Motivational Interviewing in Health Care: Helping Patients Change Behavior

Applications of Motivational Interviewing

by Stephen Rollnick, William R. Miller, Christopher C. Butler

This book has been replaced by Motivational Interviewing in Health Care, Second Edition, ISBN 978-1-4625-5037-1.

Genres: Psychology, Nonfiction, Health, Medicine, Social Work, Nutrition, Counselling

210 pages, Paperback

First published November 5, 2007

Reviews

[Jen · Rating 3 out of 5]

I read this mostly to help me improve my Motivational Interviewing skills at work. I found some areas in which I need to improve. For example, sometimes I end a reflective statement with a higher tone of voice, almost like I'm asking a question. I also tend to follow an open ended question immediately with a closed ended question, causing the patient to only focus on my closed ended question. I need to work on my summarizing too-it's not my favorite thing to do. I'm going to try and read more books related to improving my skills. I wouldn't say I really enjoyed this book, but it was very informative and gave me some areas to work on. The case studies/examples were interesting.

[Sher Free · Rating 4 out of 5]

Probably 4.5. Really great info, suggestions and usable techniques. I just wish they had tied it all together with an outline, flowchart, something. I know every interview is going to be different and need to ebb and flow, but still, a little help on that guys and it might be a perfect little book. I had to take hours I don't have after reading this to put together my own modest outline for a little more usable and practicable structure, which I am inspired to use I have to say.

[أبو فاطمة 14 · Rating 4 out of 5]

قرأت النسخة العربية من الكتاب التي كانت بإشراف و تحرير د.فلاح بن محروت البلعاسي العنزي والصادرة عام ١٤٣٤ هـ تحت عنوان: المقابلة الدافعية في الرعاية الصحية الأولية؛ مساعدة المرضى على التغير السلوكي.

في الجزء الاول يتبين أن المقابلة الدافعية هي أسلوب عيادي ماهر لاثارة الدافعية الإيجابية لدى المرضى لإحداث التغيرات السلوكية التي تحسن صحتهم، وتعتمد على الشراكة التعاونية وإعطاء المرضى ما ينقصهم مع احترام إستقلالية المريض.
هنالك أربعة مبادئ إرشادية:
- مقاومة نزعة التصحيح
- فهم واستكشاف دوافع المريض الذاتية
- الاستماع بتواحد نفسي مع المريض
- تمكين وتحفيز المريض بالتفاؤل والأمل

مقاومة نزعة التصحيح: كثيراً ما يكون لدى الأشخاص الذين يدخلون الى مجال مهن المساعدة رغبة قوية في تصحيح الأوضاع القائمة فعندما يَرَوْن شخصاً في مسار خاطئ فإنهم و بسرعة يقولون له: "قف! و ارجع فهنالك مسلك أفضل" … وهذا دافع نبيل و احدى مشكلات هذا الميل التلقائي انه له تأثيرات عكسية و متناقضة لأن مقاومة الاقناع ميل انساني طبيعي وَ هذا ينطبق بشكل خاص عندما يكون الشخص متناقضان في موقفه أو في مشاعره. وخلاصة القول انك اذا كنت تجادل لصالح التغيير على حين يجادل مريضك ضده ويقاومه فإنك تؤدي الدور الخطأ. لأنك تحتكر كل المسارات الجيدة في حين أن الاحرى أن المريض هو الذي يجادل لصالح التغيير. فالمقابلة الدافعية تتمحور حول استثارة مثل هذا الجدل من المريض نفسه.

الناس اكثر قابلية للاقتناع بواسطة الأسباب التي يكتشفونها بأنفسهم وليس بواسطة الأسباب التي تأتي من عقول الآخرين.

ويأتي الفصل الثاني للكتاب ليبين كيفية الربط بين المقابلة الدافعية و الممارسة اليومية للرعاية الصحية… حيث يعرض ثلاثة أساليب اتصال شائعة في مجال الرعاية الصحية وهي التوجيه و الإرشاد والمتابعة. والمقابلة الدافعية عبارة عن شكل مهذب ومصقول من أشكال الإرشاد
كما يستعرض ثلاثاً من مهارات الاتصال الجوهرية: السؤال والإعلام والاستماع

في الفصل الثالث: ممارسة المقابلة الدافعية
يُبين ان المرشد الجيد:
- يسأل عن الوجهة
- يُعلِم الشخص بالخيارات والبدائل الممكنة
- يستمع ويحترم ما يريد الشخص فعله.
و يتحدث عن التناقض الدافعي خصوصاً اذا كان المريض مستمتعاً بالوضع الحاضر-أسلوب حياة مستقر و يتوقع جانب سلبي في التغيير (دوافع متضاربة: يريد ولا يريد في ذات الوقت) مثلاً عندما يقول المريض "احتاج لخفض وزني ولكني اكره التمرين) …وكيف يحدث أن يعلق الناس في وحل التناقض الدافعي حيث يفكرون في البداية عن سبب وجوب التغيير ثم في سبب عدم التغيير ثم يتوقفون عن التفكير في التغيير

