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4/11/06 - All materials are completely updated. Thanks for your patience!
4/10/06 - Materials for sessions 4-6 are completely updated.
4/5/06 - Materials for sessions 1-3 are completely updated. I will get the rest done over the weekend. All readings other than the Health Behavior Change book are optional.
Recommended Books / Web Sites / Session-Specific Resources
"Teaching Patient" Roleplay Guidelines
Session 1 / Session 2 / Session 3 / Session 4 / Session 5 / Session 6 / Session 7 / Session 8
Recommended Books
Main text:
Health Behavior Change: A Guide for Practitioners (HBC) by Stephen Rollnick, Pip Mason, and Chris Butler
• Motivational Interviewing adapted for medical settings
• Presents a framework for very brief treatment encounters
• Strategies are presented in terms of principles, examples, and counterexamples with an emphasis on practicality.
Read my detailed review
See more information at Amazon.com
Or, if you just want the bare essentials:
Lifestyle Change by Chris Dunn and Stephen Rollnick
• Pocket-size "how-to" guide
• Super-streamlined 3-step model
• Focus on simple, structured techniques to help engage patients in a constructive conversation about change
Read my detailed review
See more information at Amazon.com
And if you really love this stuff, and want an expanded approach with all the theory:
Motivational Interviewing, Second Edition: Preparing People for Change (MI2) by William R. Miller and Stephen Rollnick
• Theoretical underpinnings, empirical evidence
• Some detailed examples of strategies and techniques with an emphasis on general principles
• Specialty settings, populations, topics featured in extensive edited section
Read my detailed review
See more information at Amazon.com
Web Sites
Steve Rollnick's practice-oriented online discussion board
Session-Specific Resources
Session 1 - Definition, Principles, and Evidence
HBC Chapters 1-2 (relevant to sessions 1-3)
Findings From Clinical Trials - Updated December 2004 (online slide presentation; or, download the Powerpoint file)
A Meta-Analysis of Motivational Interviewing Outcome Trials - November 2004 (online slide presentation; or, download the Powerpoint file)
Toward a Theory of Motivational Interviewing - November 2004 (online slide presentation; or, download the Powerpoint file)
MI may be conceptualized as a particular form of the "guiding" style of communication with patients - see Steve Rollnick and colleagues' recent British Journal of Medicine article for more about incorporating MI into daily practice without over-reliance on structured interventions.
"Teaching Patient" Roleplay Guidelines -
When in the role of the teaching patient, your job is to help each other learn MI.
The teaching patient is NOT the patient from Hell!
The teaching patient should also NOT be based solely on a single real patient.
Develop a role that is familiar from your work and that you can role-play convincingly.
Consider: demographics (age, gender, race, marital status, household composition); socioeconomic background; the clinician's and client's perspective on what is the presenting problem (these may disagree); the patient's goals and values; the pros and cons of the problem behavior from the patient's perspective; the pros and cons of the desired behavior from the patient's perspective.
Keep roleplays short and focused on one specific skill at a time. Allow the person in the clinician role to set - and change! - the level of readiness or resistance displayed by the teaching patient. Audiotape the roleplays for review.
Session 2
HBC Chapter 3
Evidence for a relationship between therapist clinical skills and client involvement in MI:
Moyers, T. B., Miller, W. R., & Hendrickson, S. M. L. (2005). How does Motivational Interviewing work? Therapist interpersonal skill predicts client involvement within Motivational Interviewing sessions. Journal of Consulting and Clinical Psychology, 73, 590-598.
OARS Roleplay instructions
(5-10 minutes per "turn" - do 3 times so everyone plays all 3 roles):
Suggested topics:
- What have you read lately that you would recommend?
- Who in your family are you most like?
- Tell me about a memorable trip you took. What made it memorable?
- What is your dream job?
- What do you like about yourself?
- What is the best advice you ever received?
- Tell me about a challenge you overcame successfully.
INTERVIEWER: Use OARS style to learn about a topic chosen by the TALKER.
TALKER: Respond naturally to the INTERVIEWER's prompts.
COACH: Use OARS coding sheet to keep track of whether the INTERVIEWER is using OARS. After 5-10 minutes, stop the interview. The COACH then gives feedback -
- Did the Interviewer use mostly open questions? Were there any closed questions that could have been rephrased as an open question?
- Did the Interviewer remember to affirm the Talker? Can you think of any more affirmations for the Talker?
- Did the Interviewer use reflections to show she was listening? What was your favorite reflection?
- Did the Interviewer have the opportunity to summarize? If not, have the Interviewer summarize what she heard.
Audio clip (MP3 format) demonstrating the Behavior Change Counseling model: To download the file, right click on the link, select "save target as," and choose where on your computer you want the file to go. (Mac users, you are on your own)
Rollnick interviewing a patient about his drinking (12 MB, 8:44 minutes) (this is the clip we listened to at the end of our first session)
Session 3
HBC Chapter 3
Importance/Confidence Roleplay Instructions
(5-10 minutes per "turn"- do 3 times so everyone plays all 3 roles):
INTERVIEWER: Use Importance/Confidence scales to learn about the patient's readiness to change a specific health-related lifestyle behavior. Your job is to understand how the patient feels about making a change.
TALKER: Respond to the Interviewer's prompts in the "teaching patient" role. Have your overall readiness to change be somewhere between 4 and 7; i.e., in the contemplation or preparation stages.
COACH: Help the Interviewer stay on track with the Importance/Confidence prompts. Remind her to summarize, if needed.
