MOTIVATIONAL INFLUENCE (A N EW A PPROACH TO C OUNSELING ) Douglas L. Beck, Au.D. Board Certified Audiologist photo Director of Professional Relations Oticon, Inc., Somerset, NJ dmb@oticonusa.com
S TATUS Q UO S ERGEI K OCHKIN M ARKE T RAK VIII H EARING R EVIEW , O CTOBER 2009 325 million people in the USA 34.25 million hearing impaired. 3 of 4 people with hearing loss don’t seek amplification.
H EARING A ID M ARKET P ENETRATION R ATES : C ONVENTIONAL , P RACTICAL , AND T AX C REDITS A MLANI (2010) F EDERAL S UBSIDIES & U.S. H EARING A ID M ARKET P ENETRATION R ATE . A UDIOLOGY T ODAY 22(3):40-46 ONLY HALF with hearing loss have a compelling need for HA amplification.
S URVEY OF C URRENT B USINESS P RACTICES R EVEALS O PPORTUNITIES FOR I MPROVEMENT . B RIAN T AYLOR . H EARING J OURNAL , S EPTEMBER 2009 Of those that do come into the office approx 50% do NOT acquire hearing aids.
VAST OPPORTUNITY TO IMPROVE!!!!!!!!!
I NSANITY … Doing the same thing over and over and expecting a different result…
Let’s explore a few different ways to manage this situation…
There are no outcomes-or-evidenced-based studies which scientifically determined the best, most pragmatic or most efficient way to dispense amplification! We do what we do because that’s how we were taught to do it!
AND WE KNOW … In general, people do not want to wear hearing aids! (duh…..)
Fortunately… people do want to improve/maximize their personal QUALITY OF LIFE!
H OW TO FIT HEARING INSTRUMENTS TO CHALLENGING PEOPLE …. Influence Motivational Interviewing
Robert B. Cialdini Ph.D. How to ETHICALLY influence people to make decisions (truly) in their own best interest and to improve the quality of their lives!
R ECIPROCATION Giving back, shaking hands, salutations, charitable groups, sending trinkets. Trial periods with amplification.
S CARCITY Wanting more of what you can only have less of. The perception of scarcity increases demand and desirability. Combine products and skills, dentists, optometrists…
A UTHORITY Knowing the professional is an authority, display credentials, certificates etc
C OMMITMENT & C ONSISTENCY People want to be consistent. Words predict behaviors. Important part of Motivational Interviewing
L IKING People like to work with people they like. Genuine two way street. Friendly, not threatening .
C ONSENSUS AND / OR S OCIAL P ROOF Seek others JUST LIKE ME, scrapbooks, testimonials
H OW TO FIT HEARING INSTRUMENTS TO CHALLENGING PEOPLE …. Influence Motivational Interviewing
A MBIVALENCE :
A MBIVALENCE Freud: All major decisions involve ambivalence. The co-existence of opposing thoughts. Love/Hate, Yin/Yang, Yes/No, Good/Bad, Right/Wrong.
M OTIVATIONAL I NTERVIEWING William R. Miller and Stephen Rollnick 2002 The Guilford Press … A client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence …
M OTIVATIONAL I NTERVIEWING MI has been successfully used with drug addicts, smokers, obesity, alcoholics … To elicit an intrinsic motivation to change.
M ILLER & R OLLNICK ’ S GUIDING PRINCIPLES Empathy (skillful reflective listening) Develop the Discrepancy (examine the differences between the status quo and the desired goal) Roll with Resistance (do not oppose resistance) Support Self Efficacy (the belief in the ability to change is powerful)
B UILDING M OTIVATIONAL I NTERVIEWING S KILLS – A P RACTITIONER W ORKBOOK R OSENGREN , DB. (2009): T HE G UILFORD P RESS MI Principles: R - Resist the RIGHTING REFLEX U - Understand your patient’s motivation L - Listen to the patient (reflective listening) E - Empower your patient
B UILDING M OTIVATIONAL I NTERVIEWING S KILLS – A P RACTITIONER W ORKBOOK R OSENGREN , DB. (2009): Metaphorically… Traditional counseling is like wrestling … MI is like ballroom dancing
F ROM : B UILDING M OTIVATIONAL I NTERVIEWING S KILLS – A P RACTITIONER W ORKBOOK R OSENGREN , DB. (2009): T HE G UILFORD P RESS Match your strategy to their readiness to change. Our goal is to move them along the readiness continuum.
