3/2/2015. Welcome to the COPE Webinar Series for Health Professionals! Motivational Interviewing: Overcoming Client Resistance to Change

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Kerry Armstrong
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to Change Time: Moderator: 12 noon 1 PM EST Rebecca Shenkman, MPH, RDN, LDN

of the slides are posted at: www.villanova.

Provide Continuing Education Partner with agencies and organizations

Overcoming Client Resistance to Change Nicholas D.

Recognize the occurrence and causes of resistance 2.

Identify and overcome the traps that hinder effectiveness 4.

This webinar awards 1 contact hour for nurses,1 CPEU for dietitians and 1 CEC

Suggested CDR Learning Need Code: 6020, 6000; Level 2.

provider of continuing nursing education by the American Nurses Credentialing

1 Welcome to the COPE Webinar Series for Health Professionals! March webinar Motivational Interviewing: Overcoming Client Resistance to Change Time: Moderator: 12 noon 1 PM EST Rebecca Shenkman, MPH, RDN, LDN Interim Director MacDonald Center for Obesity Prevention & Education Handouts of the slides are posted at: MacDonald Center for Obesity Prevention and Education (COPE) Goals Provide Continuing Education Partner with agencies and organizations Participate in Research Enhance Education Motivational Interviewing: Overcoming Client Resistance to Change Nicholas D. Frye, LCPC, NCC, DCC Objectives: The learner will be able to: 1. Recognize the occurrence and causes of resistance 2. Identify effective strategies for reducing resistance 3. Identify and overcome the traps that hinder effectiveness 4. Discuss key challenges to using MI in healthcare settings Credits: Notice: This webinar awards 1 contact hour for nurses,1 CPEU for dietitians and 1 CEC for fitness professionals. Suggested CDR Learning Need Code: 6020, 6000; Level 2. Villanova University College of Nursing Continuing Education is an accredited provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation. Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration and meets official meets the official criteria for official ACSM Approved Provider status from

DISCLOSURE Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products displayed in conjunction with an activity.

2 DISCLOSURE Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products displayed in conjunction with an activity. Motivational Interviewing: Overcoming Client Resistance to Change Nicholas D. Frye, LCPC, NCC, DCC Learning Objectives 1. Recognize the occurrence and causes of resistance 2. Identify effective strategies for reducing resistance 3. Identify and overcome the traps that hinder effectiveness 4. Identify key challenges to using MI in healthcare settings 2

Interrupting Ignoring Inattention Non Answering

3 What Does Resistance Look Like? Arguing Challenging Discounting Outright Hostility Denying Blaming Disagreeing Excusing Rationalizing Claiming Impunity Minimizing Pessimism Reluctance Interrupting Ignoring Inattention Non Answering Sidetracking What Does Resistance Feel Like? What Does MI Feel Like? 3

4 What is Resistance? Not an inherent problem with the client Not stubbornness Not a lack of desire for change Not a lack of pain (rock bottom) A misalliance in the practitioner client relationship What Causes Resistance? Client Generated Internal conflict Conflict with others Learned helplessness What Causes Resistance? Practitioner Generated Relationship that lacks: agreement, collaboration, empathy, or client autonomy Unwittingly elicits resistance If you continue being so inactive, you re going to continue to struggle with your weight. I know you would feel much better if you did more and were fitter. 4

5 How Do We Cause Resistance? How Do We Cause Resistance? Take control away Misjudge importance, confidence, or readiness Meet force with force Take Control Away Ask yourself: Have I undermined the client s sense of personal freedom? Can I hand this control back? 5

6 Misjudge Importance, Confidence, or Readiness Ask yourself: Have I misjudged the client s feelings of readiness, importance, or confidence? Have I jumped too far ahead of the client on these dimensions? Am I focusing on the wrong dimension? How does the client really feel about change? Meet Force with Force Ask yourself: Am I meeting force with force? Am I being too confrontational? Can I do anything to go along with the client, or even change tack altogether? Dealing with Resistance Client resistance is decreased through the use of non confrontational methods: Emphasize personal choice and control Re assess readiness, importance, or confidence Back off and come alongside client 6

What to Say to Decrease Resistance Emphasize Personal Choice and Control Avoid You should do You re biggest problem is Instead I think changing your diet is a good idea, but it s really up to you.

7 What to Say to Decrease Resistance Emphasize Personal Choice and Control Avoid You should do You re biggest problem is Instead I think changing your diet is a good idea, but it s really up to you. What are the pros and cons? Others struggle with this What do you find to be your biggest challenge? Re Assess Readiness, Importance, or Confidence Avoid Premature action talk Focusing on the wrong dimension Instead Rate importance and confidence on 1 10 scale Meet the client where they re at Acknowledge ambivalence In some ways you d like to be more active, and at the same time, there are lots of obstacles to fitting it into your life and you re not sure that it s worth it. 7

Back Off and Come Alongside Avoid Taking the bait Argumentation Defensive posture Instead Use reflective listening So you, You feel, It s as if Case Example Client: Every time I try to diet I end up

8 Back Off and Come Alongside Avoid Taking the bait Argumentation Defensive posture Instead Use reflective listening So you, You feel, It s as if Case Example Client: Every time I try to diet I end up eating the junk food that my kids eat. Diets just don t work for me. [Resistance] Practitioner: You don t want to do something that s not going to work. [Reflective Listening] Client: That s right. If I could change how I eat, I would. [Resistance] Practitioner: You can t see a way forward at this time. [Reflective Listening] Client: But what if I carry on the way I am? [Change Talk] Examples of Effective Communication 8

