Motivational Interviewing in Diabetes Care

Marc P. Steinberg and William R. Miller

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August 11, 2015
ISBN 9781462521555
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244 Pages
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August 12, 2015
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People with diabetes often struggle to make healthy choices and stay on top of managing their illness. Filling a vital need, this is the first book to focus on the use of motivational interviewing (MI) in diabetes care. The uniquely qualified authors—physician Marc P. Steinberg has devoted much of his career to diabetes care, and renowned clinical psychologist William R. Miller is the codeveloper of MI—present proven counseling techniques that can make any conversation with a patient more efficacious and motivating. Numerous sample dialogues illustrate specific ways to elicit patients' strengths and help them overcome barriers to change in such areas as eating habits, physical activity, medication use, insulin treatment, substance abuse, psychological issues, and more.

Winner (First Place)—American Journal of Nursing Book of the Year Award, Adult Primary Care Category

This title is part of the Applications of Motivational Interviewing Series, edited by Stephen Rollnick, William R. Miller, and Theresa B. Moyers.


“Steinberg and Miller provide an overview of how to apply an MI skill set to address the most common challenges in diabetes care. They provide practical examples and transcribed interviews to assist the reader in understanding the benefits of integrating an MI approach with patients struggling to better manage their diabetes care. The book is well written, easy to follow, and provides practical information for anyone working with patients who experience diabetes.”

Family Medicine


“Marc P. Steinberg and William R. Miller…have the knowledge and experience required to explore how new approaches to problem solving can be applied and can work effectively for a range of problems relating to self-management of diabetes….The authors demonstrate several useful counselling techniques that can make any conversation with a patient more effective and motivating. This thoughtful book is a helpful and well-written introduction (not just for diabetes specialists) to the essence of motivational interviewing in your routine practice….This book is well worth a look to help challenge and improve your practice.”

Journal of the Royal College of Physicians


“An incredible resource for those who care for people with diabetes. Starting with the understanding that patients are often ambivalent about behavior change, the authors help readers practice a guiding style and adopt the right 'mindset and heartset' for helping patients improve their health. Real-life examples and sample dialogues demonstrate key strategies and drill down into specific diabetes scenarios. The book is full of practical examples of how to guide patients to make changes.”

—Robert A. Gabbay, MD, PhD, FACP, Chief Medical Officer, Joslin Diabetes Center; Associate Professor of Medicine, Harvard Medical School


“Steinberg and Miller elegantly show how to infuse diabetes counseling with listening and talking skills known to enhance difficult conversations about change. Patients’ lifestyle habits are the most important factor in how well they will live with diabetes; providers of all training backgrounds can use this book to become more effective when talking to their patients about healthier habits. Beautifully written, the book is loaded with empirically supported conversational tips to maximize the chances that your patients will change. This is the consummate book on diabetes behavioral counseling.”

—Chris Dunn, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington


“Provides a concise and relevant explanation of what MI is about, plus invaluable examples of clinical conversations on the critical topics of diabetes care. This is the best resource I've seen for building skills that can make the work of busy diabetes practitioners both more successful and more satisfying—and it's a quick and easy read for our tight schedules! I strongly recommend it to any clinician hoping to build effective partnerships with people with diabetes. I wish I'd had this book when I was starting out in the field.”

—Nancy R. Eyler, MD, FACP, former 20-year Medical Director for Diabetes and Endocrinology, Community Medical Center, Missoula, Montana


“Behavior change is the cornerstone of diabetes self-management. This thoughtful book helps diabetes educators tackle the challenges of the status quo, providing tools and resources to help us maximize our impact. The authors place the person with diabetes at the center of every interaction and remind us of the need to respect that person's autonomy. Carefully laid-out scenarios will allow us to sharpen our MI skills and navigate the nuances of conversations with patients. It is easy to apply the examples and suggestions to real-world situations to make us more effective communicators and educators.”

