Psih.

Adrian Calomfirescu
Psiholog clinician, psihoterapeut de orientare cognitiv-comportamentală
Interviul
motivational
CALOMFIRESCU ADRIAN
PSIHOTERAPEUT CBT SI ECPS
Scop

1. Recunoaste importanta si avantajele Interviului Motivational in

consultatiile de sexologie;
2. Reflecta si identifica barierele in aplicarea IM si cum poti trece peste
acele obstacole;

Un nou instrument necesita timp pentru a o exersa si pentru a vedea

unde poate fi folosit.
Introducere

Traim intr-o perioada unde datorita avansurilor stiintifice si tehnologice,

majoritatea porblemelor de sanatate cu care populatia se confrunta
sunt de boli cornice, majoritatea in mare parte prevenite printr-un stil
de viata sanatos.

Implica incorporarea unor comportamente sanatoase si de a rezista

comportamentele zilnice toxice precum fumatul, mancatul
compulsive, consumul excesiv de alcool, cu scopul de a descreste
sansa dezvoltarii unor conditii cornice si morbiditatea si mortalitatea lor
Introducere

Interviul Motivational (IM) este o forma centrata pe persoana si

colaborare de ghidare pentru a provoca si a intari motivatia pentru
schimbare. (Miller & Rollick, 2009)

IM este o tehnica d ecomunicare care are ca scop sa declanseze

propriile motivatii a le pacientului pentru schimbare prin permiterea
exprimarii fricilor si frustarilor impreuna cu opiniile lor. Acele opinii vor
deveni scanteia care aprinde schimbarea si va fi folosita sa
reintareasca motivatia si sa maximizeze potential l lor intrisec.
Introducere

Mai multe publicatii sustin folosirea Interviului Motivational in mai multe

domenii medicale, cu o importanta particulara pentru Diabet, Boli
Cardiovasculare (Lee W, 2016) si Aderenta FarmacoTerapeutica
(Palacio A, 2016), toate acestea importante pentru sanatatea sexuala.
“Results suggested the potential of MI to reduce sexual risk behavior,
but many studies did not use strong attention controls. Thus, future
research is necessary to determine if MI is effective in reducing sexual
risk beyond traditional educational approaches.”
 Risk Factors for Erectile Dysfunction
Age
Tobacco and Other Drugs (AOD)
Alcohol
Obesity
Metabolic syndrome
Sedentary Lifestyle
Diabetes Mellitus
Hypertension
Depression

Integrating the knowledge of the impact of these health risk behaviors in both
sexual function per se and on the development of sexually debilitating
cardiovascular diseases, we can assume MI has a role to play in preventing sexual
dysfunction and improving patient’s sexual function
Teoria auto determinarii

Motivatia interna este crescuta prin:

Autonomie – libertate de a alege

Competenta – auto-eficienta
Relationare – relatii sanatoase/vindecatoare

BEHMS Reactance Theory = whenever a particular behavior is

threatened, the desirability to fulfill it increases
Spiritul IM

Autonomie Evocativ Colaborativ

Structura
Principii IM

Roll with resistance

When you sense resistance or arguments in favor of the status
quo instead of change talk, we suggest the ‘stop, drop and roll’
approach

Support self-efficiency
Help the patient find the inner strength and confidence for change
Principii IM (cont.)

Develop discrepancy
Behavior change due to external forces is less stable than due to
internal forces
Magnify the discrepancy between the person’s goals and their current
status quo.

Express empathy
Empathy is a key component It enhances the development of
intrinsic motivation
Microabilitati

Open-ended questions: elicit more information and prevent single-

word responses. The best balance is achieved when you use it with
reflections, on a rate of 2 reflections per 1 question. One helpful
question can be ‘What to other people bother you about?’. It can also
work as a response to a shocking statement from the patient
Affirmations: validate and confirm something the patient expressed,
increasing positive feelings about the interaction.
Reflections: simple (repeat or paraphrase the patient’s words) or
complex (add a specific meaning or emphasis to the content).
Summaries: select statements from your interaction and ‘connect the
dots’. Demonstrates you are actively listening
Microabilitati

