Motivational Interviewing

Background
Providers will inevitably encounter patients who do not follow their treatment plan. They may not fill their prescriptions; take medications as instructed, change diet, or exercise. Motivational interviewing is a technique that, when used proficiently, has shown itself to be an effective way of helping patients to become active in their self-care.

Principles of Motivational Interviewing
There are four guiding principles of motivational interviewing (Motivational Interviewing, n.d.):

  • Express empathy (See the world through the client’s eyes; Clients will feel more understood, and are more likely to honestly share their experiences)
  • Support Self-Efficacy (Believe that the client has the strength to successfully change; Focus on previous successes and identify skills and strengths that the client possesses)
  • Roll with Resistance (Resistance occurs when there is a discrepancy between the client’s view of the “prob- lem” and/or “solution,” and the clinician’s view; Avoid confrontation to the resistance (especially during the early stages). “Dance,” rather than “Wrestle” with the client, do not let discussions devolve into struggles or fighting
  • Develop Discrepancy (Help the client identify the difference between where they currently are, and where they would like to be
    “When clients recognize that their current behaviors place them in conflict with their values or interfere with accomplishment of self-identified goals, they are more likely to experience increased motivation to make important life changes”

Using Motivational Interviewing
One technique for successful motivational interviewing is the OARS approach (Hall, Gibbie, & Lubman, 2012; Miller & Rollinick, 2002):
Ask Open-Ended Questions

  • Allow the patient to do most of the talking
  • Require responses beyond simply “yes” or “no”

Make Affirmations

  • Acknowledge the difficulties the client has experienced
  • Validate the client’s experiences and feelings
  • Notice and recognize the patient’s strengths and efforts for change

Use Reflective Listening

  • Take an interest in what the client is saying, and try to understand how the person sees things
  • Encourage personal exploration and helps people understand their motivations more fully

Summarize the Conversation

  • Show that you have been listening to the client
  • Describe the differences between the client’s current situation, and where they would like to be
  • Demonstrate an understanding of the client’s perspective

It is critical to become proficient in motivational interviewing, if one is to use it effectively. Training resources can be found through the Motivational Interviewing Network of Trainers, by visiting motivationalinterviewing.org/.

References
Hettema, J., Steele, J., & Miller, W.R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1 91-111
Hall, K., Gibbie, T., & Lubman, D.I. (2012). Motivational interviewing techniques: facilitating behaviour change in the general practice setting. Australian Family Physician, 41(9), 660-667
Miller & Rollinick. (2002). Motivational Interviewing: Preparing People for Change. Guilford Press. Information retrieved fromhttp://www.amhd.org/About/ClinicalOperations/MISA/Training/MI%20H2%20Strategies%20and%20Principles.pdf
Motivational Interviewing. (n.d.). An Overview of Motivational Inverviewing. Retrieved from http://www.motivationalinterview.org/quick_links/about_mi.html