles of MI are really based on humanistic psychology (Rogers). Being in the here and now, being goal directed while also displaying warmth, empathy etc..although Rogers believes that the pt will move towards self actualization, and MI goal is towards positive change. During my work as a CDP, we used to have weekly tx meetings, where we would go over pt's and present their stage of change (pre-contemplation, contemplation, decision making, ction and maintenance). MI can help pt's move through these stages. And of course using this in conjuction with other modalities such as CBT is important. I read a study in which dually diagnosed pt's with CD and psychiatric d/o were placed in 2 groups following as inpt tx program. They both recieved aftercare, but one group had MI in addition to regular groups. The group with the MI had better outcomes, stayed sober longer and were more compliant with meds, follow up etc.
I like MI. I think it works very well in both acute and long term settings. I feel that MI is empowering because we clinicians believe in the person's ability to change, which reminds me of Rogers' Humanistic theory. Through active listening and affirming, I have seen my clients feeling motivated to change or at least realizing their ability to make change. When we talked about dyalisis pts in the last group, it made me think about MI. When we want to connect with some of the toughest patients, I think our first step is to find out what makes this person motivated to keep going. Almost all of them have that driving force. We can talk about how their poor choices have affected their family, health, career, finances, education....etc I have seen this technique work. When I was Derek's student, I remember using MI for the first time with a patient with SI. I remember leaving the room amazed by the fact that the pt worked through her ambivalance with the help of my active listening and affirming. I think MI is a very effecctive way to encourage pts to change.
Team, Kasie is hosting this exciting discussion on MI
ReplyDelete“Motivational interviewing is a brief, focused, client-centered, collaborative practice approach designed to elicit behavioral changes by helping alcohol and drug involved clients (and their partners) identify, explore, and resolve ambivalence”
ReplyDeleteThe therapeutic relationship is more of a partership or companionship then expert and recipient. The couseler that ues MI forcus on the client expereinces. They use these experiences to teach rather then directly teaching or advising. MI allows the pt to experience the ambivalence that they are feeling.
When a peron uses MI, they listen for what they call "DANCR steps"
1. Desire to change : I want to change
2. Ability to change: I could
3. Need to change: I must
4. Commitment to change: I promise to
5. Reasonns to change: becasue
steps: these are behavior steps, NOT the target behavior but steps that create the target behavior or desired change ( ie. I read the pamplet about treatment, I drove by the facility)
Using motivational interviewing techniques is used to help the client go through the stages of change. The initial phases of motivational interviewing, when clients are in the pre-contemplation stage, the clinician uses the clients own words to highlight the costs off the problem behavior and the benefits of changing the behavior. Motivational interviewing allows the client to see strengths they currently have, supports, barriers they may see, and encouraging the person to make the change.
There are five interview strategies used in motivational interviewing:
1. Reflective listening or paraphase: Lets the pt know you are listening: "You're feeling" Sounds like you, It seems you, So you have been... If I heard you correctly
2. Open ended questions: this assist to learn the details how the client has the healthy riskey behavior part of their lives:
"your partner has some concerns, but you tell me how you see things
"What have you noticed about your _______(behavior) in the last year
"@What have you liked ot enjoy about______ (behavior)
3. Affirmation (validation): THis should be something postive that refers to an aspect of the client that would last across time or situations: ie smart, resourceful, patient, strong or slso fo effort: I appreciarte you beig here today
4. Summarization: Ask where the healthy risk behavior fits in wth lifestyle, health or stress:
1. On a scale on 1-10 with 10 mbeign th most concerned, How concern are you now anout yout _____ certain behavior
2. So______(rsik behavior) helps you unwind at the end of the day. What else does it help with
The first four are considered to be nondirective intervention skills. These skills provide an opportunity for the clinician to establish rapport with the client. This is essential to assure success with any intervention.
The fifth interview strategy that is involved in motivational interviewing is eliciting self-motivational statements. “Self motivational statements are remarks that made by clients that generally fall into four categories:
1. Recognition that a current behavior or its consequences are problematic.
2. Expressions of concern about the current situation.
3. Indications of an intention or desire to change.
4. Words of hope and optimism about change.”
Some ways that clinicians can elicit self-motivational statements by asking question such as: If you continue to drink as you have, what do you think will happen to your health? In what ways does alcohol have a negative impact on your job? Finances? Relationships, etc?
Asking about impacts about relationships is essential for the patient to clearly see the effects of their habit of themselves and others. “Spousal influence is an important factor in older adults’ drinking. Thus, involving clients’ families can increase the success of motivational interviewing.
Some of the questions OF MI are similiar to what other type of therapy? What populations might MI not work as well? What restrictions if any would your find in using MI in your work enviroment? Drawbacks of MI?
MI is one of my favorite techniques to use with my clients. MI is extremely useful when working with individuals with chemical dependency issues. I find it helpful with people of all ages and it is also useful with family members. Many of those in treatment at my agency are there because of legal involvement so MI is used to try to get the pt. to identify the problems they have in their life as a result of using D/A.
