What is motivational interviewing

It grew out of the Prochaska and DiClemente model described above 2 and Miller and Rollnick's 1 work in the field of addiction medicine, which drew on the phrase 'ready, willing and able' to outline three critical components of motivation.

These were: 1. Using MI techniques, the practitioner can tailor motivational strategies to the individual's stage of change according to the Prochaska and DiClemente model Table 1. Recent meta-analyses show that MI is equivalent to or better than other treatments such as cognitive behavioural therapy CBT or pharmacotherapy, and superior to placebo and nontreatment controls for decreasing alcohol and drug use in adults 4—6 and adolescents.

In general practice, possible applications include:. 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.

Within MI, the therapist is viewed as a facilitator rather than expert, who adopts a nonconfrontational approach to guide the patient toward change.

The overall spirit of MI has been described as collaborative, evocative and honouring of patient autonomy. Although paradoxical, the MI approach is effective at engaging apparently 'unmotivated' individuals and when considered in the context of standard practice can be a powerful engagement strategy Case study, Table 2.

A male patient, 52 years of age, who drinks heavily and has expressed the desire to reduce drinking, but continues to drink heavily. It is easy to conclude that this patient lacks motivation, his judgment is impaired or he simply does not understand the effects of alcohol on his health. These conclusions may naturally lead the practitioner to adopt a paternalistic therapeutic style and warn the patient of the risks to his health. In subsequent consultations, when these strategies don't work, it is easy to give up hope that he will change his drinking, characterise him as 'unmotivated' and drop the subject altogether.

In MI, the opposite approach is taken, where the patient's motivation is targeted by the practitioner. Using the spirit of MI, the practitioner avoids an authoritarian stance, and respects the autonomy of the patient by accepting he has the responsibility to change his drinking — or not.

Motivational interviewing emphasises eliciting reasons for change from the patient, rather than advising them of the reasons why they should change their drinking. What concerns does he have about the effects of his drinking? What future goals or personal values are impacted by his drinking? The apparent 'lack of motivation' evident in the patient would be constructed as 'unresolved ambivalence' within an MI framework. The practitioner would therefore work on understanding this ambivalence, by exploring the pros and cons of continuing to drink alcohol.

They would then work on resolving this ambivalence, by connecting the things the patient cares about with motivation for change. For example, drinking may impact the patient's values about being a loving partner and father or being healthy and strong.

A discussion of how continuing to drink maintaining the status quo will impact his future goals to travel in retirement or have a good relationship with his children may be the focus. The practitioner would emphasise that the decision to change is 'up to him', however they would work with the patient to increase his confidence that he can change self efficacy.

The practical application of MI occurs in two phases: building motivation to change, and strengthening commitment to change. These basic counselling techniques assist in building rapport and establishing a therapeutic relationship that is consistent with the spirit of MI. This involves goal setting and negotiating a 'change plan of action'. In the absence of a goal directed approach, the application of the strategies or spirit of MI can result in the maintenance of ambivalence, where patients and practitioners remain stuck.

This trap can be avoided by employing strategies to elicit 'change talk'. Alternatively, if a practitioner is time poor, a quick method of drawing out 'change talk' is to use an 'importance ruler'. 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. However, definitions of MI vary widely, including out of date and inaccurate understandings.

The most current version of MI is described in detail in Miller and Rollnick Motivational Interviewing: Helping people to change 3rd edition. Key qualities include:. It is important to note that MI requires the clinician to engage with the client as an equal partner and refrain from unsolicited advice, confronting, instructing, directing, or warning. MI takes time, practice and requires self-awareness and discipline from the clinician. While the principles and skills of MI are useful in a wide range of conversations, MI is particularly useful to help people examine their situation and options when any of the following are present:.

MI is framed as a method of communication rather than an intervention, sometimes used on its own or combined with other treatment approaches. There are a number of benefits of learning MI amongst other approaches to helping conversations:.

Log in. Request new password. Understanding Motivational Interviewing. Motivational interviewing can also be useful to help manage medication use and attending appointments, tests and screenings.

Rather than providing advice or telling someone they need to change a behaviour, the approach uses skills such as:.

Motivational interviewing can effectively treat a variety of conditions. But keep in mind that there is no one form of therapy that is appropriate for everyone and works in every instance. Although motivational interviewing has helped many people find the motivation to make both small and major behavior changes, it's not the ideal course of treatment for everyone.

Motivational interviewing works best for people who have mixed feelings about changing their behavior. If you have absolutely no desire to change your behavior, or are already highly motivated to change, you may not reap the benefits of this approach.

If you feel that you or someone you love might benefit from this counseling approach, consider the following first steps:. Learn the best ways to manage stress and negativity in your life. Miller WR, Rollnick S. Motivational interviewing: Helping people change. Guilford Press; Bandura A. Self-efficacy: Toward a unifying theory of behavioral change.

Psychol Rev. Motivational interviewing as an adjunct to cognitive behavior therapy for anxiety disorders: A critical review of the literature. Cogn Behav Pract. Effect of psychotherapy on reduction of fear of childbirth and pregnancy stress: A randomized controlled trial. Front Psychol. Motivational interviewing: A systematic review and meta-analysis.

Br J Gen Pract. Motivational interviewing for adolescent substance use: A review of the literature. Addict Behav. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One. Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. Your Privacy Rights. To change or withdraw your consent choices for VerywellMind.

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