- Open the door of your office

- Maintain eye contact and focus
- Asking is not Listening - a practitioner who is listening has no other immediate
agenda than to understand the other person’s perspective and experience
- Silence - avoid roadblocks
- Facilitative responses
- Reflect back to the person a short summary of how you understand what he/she
said in somewhat different words - Listening by Reflecting
- Each time you try a reflection, you get immediate feedback about its accuracy,
and so over time you get better at it
Continuum
Tell Assist Allow
Order Collaborate Permit
Steer Inspire Shadow
Administer Motivate Stay with
Rule Support Go along with
Lead Elicit Observe
Govern Point

DIRECTING GUIDING FOLLOWING

Resistence

Reflections: simple (repeat or paraphrase the patient’s words) or

complex (add a specific meaning or emphasis to the content). You
can also amplify the emotion conveyed or double-side to enhance
discrepancy with status-quo.
Shift focus
Reframe
Agree with a twist (reflection with reframing)
Emphasize personal control
Resistance vs ambivalence

Resistance talk Recognize resistance

‘Drop’ (Step back)
Use reflections
Sustain talk Strategic responses (emphasize
personal control, Pros and Cons,
Agree with a twist, Shift focus)
Lack of conversation
Change talk

Desire: ‘I want’… ‘I would like to’… ‘I wish’…

Ability: ‘I can’… ‘I might’ … ‘I could be able to’…

Reason: Arguments for change ‘I want to live longer’… ‘I want time

with my grandchildren’..

Need: ‘I ought to’…. ‘I have to’… ‘I should’…

Change talk
- Evocative questions: ‘Do you think that decreasing your weight would improve you
energy for intercourse?’
- Elaborate: ‘Ceasing tobacco use can help improve sexual function. Do you think it could
have an impact on yours?’
- Explore decisional balance by highlighting discrepancy: ‘Smoking can affect rigidity and
you desire a more rigid erection’
- ‘In a scale from 1 to 10, how confident are you that you can insert the dilators regularly?’
- In a scale from 1 to 10, how important do you think it is to start therapy for this problem?’
- Query extremes: ‘What is the worst thing that can happen if you start physical therapy?’
- Look back: ‘Do you remember when you could control your ejaculation better?’
- Look forward: ‘What would be better if you could prolong your time before ejaculation?’
- Explore goals (values): ‘I know your wife is very important to you. Do you think trying these
exercises could be helpful for your situation?’
Commitment

I will
I promise
I guarantee Assess importance and confidence
I intend to Allow elicitation
I’ll consider Guide through and assist into taking steps
I plan to
I will try
Respond to change talk

Elaborate change talk: ‘So you pointed out that taking your
metformin could be important for your glycemic control’

Affirm change talk: ‘I think you are very brave for this decision’

Reflect change talk: ‘You think your erections could improve with
exercise and you are incorporating it on your schedule’

Summarize: ‘To improve your glycemic control you will take the pill
Make change happen

Negotiate a plan: ‘Can you decide on a day to stop smoking?’

End tasks: ‘How do you feel about this plan?’

Expert tips: Use 2 reflexions per question; Try to put yourself on the
patients shoes and actively listen to the patient, so you can more
accurately reflect; Avoid personal opinions or directive
communication to prevent the elicitation of resistance
Consultation Guide

Agree on the focus

• Establish rapport
• Set agenda
• Emphasize the spirit of your approach to the consultation
Explore and Build Motivation to Change
• Exchange information
• Ask useful guiding questions
• Consider using structured strategies
Summarize progress
• Provide a long summary
• Return to agenda setting
• Consider the next step
Take home message

❖ MI works by activating patients’ own motivation for change and

adherence to treatment
❖ All three styles – following, directing and guiding – are use in our
consultations daily
❖ A skillful practitioner is someone able to shift flexibly among these styles
as appropriate to the patient and situation
❖ Usually it is wise to start with understanding the patient’s perspectives
and preferences
❖ Direct with care, Ask permission, Offer choices
❖ Listen actively
❖ MI can seem both comfortingly familiar and difficult to integrate, but is
no different from what we normally do