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INTRODUCTION

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  • How can the pediatric health care provider use motivational interviewing (MI) to have more effective interactions with patients with obesity and their families?

  • What is the evidence for the effectiveness of MI?

  • What are the fundamental principles of MI that can apply to obesity prevention and treatment?

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This chapter will address the following American College of Graduate Medical Education competency: interpersonal and communication skills.

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Interpersonal and Communication Skills: Use of MI is a key skill in the prevention and treatment of childhood obesity and a core competency for all pediatric health care providers. This chapter will review core principles of MI and how to implement MI in a clinical practice in obesity prevention and treatment.

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THE ORIGIN OF MI

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In the early 1990s, Stephen Rollnick and William Miller described a novel approach for the treatment of “problem drinkers,” called MI.1 This approach was based on the insight that the failure to adopt important changes in health behaviors is rooted in ambivalence to change; and that “problem drinkers” and other patients must overcome their own ambivalence to successfully adopt more healthful behaviors. MI is a counseling technique and communication style designed to direct patients to explore their ambivalence by talking about the positive aspects of adopting change. This positive change talk increases a patient’s intrinsic motivation for change, commitment to change, and confidence that he or she will be successful, and is the goal of MI which hopes to increase the likelihood that the patient will be successful in adopting change.

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In their original published work, Miller and Rollnick provided the following definition:

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Motivational interviewing is a directive client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.1

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KEY COMPONENTS OF MI

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The key features of this technique reflect an emphasis on the need for patients to develop intrinsic motivation rather than imposed instructions for change from the physician or counselor. Miller and Rollnick2 (p 25) instruct that the motivation to change is elicited from the client and not imposed by the counselor. They suggest that the patient must give voice to and resolve their ambivalence rather than have it pointed out directly. They caution that direct persuasion is not effective; rather the counselor must be quiet and eliciting. At the same time the counselor is directive in focusing the conversation on the examination and resolution of ambivalence.

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Miller and Rollnick also describe a key shift in perspective that drives MI. This new perspective recognizes that readiness to change is a dynamic phenomenon and is influenced by interactions with the counselor and others. There is also a shift in power that recognizes the therapeutic relationship as a partnership rather than authoritative expert and passive recipient. Thus, the counselor does not provide a prescription for ...

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