9 Avoid Playing the Expert What NOT To Say You re not having success in changing your diet because you re not tracking what you eat. What To Say What do you find to be your biggest barrier right now? Often healthcare seems to involve giving clients what they lack, instead seek to evoke from them that which they already have. Challenge the client to listen to his/her inner wisdom instead of providing them with the answer. Avoid Arguing the Positive Side What NOT To Say The benefits of exercise are innumerable! Including improved mood, better sleep, and increased energy. What To Say How would things be better for you if you were to start exercising regularly? If you are arguing the positive side of change and your client is resisting and arguing against it, you re in the wrong role. It is the client who should be voicing the arguments for change. Avoid Giving Unsolicited Advice What NOT To Say You should really stop going to happy hour with your coworkers on Fridays because it makes it so difficult for you to stick to your program. What TO Say If you decided to change your social activities so that they promote a healthy lifestyle, how would you go about that? Unsolicited information or advice can seem like judgment which leads to resistance. Ironically, it is acknowledging the client s freedom not to change that can make change seem possible. 9

Avoid Premature Focus on Change What NOT To Say We ve been talking alot about how important it is for you to start exercising, and this week I d like you to walk for 30 minutes everyday after work.

10 Avoid Premature Focus on Change What NOT To Say We ve been talking alot about how important it is for you to start exercising, and this week I d like you to walk for 30 minutes everyday after work. What TO Say Ultimately you re the one who has to decide whether you want to get regular physical activity. What do you think is a reasonable first step for starting an exercise routine? Some clients, in some situations, want to be told what to do. If you have a client that wants this then respond accordingly. However, in most behavior change consultations, clients react against being told what to do and prefer greater autonomy of decision making. Avoid Asking Backward Focused Questions What NOT To Say What TO Say Why did you buy that ice cream at It sounds like you were pretty the grocery store when you knew it frustrated before you went grocery was going to get you into trouble? shopping which got you into a bit of trouble. What can you do this week to move this thing forward? This type of questioning elicits guilt and self loathing which is demotivational, anxiety inducing, and downright mentally draining. Instead help the client to get back on the horse by focusing forward. Key Challenges to Using MI in Healthcare Settings 10

11 Key Challenges to Using MI in Healthcare Settings Multiple Priorities Avoiding Premature Focus Time (both length of consultation and training time) Key Challenge: Multiple Priorities One specific behavior at a time Healthy lifestyle in general is less effective Use agenda setting Key Challenge: Avoiding Premature Focus Unfortunate balance shift towards directing rather than following and guiding Clients become passive recipients Problems are more effectively solved with following, guiding, and directing 11

12 Key Challenge: Time (Length of Consultation) Better off asking rather than telling More listening and less directing can actually save you time Listening makes clients feel as though you ve spent more time with them Key Challenge: Time (Length of Training) Although I have given you some guidelines for using MI, your real teachers are your clients. If you hear more 1. Advantages of change 2. Optimism for change 3. Intention to change Then you know you re doing it right!!! Key Takeaways Resistance is a nuisance but normal Meet with non confrontational methods Be aware of any misalliance in the practitioner client relationship Allow your clients to teach you how to use MI more effectively 12

National Institute of Corrections http://nicic.gov/library Wiles, M. (2014).

13 References Mason, P. & Butler, C. C. (2010). Health behavior change: A guide for practitioners (2 nd ed.). Edinburgh, UK: Elsevier Limited. Miller, W. R. & Rollnick, S. (2012). Motivational interviewing: Helping people change (3 rd ed.). New York, NY: The Guilford Press. National Institute of Corrections Wiles, M. (2014). Motivational interviewing: Overcoming client resistance to change [Course Workbook]. nfrye@choosemedifast.com 13

Evaluations and CE Certificates Everyone who has completed the webinar will be emailed a link to the evaluation. The email will be sent to the email address that you used to register for the webinar.

Once the evaluation is completed, the CE certificate will be emailed separately within 2 business days. COPE s April Professional Webinar Carole A.

14 Evaluations and CE Certificates Everyone who has completed the webinar will be ed a link to the evaluation. The will be sent to the address that you used to register for the webinar. Please complete the evaluation soon after you receive the . The evaluation does expire after 3 weeks. Once expired, you cannot obtain a certificate. Once the evaluation is completed, the CE certificate will be ed separately within 2 business days. COPE s April Professional Webinar Carole A. Palmer, EdD, RD, LDN Professor Tufts University School of Dental Medicine and Friedman School of Nutrition Science and Policy There s More to it than Candy and Soda: important interrelationships between oral health, diet and nutrition. Date: Wednesday April 15 Time: 12:00PM - 1:00PM EST CE Credit : 1.0 contact hour, 1.0 CPEU Save the Date! The MacDonald Center for Obesity Prevention and Education and Philadelphia Dietetics Association are proud to co-host: EPIC : Pediatric Obesity Evaluation Treatment and Prevention in Community Settings Date: Location: Time: CE Credit : Tuesday May 19 th Driscoll Hall, Villanova University 5PM - 7PM EST 0.15 CEU, 1.5 CPEU, 1.5 CME 14

15 Questions and Answers! Moderator: Rebecca Shenkman, MPH, RDN, LDN Web site: villanova.edu/cope To receive monthly s on upcoming COPE events, please join COPE s Contacts on our website. Thank you for your time and interest. 15

Overview. What is Motivational Interviewing?

Overview. What is Motivational Interviewing? Welcome to the COPE Webinar Series for Health Professionals! November 19 th webinar: Time: Moderator: 12 1 PM EDT Rebecca Shenkman, MPH, RD, LDN Program Manager, MacDonald Center for Obesity Prevention