Key elements to Motivational Interviewing
The basis of MI (motivational interviewing) is that the patient remains in control of their own decisions: the clinician is simply evoking talk about change, working with the patient to consider and support reasons for change, to address barriers and to work on the patient’s own goals.
MI was developed by Miller and Rollnick [Miller, W.R., & Rollnick, S. Motivational Interviewing, 3rd ed. Guilford Press, 2012] and is a skill that is typically taught on a two day course. This module is intended as a brief introduction and not as a replacement for a practical course.
Click on the 'More info' buttons for further information on the three key elements of MI.
Autonomy
The patient will only change if they want to, not because you tell them to. Instead, help the patient to explore their reasons for change.
Collaboration not confrontation
Resistance is a normal part of change and does not need to be fought. Work with your patient, not against them. You will know if you are doing it right if you can avoid statements where your patient could reply ‘yes, but…’.
Evoke don’t impose
Ask questions and give information; don’t tell people what to do. The power is in knowing which questions to ask.
Patient Scenario: Chetan
Patient Details
- Name: Chetan Chowdhury
- Age: 35
- Ethnicity: Bangladeshi
- BMI: 29
- Waist circumference: 98 cm
- Occupation: IT worker
- Family Background: Lives with his wife and mother who has type 2 diabetes. Attends for support with smoking cessation.
- Last Appointment: Three years ago
Summary
This is Chetan. We will be using Chetan’s story to illustrate some of the principles of Motivational Interviewing.
He comes to your clinic asking for advice on smoking cessation. Chetan is overweight but not obese, however he has several additional risk factors, including his ethnicity and family history, putting him at high risk of developing type 2 diabetes in the future. He could substantially reduce this risk by losing weight. Like many young men, Chetan doesn’t often visit his general practice, so you may not see him again for several years.
As a health care professional (HCP) decide on the following (using the sliding scales below):
1] How important do you feel it is to open up a dialogue about Chetan's weight at this appointment?
"I'd rather not broach this."
“I haven’t seen Chetan in 3 years, he’s at very high risk of developing diabetes , I’d better have a chat with him.”
Not importantVery important
2] How confident do you feel in your ability to have a productive discussion about his weight?
“Saying ‘exercise more and eat less’, doesn’t get me very far”
“I’m looking forward to using my well practised MI techniques to set a SMART goal and action plan, with follow up.”
Not confident Very confident
Every practitioner will start this course with different levels of behaviour change skills. You will be introduced to the skills as you progress through this module.
You will be learning the principles and techniques of motivational interviewing and how to complete a brief behavioural change intervention: exploring and explaining, setting a SMART goal and action plan, with relapse management and follow-up and/or referral.
