Motivational Interviewing in New Hampshire

Motivational interviewing is an evidence-based technique that helps clients in making changes and committing to goals.

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Those who are told that they are not expected to improve indeed do not”—Miller, & Rollnick, 2014

Managing stress, breaking a bad habit, becoming health conscious, or losing weight are all worthy pursuits. But many people can’t make any improvements in these regards, no matter how much they try.

People feel stuck many times throughout their lives; they want to improve their circumstances, but somehow fail to take the necessary steps to reach their goals. That’s why several practitioners are now offering motivational interviewing as a way to help these individuals in making sustainable changes.

In this article, we explore the growing usage of motivational interviewing in New Hampshire. What this method is all about? How it’s done? And how effective is it?  

Understanding Motivational Interviewing

Motivational interviewing is an evidence-based technique that helps clients in making changes and committing to goals. As simple as that might sound, finding the will to drop a habit, or develop one is a monumental task.

Many times, we need to gather momentum to take the first step, and then we need patience and support to keep going. Finding enough motivation to take that first step remains hard for the vast majority of humans. Otherwise, we’d all be svelte, disciplined, overachievers.

Who Developed Motivational Interviewing?

In the 1980s, William R. Miller developed the technique of motivational interviewing and conducted the necessary studies to prove its efficacy. His work was mostly in the context of substance abuse. Stephen Rollnick was Miller’s partner, and he formulated this method and its core principles. 

How Is Motivational Interviewing Done?

Motivational interviewing adopts an approach that brings out a person’s willpower through dialogue. Few people respond well to direct advice or direct interventions. But they follow through when an idea comes from within them.

What Does a Motivational Interviewer Do?

The task of the motivational interviewer, or clinician, is to gradually get the client to reveal their true motive. A guided conversation should focus on why a person needs to achieve a certain goal, and how that could be done.

Fine-tuning with follow-up questions would iterate the client’s answers, and conclude with the best way to keep the client motivated. 

Implementing Motivational Interviewing in New Hampshire

New Hampshire ranks as the 5th state in the US in terms of the number of people needing substance use treatment. In 2021, the number of people seeking treatment was 15,408 out of the 1.35 million inhabitants.

A 2021 SAMHSA survey showed that another sector of the population needed help to get out of drug abuse habits, but were reluctant to take the necessary steps. They believed that they didn’t need that treatment.

In other cases, substance abuse patients find access to health care rather difficult, due to the high cost of treatment and lack of nearby facilities. They seem to be discouraged by the long waiting lists as well.

Besides drug abuse, New Hampshire has an evident obesity problem, with 30.2% of the adult population having a BMI of 30 or higher. This is the 2022 data, and the trends show a consistent increase in BMI. 

Diabetes is another issue that New Hampshire has to deal with. 8.7% of the adult population is diagnosed with type II diabetes. An additional 32.9% have prediabetes. Also, there’s an estimated increase of 8200 people diagnosed with diabetes each year. This costs the state $1.3 billion per year.

Motivational investigation is an approach that can be applied effectively to help people with drug abuse, obesity, and diabetes, plus similar concerns. New Hampshire has some mental health centers that offer this service, but there’s room for adding more wellness facilities. 

The Principles of Motivational Interviewing

The following principles set the stage for the motivational interview. Unlike normal counseling sessions, the dynamic between the practitioner and patient/client is that of peers, rather than a one-sided doctor-to-patient monologue.

Collaboration

The doctor and patient go into the session with a “team spirit”. This collaboration is necessary, as the interviewer’s role is to guide gently, as opposed to, enforcing behavior change on the patient.

The process is all about shared decision-making. Motivational interviewing emphasizes this collaborative approach to explore the patient’s motivations, goals, and reasons for resisting change.

Motivational interviewing should also lean more towards a patient-centric perspective. The doctor relinquishes dominance voluntarily and lets the patients tell their stories. The doctor’s job is to support the patient’s journey of self-discovery.    

Evocation

This consists of two parts: bringing to the surface the true reasons for change and identifying the discrepancies between the current and desired states. 

Drawing out the patient’s real reasons for change is essential before proceeding to other parts of the session. Change talk, and using open-ended questions, should flesh out the pros and cons of change from the patient’s point of view.