Audio clip (MP3 format) demonstrating the the use of importance and confidence rulers: To download the file, right click on the link, select "save target as," and choose where on your computer you want the file to go. (Mac users, you are on your own)
Rollnick interviewing a patient about smoking (6.09 MB, 4:29 minutes)
Session 4
HBC Chapter 4
Change Talk Exercise
Identify examples of client "change talk" (desire, ability, reasons, need, and commitment to change) and counselor response (does counselor reflect, ask for elaboration, affirm, summarize, or do something else?) in ONE of the following. Don't get too hung up on the categories of change talk. You can do both if you have time.
a) The PAIR of audio clips below (they are short)
b) Video of Bill Miller interviewing a client about the pros and cons of drinking. This clip is found on the first DVD. On the DVD menu, select "B" (Phase I), then choose Chapter 6, scene 4 (examples of exploring pros and cons). The first example just shows a female counselor asking a question. Then, you will see Miller saying something along the lines of "so, John, we've talked some about what brought you here, and it has something to do with alcohol..." This is the clip I am referring to. It runs about 10 minutes, maybe a little less.
Audio clips (MP3 format) demonstrating use of specific techniques to elicit change talk: To download the files, right click on the link, select "save target as," and choose where on your computer you want the file to go. (Mac users, you are on your own)
The good things and the not-so-good things about smoking - 6.86MB, 5 minutes. From the Health Behavior Change video.
Exploring values, fruits and vegetables - Demonstration of an MI-based peer counseling program developed by the National Cancer Institute for African-American churches. 4.12MB, 3 minutes. From the Body and Soul peer counselor training DVD.
Good/Not-So-Good Roleplay Instructions
(5-10 minutes per "turn"- do 3 times so everyone plays all 3 roles):
INTERVIEWER: Ask the client about the good and not-so-good things about the health-related behavior they have agreed to discuss. Your job is to understand their decisional balance, not necessarily to try to change it. Try to reflect, ask for elaboration, affirm, or summarize when you hear change talk.
CLIENT: "Teaching client" role as developed previously. On the first "turn," the client's overall readiness should be around a 3. On the second "turn," start over again from the beginning. This time, the client's overall readiness should be around a 5-6. On the third "turn," start over again from the beginning, but this time the client's overall readiness should be around a 7-8.
COACH: Help keep the interviewer on track.
AS A GROUP - notice any differences between how the interview unfolds with a client at low, medium, and high level of readiness.
Be prepared for the next session with some examples of the difficult things clients say!
Optional: If you like theory and research, check out a recent series of literature reviews regarding "change talk" - several articles in recent issues of the MINT Bulletin. Look for "what the research says" articles by Grant Corbett in October 2004, May 2005, September 2005 issues.
Session 5
HBC Chapter 5
Group discussion topics:
- Identify most likely sources of resistance in your clinical population.
Brainstorm: How can you help patients feel in control and understood?
- When is it hardest to avoid an unproductive back-and-forth with patients/clients?
Brainstorm: Reflective/strategic solutions
Be prepared to discuss when providing information leads to resistance. Also, be prepared to present a couple of simple examples of the kinds of information you most often provide.
Session 6
HBC Chapter 5
Elicit-Provide-Elicit Roleplay Instructions
(5 minutes per "turn"- do 3 times so everyone plays all 3 roles):
INTERVIEWER:
- Ask permission to provide information
- Elicit patient's ideas before providing information
- Provide information in small chunks
- Elicit patient's reactions to information
- Reflect patient's reaction
CLIENT: Respond naturally in "teaching client" role
COACH: Give feedback to interviewer: did she follow the steps?
Video case examples for review:
Low-readiness client: DVD Disc 2, part D, Chapter 4: Case example of elicit-provide-elicit
High-readiness client: DVD Disc 2, part D, Chapter 5: Case example with cardiac patient.
Optional: Audio clips (MP3 format) Some excerpts from a drinker's check-up feedback-based intervention. First (3.31 MB MP3, 2:24 minutes), a brief example of giving personal feedback. Next (5.97 MB MP3, 4:20 minutes), a summary of feedback given over a lengthy session, and example of eliciting change talk and managing resistance (in this case, demoralization more than argumentation). To download the files, right click on the link, select "save target as," and choose where on your computer you want the file to go. (Mac users, you are on your own) NOTE - these clips are from DVD Disc 2, part D, Chapter 2: Case example of giving feedback.
Session 7
HBC Chapter 4
Building Confidence Roleplay Instructions
(one or two times through - there is an interviewer tag team instead of a coach for this one):
Don't start all over again at the beginning! This exercise focuses on what to do once the client has expressed reasonably high importance of change, and you are now ready to move on to confidence. So, decide among yourselves what the target behavior change will be, and how the client feels about it, and jump right in and start in the middle! The client should be at a pretty high level of readiness for this exercise.
INTERVIEWER 1: Begin with a brief summary of the client's decisional balance (taken from a prior roleplay, or made up on the basis of your pre-roleplay discussion). Then ask a key question, such as "where does that leave you?" or "what do you want to do?"
CLIENT: Respond in "teaching client" role. You should have a high level of readiness to change - you are convinced of the importance of change, but still need to work on the practical matters.
INTERVIEWER 1: Engage the patient in exploring past change efforts. Remember to reflect and summarize.
INTERVIEWER 2: Engage the patient in brainstorming solutions. Remember to reflect and summarize.
Be prepared to discuss:
1. What are the areas of obvious good fit between the behavior change counseling model and your protocol?
2. Where will it take some work to figure out how to apply the behavior change counseling model within your protcol?
Session 8
HBC Chapter 6, 8
Change Plan Worksheet
Sample MITI Feedback form
Explanation of MITI (PDF from University of New Mexico website)
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