—Joan K. Bardsley, RN, CDE, FAADE, past president, American Association of Diabetes Educators


“Marvelous. The book addresses many of the types of conversations and behaviors that we encounter every day in people with diabetes or pre-diabetes, and common flaws in our interactions with patients are highlighted. The authors emphasize that MI is not a series of ‘magic words,’ but a skill. Easy to read, the book offers keys to helping patients harness their internal motivation, make positive changes in their lifestyle, and enhance their responsiveness to all the members of the health care team. Having been an educator for many years, I would make this mandatory reading for anyone working in the field of diabetes.”

—Kim L. Kelly, PharmD, Kelly Diabetes Associates, LLC


“Unlike many medical guides that are best suited to putting tired minds to sleep, this little gem is hard to put down! The book is full of realistic and challenging clinical scenarios. Steinberg and Miller provide superb suggestions for how to integrate MI into diabetes care, with a unique focus on the words, phrases, questions, and statements to use with patients to facilitate health behavior change. MI can help improve the overall quality of the clinical relationship—to the benefit of patients and providers alike.”

—Melanie A. Gold, DO, DABMA, Department of Pediatrics, Columbia University Medical Center


“This book offers research-supported techniques for overcoming common challenges associated with caring for patients with diabetes. The authors include practical tips and numerous case examples that bring MI to life. Incorporating these ideas into everyday medical practice can help achieve a most important goal in diabetes care—actively engaging the patient.”

—Ann E. Goebel-Fabbri, PhD, Department of Psychiatry, Harvard Medical School

Table of Contents

I. Motivational Interviewing as a Clinical Style

1. Why Don't People Do What We Tell Them to Do?

2. Mindset and Heartset

3. Four Processes of Motivational Interviewing

4. OARS: Four Foundational Practice Skills

5. Hearing, Evoking, and Responding to Change Talk

6. Offering Information and Advice

II. Motivational Interviewing and Common Challenges in Diabetes Care

7. A New Diagnosis of Diabetes

8. Physical Activity and Healthy Eating

9. Medication Use

10. Insulin Use in Type 2 Diabetes

11. Addressing Self-Care during Follow-Up Visits

12. Substance Use

13. Psychological Stress and Depression

14. Talking with the Family

15. Adolescents and Diabetes Self-Care

16. Managing Diabetes-Related Complications

III. Learning and Applying Motivational Interviewing

17. Learning Motivational Interviewing

18. Motivational Interviewing in Groups

19. Motivational Interviewing, Diabetes Prevention, and the Global Epidemic of Diabetes

Appendix. Systematic and Meta-Analytic Reviews of Motivational Interviewing

References

Index


About the Authors

Marc P. Steinberg, MD, FAAP, developed a focus on diabetes care during his 32 years of practice as a physician. He became increasingly interested in working more effectively with people struggling with the self-care of chronic conditions. Since ending his medical practice in 2013, he has focused on training health care providers in MI. Dr. Steinberg has written articles on MI in Diabetes Spectrum and is a member of the Motivational Interviewing Network of Trainers. He belongs to the national medical honor society, Alpha Omega Alpha, and is a Fellow of the American Academy of Pediatrics. For more than 40 years, he has maintained an active lifestyle with type 1 diabetes.

William R. Miller, PhD, is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. Particularly interested in the psychology of change, he introduced the concept of motivational interviewing in 1983. Dr. Miller has published over 400 professional articles and chapters and 50 books, including Motivational Interviewing, now in its third edition, and Motivational Interviewing in Health Care. He is a recipient of the international Jellinek Memorial Award, two career achievement awards from the American Psychological Association, and an Innovators in Combating Substance Abuse Award from the Robert Wood Johnson Foundation, among many other honors. The Institute for Scientific Information has listed him as one of the world’s most highly cited researchers.

Audience

Diabetes educators, physicians, nurses, nurse practitioners, social workers, health psychologists, and dietitians; educators and students in these fields.

Course Use

May serve as a supplemental text in graduate-level courses.