Tuesday, September 16, 2014

Decisions, Decisions: How to Help Your Aging Parent Make Them

Giving up the car?  Moving to an assisted living community?  Eating a healthier diet? Whatever the decision your aging parent faces, there's ambivilance. Through a process called "Motivational Interviewing," you can help your parent resolve the vacillation and commit to change.

"There are pros and cons for every decision we make," Carilyn Ellis says.  Ellis uses motivational interviewing in her work with veterans who are grappling with issues including drug and alcohol abuse.  Some are seniors. She contends that the same principles she uses as a clinician can be used by family members and others in helping seniors make decisions.

In a nutshell:  "Motivational Interviewing is collaborative conversation that strengthens someone's own motivation for and commitment to change."

Words that describe the process, according to Ellis:

  • Collaborate--rather than confront or be authoritative.  You let go of the outcome, but focus on your parent and how you can work together.
  • Evoke your parent's motivation--Discover what he or she wants, rather than attempting to persuade him or her of  your point of view.
  • Honor your parent's independence and autonomy in making decisions for their own lives.
Principles of "Motivational Interviewing":
  • Express empathy.  Use phrases like "This is really concerning to you."  "It's a hard decision."  And if your parent dismisses the difficulty, say something like "I know what you're saying.  I still think it is hard."
  • Normalize their feelings.  You can say something like "What you're going through is normal. To think about what's important to you is always OK."
  • Summarize their words.  You might say, "I think I'm hearing you say...Am I right?  Please correct me if I'm wrong."
  • Support self-sufficiency.  They need to believe they're able to make the change.  You can help by validating the steps they've already taken or validate their successes in life.  Remind them of how they overcame obstacles.
  • Roll With Resistance.  Don't argue.  If a tug of war ensues, go back to empathy.
Developing Discrepancy:  
  • The goal is for your parent to initiate the "change talk."  How can you recognize this "change talk?" Instead of using phrases like, "Living in a retirement community is good for some people," he or she might say, "I want to visit one to see what it's like." 
  • Ask evocative questions.  Some possibilities: "Let me ask you, what if you chose not to..."  Or "What if you decided to continue..."  Or "On a scale of 0 to 10, where 0 is absolutely not and 10 is absolutely committed, where would you put yourself right now?" If he or she answered, 5, you could ask, "What would it take to move you from a 5 to a 6?"
  • Ask, "What are your top three values and why?"  How does your current situation/behavior fit with these values?  Since you know your parent well, you probably won't have to ask his or her values, but say something like, "You know I know you well, and it seems to me like family (or saving money, or friendship, or...) is a huge value for you.  Right?" 
Use a gentle, supportive tone, Ellis advises.  

Much of this information was taken from Carilyn Ellis' presentation to the Certified Senior Advisors.  It was entitled "Motivational Interviewing:  Tools for Fostering Improved Motivation in Your Clients to Make Decisions and Achieve Their Goals."

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