الفصل الرابع يتحدث عن السؤال/وطرح الأسئلة… حيث أن هنالك أسئلة مقفلة وأسئلة مفتوحة و يُبين ما هو السؤال الماهر و يحذر من فخ سؤال/جواب

الفصل الخامس عن الاستماع والسادس عن الاعلام/الإخبار

و في الجزء الأخير يتحدث عن دمج كل العمليات والمهارات مع الأمثلة و طرق تحسين الأداء في الإرشاد

[Emily Blasik · Rating 3 out of 5]

Have you ever left your doctor's office feeling as if your observations/concerns/questions about your health weren't fully heard or answered? That's our modern healthcare system for you: quick, efficient, and sorely lacking in empathy. While the basic problem-solution approach is great for emergency situations (when time is of the essence!), chronic sufferers and preventative care patients would greatly benefit from just a few minutes of every day, old-fashioned conversation with their medical practitioner(s). That's where the Motivational Interviewing method comes in.

As someone who is training to become a holistic health coach—a role that exists solely to motivate healthy change in clients—the concept of Motivational Interviewing (MI) and the guidelines described in this book are hugely helpful. The idea is simple: rather than try to direct your clients/patients to better health, guide them. How does one do that? By listening, for one. As soon as we stop lecturing and start listening, we can begin to learn more about our clients—what's important to them, what motivates them, etc.—in order to better inspire them.

[MSB · Rating 4 out of 5]

Although the primary purpose of this book is to define and describe an approach to one-to-one health care consultations, it is also usefull for reader whose aim is just gain some personal development abilities like me. In addition to learn how to motivate people and make them change, personally, I found an opportunity to evaluate the medical doctors behaviours. After that book, I undestood why I like some doctors more than others. It is not just depends on their professionality but also their style of approach on me. The most mindful point of the book is about describe who is the good listener with "A truly good listener suspends his or her own “stuff” in the interest of giving full attention to understanding the other’s experience". Indeed being good listener is not so easy. Just very limited number of wonderful person that one of them also recommended me to read this book is really good listener.

[Jamie Fuller · Rating 4 out of 5]

This wasn't a fascinating read, but the lessons were important. I actually feel like they apply pretty broadly - any time you're talking to someone who is trying to make a change, needs to change or is coming at a subject from a different perspective than you are. Being aware of your automatic reflexes, how they come across and what that does to the dynamics makes a huge difference. There is particularly a lot be said for the section on really listening to the other person's motivations and working with them.

[Kathryn Saunders-Allen · Rating 5 out of 5]

While this was written for health care workers, it also simply lays out the information and practical tools to use Motivational Interviewing, which is a way to engage with people through honoring their autonomy and letting them guide the question. It is incredibly useful for anybody who has to work with people in their day-to-day job.

[Sarah · Rating 5 out of 5]

I read this book not as a health care provider, but in order to gain greater insight in advising and working with grad & undergrad students. This book is solid, and it honestly a great read for anyone who wants to work with and help motivate others in any capacity, whether in the workplace or person-to-person.

[Audrey Eisel · Rating 5 out of 5]

Read for my masters in counseling class…great application for more medical based fields/occupations but I think this it’s still an easy to understand basis of MI for anyone. I honestly think all medical personnel should read this…I feel like a lot more of their patients would follow thru on aftercare if they did.

[Tristan Roxburgh · Rating 4 out of 5]

Great book but I wish they would put their sources at the back of the book. There are literally half page paragraphs containing 2 actual sentences mixed alongside a bunch of sources, make it hard to follow at times.

[BMR, LCSW · Rating 4 out of 5]

Finally read this one, I've owned it for months.

I'm a medical social worker, so I will definitely be using it at work.

Recommended for medical clinicians of all types, anyone who can positively influence patient outcomes.

[Matt Bucklin · Rating 4 out of 5]

Really good explanation of techniques of Motivational Interviewing in healthcare practice.

[Coreena Witzig · Rating 4 out of 5]

This is an easy to read, easy to apply guide to using MI in clinical relationships. I would highly recommend for anyone working with people in their careers.

[Martha Karen · Rating 5 out of 5]

Invaluable resource for any healthcare professional who counsels patients on behavior change (I.e. all healthcare professionals)

[Jillybb · Rating 5 out of 5]

Very, very useful in patient care.

[Phillip · Rating 4 out of 5]

A good, manageable introduction into Motivational Interviewing for those working in a healthcare setting. Having never read the main book or gotten extensive training in MI, I cannot say whether or not this cut out too much of it to be successful. However, after reading it I definitely thought it reinforced important skills and provided a good jumping off point. I particularly liked the consultation examples provided near the end of the book. I don't think reading this book is enough to really get a handle on MI, but as an introduction to this worthwhile approach to working with patients I found it comprehensive. I plan on reviewing it to help my practice in the future.