ReplyDeleteI think that my agency does a good job at identifying where the pt. is in regards to their desire to change. Our assessment process asks some questions to help the assessor identify the stage they are in. I don’t think, however, that we do such a good job at continuing with MI to help move people along in the different stages of change.
MI, in my view, is so helpful because you as the clinician are able to use the pt. own words and ask more questions and challenge their thinking with their own words. Pointing out the contradictions in the pts. thinking is the main objective of the clinician and it is so rewarding to see the pt. have a “light bulb” moment while using MI. I also think that MI can be used in brief and/or longer term treatment which is another benefit of this technique.
MI approach seems to be similar to strength-based approach. Rather attempting to solve the client problems or suggesting solutions to the client, the therapist focuses on the client’s strengths. I think this approach will work well in any situation because it is less threatening to the client in terms of making a change. But I am not sure this approach would work well with clients who are severely addicted or having mental health issues. I can’t think of MI’s drawbacks at the moment but I will keep thinking.
ReplyDeleteTara, Thanks for your input and emphasizing how much legal implications impact your clients motivation to change their behavior.
ReplyDeleteTim, I am wondering why your not sure this approach may not work well with "severely" addicted clients? Can we qualify the level of someones addiction and if so are there and dangers to doing so?
I admire the fact that Motivational Interviewing allows for acceptance of the "Middle Ground" with changing behavior and that is it allows for "Ambivalence" Ambivalence isn't perceived as failure or a weakness. If the average addicttion takes 7 X's to end, there is going to be inherit ambivalence and so "called failure in that process.
But, our black and white society doesn't easily allow for failure or for someone to be on the fence about change behavior because there are some legitmate pleasurable things concerning this behavior they want to change
I like what Derek said about ambivalence. I think that we have to remember that in many ways people think that their addiction and/or MH issues are who they are. I think many people have developed a sense of self and in some ways are afraid of what they may become without their addiction or by treating their MH issues. Ambivalence is an importsnt factor because when we think of individuals as part of a greater system, we have to help people see that they are 1) part of a greater system and 2) that they can change the way in which they particpate within these systems. MI is beneficial because it empowers people to change at their own pace or to not change at all.
ReplyDeleteTara, I think changing at your own pace is the key. I think when people are shamed, pressured, coerced into change, there may be some interim change but it is short lived and high risk for relapse. I think the cognitive part of really understand there individual thought process and motivations for change is huge.
ReplyDeleteI also think that it is imperative that clinicians are patient, non judgemental and that they educate others around the change process during this time of ambivalence because other providers will be so quick to throw a label on your clients and it is our duty to protect their dignity and opportunity to succeed
ReplyDeleteTara, I think your clinical setting really lends for MI to be successful. For the LICSW exam Team, With regard to ACUTE Medical Settings MI isn't highly regard as the primary modality of choice. I am thinking probably because you don't have the enough time to thoughtfully address ambivalence/Resistance and carry out a treatment plan. Nevertheless, I do think it has it's place and I want to discuss that with you. But, I want you to remember for the LICSW Exam and application questions about theoretical modalities, average length of treatment sessions and clinical settings are going to be important variables that require congruency. For example, brief Therapy, on average is 4 to 6 weeks or sessions may not necessarily be a good match for a contextual questioning where the clinician may need long period of time to explore someones childhood abuse experiences related to PTSD
ReplyDeleteTeam, thank you for such a thoughtful discussion! Tim, I had the same reservations as you regarding MI being effective with those "severely addicted" or perhaps longer term uses. My reservation comes in part from reading Beautiful Boy and reading about the amount of manipulation the son uses in order to continue as he wishes while appeasing those around him who want to see improvement. Of course, this is just one book and I have limited experience with CD, so I look forward to learning more from all of you.
ReplyDeleteI had a very recent experience with a client who I think MI would have been incredibly useful for and I wish I had a better understanding of the critical components of the theory prior to my visiting her. In this case, the patient was not described by the medical team as an "addict" but had a history of illicit substance abuse during her pregnancy and tested positive following the birth of her baby. When I questioned the patient, she said that she had stopped but that people were using around her and she ingested the substance second-handedly. During the course of our meeting, the patient insisted that she was done with drugs and was excited to be a new mom (MI's need to change/reason to change). My concern was more about the people around her and how she was going to ensure that she would continue to be strong enough to insist that they not do drugs around the baby. I asked her what her plan was to discuss this situation with those individuals and she said that she plans to talk to them (MI's desire to change) and will insist that they go somewhere else if they try to use drugs at her home. Due to mandated reporting laws, I reported this case to CPS and discussed this with the patient in a follow up meeting. Despite the grave news for most patients, this patient seemed to receive this news as further motivation that she not use again and that it was up to her to ensure that those around her not use either. (as a background note, the patient had asked if this would likely trigger an investigation and due to the type of substance and lack of other reports, I told her that it was unlikely, but that I could not be sure if there were other reports made unbeknownst to me.)
