Example: 'If you can think of a scale from zero to 10 of how important it is for you to lose weight. On this scale, zero is not important at all and 10 is extremely important. Where would you be on this scale? This technique identifies the discrepancy for a patient between their current situation and where they would like to be.
Highlighting this discrepancy is at the core of motivating people to change. This can be followed by asking the patient to elaborate further on this discrepancy and then succinctly summarising this discrepancy and reflecting it back to the patient. Next, it is important to build the patient's confidence in their ability to change. This involves focusing on the patient's strengths and past experiences of success.
Again, a 'confidence ruler' could be employed if a practitioner is time poor. Example: 'If you can think of a scale from zero to 10 of how confident you are that you can cut back the amount you are drinking.
On this scale, zero is not confident at all and 10 is extremely confident. Finally, decide on a 'change plan' together. This involves standard goal setting techniques, using the spirit of MI as the guiding principle and eliciting from the patient what they plan to do rather than instructing or advising. If a practitioner feels that the patient needs health advice at this point in order to set appropriate goals, it is customary to ask permission before giving advice as this honours the patient's autonomy.
Examples of key questions to build a 'change plan' include:. It is common for patients to ask for answers or 'quick fixes' during Phase II.
In keeping with the spirit of MI, a simple phrase reminding the patient of their autonomy is useful, 'You are the expert on you, so I'm not sure I am the best person to judge what will work for you. But I can give you an idea of what the evidence shows us and what other people have done in your situation'. In general practice, the particular difficulties associated with quick consultation times can present unique challenges in implementing MI. Miller and Rollnick 17 have attempted to simplify the practice of MI for health care settings by developing four guiding principles, represented by the acronym RULE:.
The righting reflex describes the tendency of health professionals to advise patients about the right path for good health. This can often have a paradoxical effect in practice, inadvertently reinforcing the argument to maintain the status quo.
Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behaviour. Motivational interviewing in practice requires clinicians to suppress the initial righting reflex so that they can explore the patient's motivations for change. It is the patient's own reasons for change, rather than the practitioner's, that will ultimately result in behaviour change. By approaching a patient's interests, concerns and values with curiosity and openly exploring the patient's motivations for change, the practitioner will begin to get a better understanding of the patient's motivations and potential barriers to change.
Effective listening skills are essential to understand what will motivate the patient, as well as the pros and cons of their situation. A general rule-of-thumb in MI is that equal amounts of time in a consultation should be spent listening and talking.
Patient outcomes improve when they are an active collaborator in their treatment. A truly collaborative therapeutic relationship is a powerful motivator. Patients benefit from this relationship the most when the practitioner also embodies hope that change is possible.
If a practitioner has more time, four additional principles Table 5 can be applied within a longer therapeutic intervention. Barriers to implementing MI in general practice include time pressures, the professional development required in order to master MI, difficulty in adopting the spirit of MI when practitioners embody an expert role, patients' overwhelming desire for 'quick fix' options to health issues and the brevity of consultation times.
These barriers to implementing MI in primary care represent significant cons on a decisional balance. On the other hand, the pros for adopting an MI approach with patients who are resistant to change are compelling. While we are not advocating MI for all patient interactions in general practice, we invite practitioners to explore their own ambivalence toward adopting MI within their practice, and consider whether they are 'willing, ready and able'. Practitioners who undertake MI training will have an additional therapeutic tool to draw upon when encountering patient resistance to change and a proven method for dealing with a number of common presentations within general practice.
For further information and online motivational interviewing training opportunities visit www. Motivational interviewing techniques updated PDF 1. Australian Family Physician. Search for: Search AFP. Filter Relevance Date. Issues by year. Volume 41, Issue 9, September Motivational interviewing techniques Facilitating behaviour change in the general practice setting.
Background One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks. Objective To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting.
Discussion Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management. The Stages of Change model and motivational interviewing Prochaska and DiClemente 2 proposed readiness for change as a vital mediator of behavioural change.
These were: 1 the importance of change for the patient willingness the confidence to change ability whether change is an immediate priority readiness.
The spirit of motivational interviewing Motivational interviewing is underpinned by a series of principles that emphasise a collaborative therapeutic relationship in which the autonomy of the patient is respected and the patient's intrinsic resources for change are elicited by the therapist.
Case study — using the spirit of motivational interviewing A male patient, 52 years of age, who drinks heavily and has expressed the desire to reduce drinking, but continues to drink heavily. Table 2. The spirit of motivational interviewing vs an authoritative or paternalistic therapeutic style The spirit of motivational interviewing Authoritative or paternalistic therapeutic style Collaboration: a partnership between the patient and practitioner is formed. Joint decision making occurs.
The practitioner connects health behaviour change to the things the patient cares about Education: the patient is presumed to lack the insight, knowledge or skills required to change.
Table 3. Can you tell me about them? Versus Are you concerned about your drinking? But you are beginning to worry about the impact drinking is having on your health. How am I doing? Examples of key questions to build a 'change plan' include: It sounds like things can't stay the same as they are. What do you think you might do? What changes were you thinking about making? Where do we go from here? What do you want to do at this point? How would you like things to turn out?
After reviewing all of this, what's the next step for you? Table 4. What difficulties have resulted from your drinking? In what way does your weight concern you? What are the advantages of reducing your drinking? What would be different in your life if you lost weight? Becoming ambivalent is the first step in developing motivation to change.
Motivational Interviewing MI offers an alternative response to ambivalence, as it recognizes that ambivalence is normal, and it defines readiness to change as a dynamic and not a static factor Miller, Motivational Interviewing helps people explore ambivalence — what keeps the person doing what they do and what might move them towards wanting to make a change. It is a shift from the pre-contemplative stage of change, e.
What are the good things about…? What do you enjoy about…? What would you miss about…? What about some of the less good things? How do you feel about…? Veriti conducts regular Introduction to Motivational Interviewing workshops, as well as Advanced Motivational Interviewing workshops.
That is why a good interviewer gets herself out of the way. A client is allowed to explore the arguments for and against change in his own head. Many skill-based therapeutic models are based on giving information, teaching proven strategies and developing ways to help clients achieve goals. Motivational Interviewing is different. Most importantly, the goals are determined entirely by the client.
The counselor helps to affirm, reflect and summarize what the client is thinking and is careful not to be influenced by her own agenda. A good motivational interviewer cleanly and clearly reflects what the client is telling her.
When a person is undecided about something, the pressure to resolve the issue can grow. He might feel paralyzed by indecision.
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