[Shendoah · Rating 3 out of 5]

There was a bit of a mismatch here for me. I am a health counselor, but it is a counselor type of position. This book is much more aimed for the clinical setting, especially where time with each client is very limited. They are directing this book much more to Doctors, Nurses and their aids than to someone like me.

That said, as a Holistic Health Coach, the concepts set forth are extremely helpful. Since my job is to actually coach people through the changes that doctors are guiding them to make, helping keep them motivated to make the changes is imperative.

This book is setting out to lay the verbiage, mindset, and techniques that are helpful in guiding people to make the changes they really probably already know they need to make to improve whatever health issues are at hand, in such a way that they think it was really their idea all along. People adhere to their own ideas more than someone else.

It utilizes role play, context taken from actual clinical settings, examples of how one thing works over another. It reads very much like a text book. Unfortunately, it's a text book for a class I didn't enjoy much because it was so monotonously dull. I often had to force myself to keep going in the "please just let me finish this" mode.

Perhaps the lack of enjoyment stems from the mismatch between my counseling setting and the clinical drive of the book. I also bought the MI workbook, and have some guardedly higher hopes for that.

[Maan Kawas · Rating 5 out of 5]

A very good book that provides clear information on the concept, principles, tools, and skills of the ‘Motivational Interviewing” in general, and its use within the health care context in particular! One of the key points the book stressed is the importance of eliciting from patients their own good motivation for making health-related behavior change, using various strategies and tools. The books explain the overall spirit of the approach in the following points: “collaborative, evocative, and honoring of patients autonomy”. What I particularly loved about this book is explanation and addressing of the resistance by patients and the ambivalence in their feelings toward change, as well as its emphasis on understanding patient’s feelings and the necessity to empower them. The book is full of cases and examples that clearly demonstrate the different communications styles, their consequences, and the barriers to achieving effective results with patients and how to overcome these challenges. I find the book an important reference for professionals who seek to help their patient make behavior change in order to enhance, maintain, and protect their health.

[Myridian · Rating 2 out of 5]

This book tries to do basically what the title says, present motivational interviewing techniques geared toward a healthcare (really primary care) setting. The information is good and I am a believes in the techniques it was just oversimplified for someone who's already been to trainings and read the original Miller & Rollnick book. I would recommend this to people who think they need what the title says, but for someone at more of an intermediate level with MI, just go back to the original book or head to another training.

[Julie · Rating 4 out of 5]

This book describes how a social worker, MD, RN or other health care professional can talk to a patient about behavioral changes necessary for improving their health in such a way that the patient is motivated to change. This is done through enouraging the person to identify why, how much, and how they'd want to make changes, rather than the professional trying to argue, persuade, or guilt them into it. The authors, (and now I) are convinced that this is most effective way to encourage adult patients to make positive changes in their lives.

[Cyndie Courtney · Rating 4 out of 5]

For every medical professional who has ever wanted to bang their head into a wall due to patient non-compliance despite strong patient understanding of their condition and its risks.

This book explains so many phenomenon we experience in practice, especially why patients resist making health changes more the more evidence for the importance of those changes we present. Using case based examples this book presents an alternative listening, problem-solving based approach that still is fueled by the need for improved health outcomes.

Amazingly insightful.

[Patty · Rating 3 out of 5]

I had to read this for one of my classes and the information is helpful. However, it rambled and really got hard to follow in the last 1/4 of the book. Maybe my motivation was waning and the book was fine...I don't know. In any case, I learned about motivational interviewing and guidelines on how to do it. The examples helped. I think the content could have been organized a little better to make it easier to grasp. Probably could have cut 50 pages out, too, and not even noticed.

[Spieges]

Surprisingly good book if you are looking to improve your communication skills. While this book was written for the healthcare provider, I can see it's application across many interactions, including anyone with kids. It's a quick and easy read. Very informative.

[Becky Webb · Rating 5 out of 5]

This book is amazing! Although the technique takes some practice it can be used in so many parts of life, not just in a medical practice. For anyone who wants to improve their communication skills I recommend it!

[Tracey · Rating 5 out of 5]

Great resource if you work with people on behavior change.

[Joy · Rating 4 out of 5]

Interesting...I can think of a lot of different ways and circumstances in which this would be useful. I would especially recommend it to anyone in social services or medicine.

[Olwen · Rating 4 out of 5]

Great reference for revisiting the principles of motivational interviewing specifically in relation to health care. Easy to read and understand, well set out.

[Laura · Rating 4 out of 5]

Very useful.nNeed to reread and apply knowledge.

[Elizabeth · Rating 4 out of 5]

Good introductory piece. Very accessible to anyone who is considering implementing this technique.

[Kristina · Rating 4 out of 5]

Very applicable to my work, and a bit less dense than the main "motivational interviewing" book.