Change Is Really Hard Addictive behaviors persist despite negative outcomes. Increasing the severity of the negative outcome doesn’t alter the negative behavior. Heart attacks, imprisonment, hangovers, drunk driving, lung cancer, obesity, diabetes, high blood pressure… People don’t always do what’s in their own best interest.
W HAT ARE WE LOOKING FOR ? The professional directs conversational discourse to probe and reveal the desired outcome. The professional sets up a context in which the patient states the reasons for change.
MI R ULES OF E NGAGEMENT Change talk is impacted by the style of counseling and the relationship with the counselor. Confrontational styles increase resistance. Dose (length and number of sessions) is irrelevant. Ask the RIGHT questions. Don’t ask the WRONG questions.
M OTIVATIONAL I NTERVIEWING Self-Motivational Statements (change talk): 1- Problem Recognition 2- Expression of Concern 3- Intention to Change 4- Degree of Self-Efficacy
I S THIS REALLY THE BEST QUESTION TO ASK AN ALCOHOLIC ? “Do you have a problem drinking?”
Nope. I drink, I fall down, no problem.
I S THIS REALLY THE BEST QUESTION TO ASK SOMEONE WHO ’ S BEEN REFERRED IN ? “D O YOU HAVE A PROBLEM HEARING ?”
The problem is the kids mumble … wife doesn’t speak clearly … mobile phones are terrible … nobody speaks clearly anymore … When I was a lad we were taught to speak clearly … . blah, blah, blah …
W RONG Q UESTION Do you think you have hearing loss?
W RONG Q UESTION Do you think you need hearing aids?
W RONG Q UESTION Does your hearing loss cause problems?
W RONG Q UESTION Are you concerned about your hearing loss?
T HE ULTIMATE W RONG Q UESTION How does that sound?
R IGHT Q UESTION What caused your hearing loss?
R IGHT Q UESTION Has your hearing loss gotten worse?
R IGHT Q UESTION How long have you had hearing loss?
R IGHT Q UESTION Which is worse; a noisy cocktail party or a noisy restaurant?
R IGHT Q UESTION Who’s voice is the hardest to understand?
R IGHT Q UESTION Many of my patients with similar hearing loss tell me women’s and children’s voices are very difficult… Is that true for you, too?
R IGHT Q UESTION How long have you had difficulty hearing?
D O NOT WRESTLE … When you push, they pull… Don’t challenge them, don’t draw a line in the sand, don’t back them into a corner.
D O NOT USE THE AUDIOGRAM AS A WEAPON !
Don’t be in such a hurry to help …
How Doctors Think Jerome Groopman On average, physicians interrupt their patients how often?
18 Seconds
M OTHER T HERESA … Before you speak, it is necessary to listen…. “They may not remember what you said or did, but they will remember how you made them feel.
T IME FOR HEARING ... RECOGNIZING PROCESS FOR THE INDIVIDUAL Gitte Engelund Oticon’s Research Centre If you intercede before the patient is ready to explore and accept amplification, the chances of success diminish.
The professional should get the PATIENT to do most of the talking. What the patient says is probably what they’re gonna do…
“W HY CAN ’ T I SAVE TIME AND ADMINISTER A QUESTIONNAIRE ?” It’s important for your patient to tell you their story. RAPPORT, TRUST, LIKING …
R ED FLAGS FOR MENTAL HEALTH REFERRAL Suicidal verbalizations Expressions of hopelessness Tearfulness Manifestations of rage Person withdrawing from pleasurable activities Sleep disturbance Isolation (“No one understands”) Recent significant losses, e.g., spouse Abrupt change of behavior
A ND IF YOU REFER … HUMANIZE THE MENTAL HEALTH PROFESSIONAL “I’ve known Dr. Smith for over 20 years. She’s nice, maybe about 55-years old, been practicing psychology for over 20 years. I think she also collects antiques. She has a dry sense of humor. I think you’ll like her.”
T HANK YOU FOR ATTENDING ! To be eligible for CE credit Be sure to have your Attendance Form hole-punched as you exit! Douglas L. Beck, Au.D. Board Certified Audiologist Director of Professional Relations Oticon, Inc., Somerset, NJ dmb@oticonusa.com These presentations slides will be available at ihsinfo.org
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