Hello. Welcome to the first in our four part podcast series called Motivational Interviewing Tips In 10. The goal of this podcast is to discuss the topic of motivational interviewing and how it can be used in your facilities and in your own lives. My name is Alex Harris and I'm joined by my cohost, Cathie Nicholson.
Hi Alex, it's great to be with you today. As you remember, we recently did a series for our nursing home office hours on motivational interviewing. This podcast series will provide a recap of four practical skills, each highlighted from the nursing home office hour sessions. If you would like to watch the full webinar, a video recording is available on tmfnetworks.org.
To start us off, let's define Motivational Interviewing, also known by the abbreviation MI. Alex, would you tell us a little more about what MI is?
Sure. Motivational interviewing is basically a collaborative, strength based approach for working with people needing to make a change. It respects autonomy without being judgmental or telling someone what decisions to make. The focus is centered on leading a person to find their own reasons for deciding to change their behavior. It is also centered on early intervention to prevent illness or reduce risk.
Early intervention helps people identify their feelings about behavior change, resolve inconsistencies, and then plan for the change. Since behavior changes don't happen overnight, incremental and small behavior changes are valued and even celebrated. In a nutshell, MI helps to understand where a person is at, identify their own motivation for change, and develop steps needed to make that change.
You know, Alex, there's a quote I really love by William R. Miller and it says when a person feels accepted for who they are and what they do, no matter how unhealthy or destructive, it allows them the freedom to consider change rather than needing to defend against it. That's exactly what we want to do in motivational interviewing. Providing a non-judgmental conversation to help someone understand their own whys for making change.
One way that you can remember the key principles of MI is through the acronym GRACE. Generate a gap, roll with resistance, avoid arguing, can do, and empathy. So Alex, why don't you start off by breaking down the acronym for us?
You bet. Let's start with the G, which stands for generating a gap. This gap is the difference between where someone is and where they would like to be. Generating a gap requires highlighting discrepancies in what they say that they want and what they are actually doing. It is about understanding how those two things fit together or don't fit together and what would need to change to bridge that gap. There are a number of ways to highlight the gap, including looking at the difference between core values and behavior, how current behavior adds up to ultimate goals, and the cost of not making any changes.
For example, you say clearly you want to keep your mom safe. You get her to all of her doctor's appointments and make sure she's taking all of her medications. I'm confused why you are choosing not to let her get her booster. Can you help me understand? Drawing attention to these inconsistencies builds awareness that can be used to develop small steps towards change. Cathie, want to break down the R for us?
Of course. The next letter is R, which stands for roll with resistance. You're almost always going to get some resistance. Everyone is going to have some reason why they do not want to make a change. The important thing to remember is that you don't want to oppose it. Trying to fight resistance with more resistance is only going to make the situation worse. You do not want to argue or oppose them. You just want to offer new perspectives.
It's easy to fall into what's called the righting reflex, which is that immediate response to attempt to fix or right the person. This is a very common occurrence in health care and can often lead to the opposite effect than intended. Instead let's reframe or reflect their ideas. You can also explore the positive or negative outcomes of continuing or discontinuing a certain behavior. An example might be you mentioned you are concerned that the pharmaceutical companies are using COVID vaccines to make money. Tell me more about that.
That's great. And this brings us to our next letter, A, avoid arguing. Again, the more someone resists, the less likely change is going to occur. Also, like we said before, we don't want to come at this from a judgmental angle. We want to keep this conversation in a really positive light. Thus avoiding arguing is a huge step in the MI process.
Let's use an example with COVID vaccines. Say you have a patient who believes that the COVID vaccine is a scam to make drug companies money. If you come into this discussion criticizing what they think, they're going to get defensive, tense, and even more stuck in this belief. Even though you know it's not true, if you immediately try to fight fire with fire, it will just burn even brighter.
Instead we focus on the actual behavior and try to avoid more of the negative pieces of the conversation. You could say something like earlier I heard you say your mother's safety is of the utmost importance to you. If you don't think vaccines are the way to go, what other options do you have?
Alex, I think you and I would both agree that it's a great thing when we can avoid those negative conversations. This leads us into the C of the acronym, which stands for can do attitude. In order for someone to make a change, they need to have the confidence that they can. That's called self efficacy. Your goal as a practitioner is to strengthen that can do attitude. You could say something like, I can see that you're often reading, and that is important that you make informed decisions for yourself. Would you be open to reading a new independent report on where the vaccine profits are going?
At the end of the day, it's always going to be their choice whether or not they want to change and how they're going to change. The most we can do is give them the information and let them do with it what they will. And then also give them the feeling that they can do this.
And lastly, there's another really important piece that we can't forget. The E, express empathy. We want to create an atmosphere where people can safely explore conflicts and discuss realities. And empathy isn't necessarily sympathy. We may not share their feelings, but we understand them. We don't need to have lived this experience in order to feel empathy for them. We do want them to know that their thoughts and their fears are valid.
You might say something like, I can see why you might question the motives of the pharmaceutical companies, especially given your son's past experience with opioids. When they feel heard, they're going to feel like they can open up, which leads to better conversations and openness in hearing other perspectives.
So there you have it. The GRACE acronym provides the framework that guides all motivational interviewing conversations. Hopefully these tips will help you better understand the basis of MI techniques. This was just a short overview. Over the next few weeks, we will be sharing more MI tips in 10 podcasts that dive a little deeper and provide examples of how you can use MI with your residents, friends, and even family. Remember, you can always visit tmfnetworks.org to see the full recordings of our four part motivational interviewing webinar series. Once again, I'm Cathie Nicholson.
And I'm Alex Harris. Thanks for listening to TMF's first installment of MI Tips in 10.
Music Attribution: Puppy Love Sting by Twin Musicom is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/