This article was downloaded by: [Dr Mirsad Serdarevic] On: 11 December 2013, At: 16:44 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK International Journal of Mental Health Promotion Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rijm20 Motivational interviewing with the older adult Mirsad Serdarevica & Sonne Lemkeb a Geriatrics Research, Education and Clinical Centers (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA b Center for Health Care Evaluation and Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA Published online: 11 Dec 2013. To cite this article: Mirsad Serdarevic & Sonne Lemke , International Journal of Mental Health Promotion (2013): Motivational interviewing with the older adult, International Journal of Mental Health Promotion, DOI: 10.1080/14623730.2013.862362 To link to this article: http://dx.doi.org/10.1080/14623730.2013.862362 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. 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Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms- and-conditions Downloaded by [Dr Mirsad Serdarevic] at 16:44 11 December 2013 International Journal of Mental Health Promotion, 2013 http://dx.doi.org/10.1080/14623730.2013.862362 Motivational interviewing with the older adult Mirsad Serdarevica and Sonne Lemkeb* aGeriatrics Research, Education and Clinical Centers (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA; bCenter for Health Care Evaluation and Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA (Received 29 October 2013; final version received 6 November 2013) Motivational interviewing (MI) is an evidence-based psychotherapeutic approach to health behavior change and has great potential to improve medical regimen adherence among the older population. This article provides a concise summary of MI as it can be applied to geriatric patient populations. The goal is to provide readers with an overview of MI, its clinical applications within psychological and medical settings and its adaptation for use with older individuals dealing with both mental health and general medical conditions. The article also discusses how varied systemic and therapeutic contexts (e.g., biomedical vs. psychological) may affect the meaning and implementation of MI. Although published randomized controlled studies on the effects of MI in the older population are limited, the majority of such studies indicates that MI is effective in influencing change in health behaviors. As a proven, cost-efficient treatment, MI should be considered for clinical use in geriatric and primary care clinics providing care to older adults. Keywords: Empathy, health behavior change, primary care, self-efficacy, therapeutic alliance, treatment adherence. Why motivational interviewing for the elderly? Older patients are likely to present health-care settings with multiple, interacting problems or complaints, such as chronic pain, diabetes, hypertension, congestive heart failure, dementia and depression. They are consequently likely to be on complex treatment regimens requiring multiple medications or medical interventions that may increase the likelihood of negative side effects. Furthermore, older patients are often dealing with grief over losses, fear of physical illness and guilt over past events, all of which can have a negative impact on self-efficacy and can impede treatment adherence and needed behavior Downloaded by [Dr Mirsad Serdarevic] at 16:44 11 December 2013 change. Undertaking and maintaining positive health behaviors, such as physical activity and exercise, medication adherence and other forms of medical and psychological treatment engagement, can be challenging but can significantly improve both quality of life and longevity for the elderly (e.g., Phillips, Schneider, & Mercer, 2004). Thus, to address the varied medical and mental health needs of their clients, geriatric medical and mental health services would benefit from non-psychopharmacological treatments that are person-centered, that address the need for behavior change and that are adapted to the needs of elderly clients (e.g., Bugelli & Crowther, 2008). Motivational interviewing (sometimes referred to as MI) is one such approach. It has been defined as: ‘A skillful clinical style for eliciting from patients their own motivation for making changes in the interest of their health’ (Rollnick, Miller, & Butler, 2008, p. 246). As such, *Corresponding author. Email: [email protected] q 2013 The Clifford Beers Foundation 2 M. Serdarevic and S. Lemke MI could be a powerful psychological intervention in working with older peoples’ ambivalence or resistance to change during psychotherapy and other health-related treatments. The word ‘style’ in the definition of MI implies a degree of therapeutic flexibility, which allows the clinician to continuously adjust to unique demands of each individual patient. As a therapeutic style, rather than restrictive, manualized psychotherapeutic treatment, MI lends itself to adaptation across different settings and different populations. MI’s greatest strength is its adaptability to different clinical problems and situations. MI is grounded in the Rogerian premise that all humans have the built-in motivation to develop their potential to the fullest extent possible, even when faced with barriers and challenges (Rogers, 1995). Making use of this internal motivation to encourage change of maladaptive health-related behavior is the primary focus of MI. Within Rogers’ framework, change occurs through the ‘paradox of acceptance,’ as only after the patient experiences empathy and acceptance and perceives the clinician as genuine can change begin. By exploring and resolving the patient’s ambivalence, MI enhances intrinsic motivation to change. It also elicits from the patient and reinforces ‘change talk,’ as the patient feels safe to explore and verbalize his/her goals to the clinician. Incorporating a Rogerian approach as a fundamental part of MI, the clinician is able to listen and reflect the client’s story in a therapeutic (or ‘holding’) environment where the whole experience (emotions, actions, thoughts, etc.) is unconditionally accepted by the clinician. It is thought that such an approach allows the patient to become gradually more comfortable with aspects of the self that may be anxiety-causing, shameful, scary, threatening and so on, which in turn facilitates the patient’s growth and eventual change. Rogers described this process as follows: ‘If I can provide a certain type of relationship, the other person will discover within himself the capacity to use that relationship for growth, and change and personal development will occur’ (Rogers, 1995, p. 33). The ‘if’ in Rogers’ statement implies that ‘a certain type of relationship’ is a primary goal for the clinician as it will lead to gradual self-acceptance and growth on the patient’s part. While acceptance can be conceptualized in many ways, an example may best illustrate it. Picture a toddler who is roaming around in a supermarket with her parents, picking up random items from shelves, which she then, with a smile on her face, offers to some total strangers. Other than being charmed by a young child, these recipients will most likely feel accepted by this toddler, who is not judging them, not telling them what or how to be, but simply rewarding them with a smile, acknowledging their presence and offering a ‘present’ in turn. At the most fundamental level, such an Downloaded by [Dr Mirsad Serdarevic] at 16:44 11 December 2013 experience has a psychologically (and possibly physiologically) beneficial effect on these individuals. MI integrates both person-centered and directive psychotherapeutic approaches. As noted above, MI affects positive behavioral change by utilizing therapeutic empathy forged within a person-centered psychotherapeutic framework. It also entails a goal- oriented therapeutic collaboration focused on problem solving, which in turn can bolster a patient’s self-efficacy (Bandura, 1982). Self-efficacy within health-care settings refers to the patient’s belief that he/she can successfully perform the targeted behavioral change that would lead to improved health outcomes. When a patient’s