Identifying the inconsistencies between present states and coveted outcomes is a powerful way to get patients to commit to their goals. For example, getting a patient to describe how they feel after smoking, as opposed to how a healthy person feels after exercise.

Evoking strong feelings about change is pivotal in motivational interviewing.   

Autonomy

Motivational interviewing respects the patient’s decisions whether or not the doctor concurs or shares the same perspective.

Empowerment means that a doctor develops the patient’s skills and confidence, to the point that the patient can make sound decisions for themselves. Doctors understand the importance of self-determination.

The goal is lasting change, and that only comes from personal commitment. External pressure rarely leads to sustainable outcomes.  

Responding to Ambivalence During Motivational Interviewing

Ambivalence should be expected in various parts of the interview. People often want to see improvement in their lives, and at the same time, want everything around them to stay the same.

Having mixed feelings about change is normal, and a skilled practitioner/doctor would know how to handle it.

Rolling With Resistance

Stonewalling is a counterproductive outcome, and it should be avoided by guiding the discussion away from that end.

Rolling with resistance doesn’t mean that a doctor accepts the reasons a patient gives for not changing. It means that a certain area of the patient’s psyche, temperament, and circumstances needs further exploration.

Understanding and affirming the patient’s doubts is necessary to gain their trust and keep them talking. Doctors acknowledge their patient’s concerns and validate their feelings. Instead of arguing against their resistive stance, they redirect the discussion toward evocation.   

Normalization

Normalizing and accepting the patient’s ambivalence gives them a much-needed safe space, so they can continue their self-exploration journey. Telling patients that their fears are justified and that millions of other people share these feelings, puts them at ease.

This should be followed by a deeper discussion about the pros and cons of change.

The Core Elements of Motivational Interviewing

Motivational interviewing requires a high level of communication skills. A background in psychotherapy is essential for the success of this approach. The process employs four core elements to achieve the desired outcomes.

Open-ended Questions

The purpose of open-ended questions is to allow the patients to elaborate on their lived experiences. The doctor guides the conversations so the patients can talk openly about their thoughts and feelings.

Examples include:

“How did that situation impact your life?”

“Can you tell me more about why you want to achieve this goal?” 

“What are your thoughts on making big changes in life?”

Practitioners have individual methods for motivational interviewing, but they all phrase their questions in a way that keeps the conversation going.

It allows them to become closely acquainted with their patients’ current state. In addition to getting their patients to articulate their goals, concerns, and how they intend to achieve long-lasting changes. 

Affirmations

This is all about acknowledging the patients’ positive qualities, strengths, and efforts. If you tell a person that they can do something, they can, and the opposite is also true.

Examples include:

“I appreciate your openness about your struggles”

“It takes courage to take this first step”

Affirming a patient’s ability to articulate goals and achieve them is a huge propeller to making changes. Especially if the words ring true.

Reflective Listening 

Repeating what the patient has just said is a powerful way to frame and redirect. Doctors repeat what the patient has just said in a slightly different, more condensed, manner. This can either emphasize a point or open up a segway for reconsidering an opinion.

Reflecting a person’s thoughts has the following benefits:

  • Demonstrating full understanding
  • Validating the patient’s experiences
  • Acknowledging the patient’s emotions
  • Building a therapeutic alliance

Summaries

Doctors should summarize and recap the main points of the discussion to maintain understanding and clarity.

These summary milestones reiterate what has been covered so far, what is the point that is being explored at the moment, and where the discussion needs to go next. It’s an effective way to keep the conversation on track and get the desired outcomes from it. 

Conclusion

Miller and Rollnick’s motivational interviewing is gaining momentum all around the US, and New Hampshire is no exception. With the high figures of drug use, obesity, and diabetes among other issues, New Hampshire could benefit from this program.

The best approach to motivational interviewing is fostering collaboration, respecting patients’ autonomy, and evoking their own reasons for wanting to change.

Not all patients are eligible for motivational interviewing. A higher success rate would be seen with individuals who want to make long-lasting changes. Others who aren’t interested, or who are too attached to their “old ways” aren’t likely to get much improvement. Skilled practitioners might give it a try though! 

Additionally, there are specific stages of change that the patients would go through. Doctors should walk them through gently all the way to achieving a full behavioral upgrade. 

Published on: 2024-07-10
Updated on: 2024-07-10