Hi Team, Great topic! Thanks for the valuable insight. I get kind of excited about MI, as I did when I first disovered the principles of the Rogerian approach. It seems that many of its principles have become part of what we naturally do as counselors.
ReplyDeleteDerek, I am looking forward to a discussion of how to use MI in medical settings, where we may have only one interaction. I have found that it "feels" good to support self-efficacy and to apply some of the directive approaches like "agreeing with a twist," but we have no way of knowing the outcome when we don't see a patient again.
I have been watching a training video made my Miller and Rollnick that some of you may have seen. In it Miller talks about 6 commonalities in brief interventions that he found to be consistent with MI. He uses the acronym FRAMES to stand for Feedback - the sharing of test results and such; Resonsibility - the idea that the decision to change lies with the client; Advice - the directive nature of these interventions; Menu of options - the idea of providing a range of responses to a maladaptive behavior; Empathy; and Self Efficacy - developing clients belief in their ability to change.
He shows how even a single brief session can contain all these elements. I am trying to imprint this acronym and its contents in my mind as I approach patients in the ER.
I really enjoy the concept and practice of MI. While I find that it was more appropriate in the CD setting, I also find myself using it in the acute setting (in the ER and the hospital). Of course, in the ER and hospital, it is much more brief and limited. When I think back to pt's I have worked with in the hospital and the MI approach that has been useful, I think of those pt's that come in with comorbidities that may be linked to unhealthy behaviors/choices and addictions. I see pt's coming in through the revolving door all the time. Despite the fact that they have end stage liver disease, they continue to drink on a daily basis, or despite their end stage COPD,on home O2- they continue to smoke daily. In these cases, MI comes in handy, but it is knowing how to effectively engage the pt in MI type of conversation and assessment that is key, as time is limited.Another example I can think of is working with pt's who have had multiple admits, yet despite the fact that home is not a safe option for them to d/c to, they continue to refuse SNF, HH etc.... having dialect w/ these pt's re: their ambilvalence towards going to a SNF, or allowing for home services is important and I think our word choices and questions we choose to engage them in can sometimes allow for them to really think about the consequences their choices have had on their current situation (medical and psycho-social). It is during these times, where I am able to briefly pull out the MI that I am able to see the pt's decide to try another option such as SNF or HH (this does not work all the time, but if I am going to have success, I automatically go to the MI mindset).
ReplyDeleteI think people have ambivalence for many reasons. One obvious one, is that they are scared to change. I think we can all recall a time in our life where we were scared of a change...... I know I can. ANother reason is that maybe they have never had/don't know how to access the support they need to make the change. The central purpose of the MI framework is to help the pt (always being pt centered in this approach) to empower themselves through resolution of their ambivalence. I can think back to many pt's where this has worked (mostly through my work as a CDP, but also in brief ways like a pt finally agreeing to go to a SNF after talking through why they have not gone in the past, and how making the choices they have has also not worked in the past). I can also think back to ways in which this has not worked. So I think it is all about meeting the pt's where they are at. For some pt's, this is exactly what they may need to make that next step towards recovery/change. For others, they may not be at a point (maybe they have not reliazed their losses, are still in denial etc..) where this will be beneficial for them. I think that the principles of MI are really based on humanistic psychology (Rogers). Being in the here and now, being goal directed while also displaying warmth, empathy etc..although Rogers believes that the pt will move towards self actualization, and MI goal is towards positive change.
During my work as a CDP, we used to have weekly tx meetings, where we would go over pt's and present their stage of change (pre-contemplation, contemplation, decision making, ction and maintenance). MI can help pt's move through these stages. And of course using this in conjuction with other modalities such as CBT is important.
I read a study in which dually diagnosed pt's with CD and psychiatric d/o were placed in 2 groups following as inpt tx program. They both recieved aftercare, but one group had MI in addition to regular groups. The group with the MI had better outcomes, stayed sober longer and were more compliant with meds, follow up etc.
I like MI. I think it works very well in both acute and long term settings. I feel that MI is empowering because we clinicians believe in the person's ability to change, which reminds me of Rogers' Humanistic theory. Through active listening and affirming, I have seen my clients feeling motivated to change or at least realizing their ability to make change. When we talked about dyalisis pts in the last group, it made me think about MI. When we want to connect with some of the toughest patients, I think our first step is to find out what makes this person motivated to keep going. Almost all of them have that driving force. We can talk about how their poor choices have affected their family, health, career, finances, education....etc I have seen this technique work. When I was Derek's student, I remember using MI for the first time with a patient with SI. I remember leaving the room amazed by the fact that the pt worked through her ambivalance with the help of my active listening and affirming. I think MI is a very effecctive way to encourage pts to change.
ReplyDelete