What is motivational interviewing?

What is motivational interviewing?

Motivational interviewing is a directive, patient centred counselling style that aims to help patients

explore and resolve their ambivalence about behaviour change. It combines elements of style

(warmth and empathy) with technique (e.g. focused reflective listening and the development of discrepancy). A core tenet of the technique is that the patient’s motivation to change is enhanced if there is a gentle process of negotiation in which the patient, not the practitioner, articulates the benefits and costs involved.

The four central principles of motivational interviewing

1 Express empathy by using reflective listening to convey understanding of the patient’s point of view and underlying drives

2 Develop the discrepancy between the patient’s most deeply held values and their current behaviour (i.e. tease out ways in which current unhealthy behaviours conflict with the wish to ‘be good’ – or to be viewed to be good)

3 Sidestep resistance by responding with empathy and understanding rather than confrontation

4 Support self-efficacy by building the patient’s confidence that change is possible

 The skills of a good motivational therapist

• Understand the other person’s frame of reference

• Filter the patient’s thoughts so that statements encouraging change are amplified and statements that reflect the status quo are dampened down

• Elicit from the patient statements that encourage change, such as expressions of problem recognition, concern, desire, intention to change and ability to change

• Match the processes used in the theory to the stage of change; ensure that they do not jump

ahead of the patient

• Express acceptance and affirmation

• Affirm the patient’s freedom of choice and self-direction

Models of health behaviour change

The basic principle that underpins most models of health behaviour change is that people hold a

range of representations about their problematic symptoms and behaviours. For example, at one

extreme are individuals who are stoical or in denial and neglect themselves or their symptoms. 

At the other are those who display abnormal illness behaviour and readily adopt the sick role. Most

models of health behaviour change include the idea that there are at least two components to readiness to change. These are importance/conviction and confidence/self-efficacy (Keller & Kemp-White, 1997; Rollnick et al, 1999), encapsulated in the adage ‘ready, willing and able’. ‘Importance’ relates to why change is need. 

The concept includes the personal values and expectations that will accrue from change. ‘Confidence’ relates to the person’s belief that they have the ability to master behaviour change. Motivational interviewing works on both of these dimensions by helping the patient to articulate why it is important for them to change and by increasing self-efficacy so that they have confidence to do so.

Sunil Kumar                                    Jayasudha Kamaraj
Clinical psychologist                       Counseling psychologist
Founder                                            co-founder
http://mindzone.in/addiction/

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