Professional Documents
Culture Documents
Interviewing Techniques to
Help Patients to Change
Risky/Problem Behaviours
Patient-centered, directive
method for eliciting intrinsic
motivation to change, by
exploring and resolving a
patients ambivalence to
change using reflective
listening
Focus of
Motivational Interviewing
Patients concerns and beliefs
Explore ambivalence about
changing in manner that
increases motivation to changing
without invoking resistance
MI gives patients sense of
empowerment
Motivational Interviewing
Developed early 1980s
Bill Miller (US) and Steve
Rollnick (UK)
Initially for substance abusers
Why did it develop?
High dropout, high relapse
rates, and poor outcomes
Motivational Interviewing:
Common Currency
Over past 20 years, MI has had wide
application to variety behavioural
domains and patient populations
Today practitioners use MI with all types
of patients and problems (e.g., dietary
and medication compliance problems--
hypertension, asthma, insulin dependent
diabetes to eating disorders to
schizophrenia to flossing)
> 150 clinical studies
Today MI COMMON CURRENCY
among Health Care Practitioners
New View of Motivation
Conceptualized As
STATE of Readiness to Change
Can vary from situation to
situation
Dynamic, fluctuating and a
modifiable state
Importantly, can be influenced
by Practitioners interaction
style
EMPATHY KEY MI FEATURE
WHY? High levels of empathy
associated with positive patient
outcomes
Key to expressing empathy through
Reflective Listening
Listening in a reflective manner
demonstrates an understanding of
patients and validates their concerns
It sounds like you are ambivalent
about changing (insert
Focus:
Eliciting Change Talk
HOW: Arguments for changing elicited
from patients
You are (insert problem or concern), what
will happen if you dont change (insert
behaviour) in (use time frame if you want)
Example 1: Youre 55 & seem to be having
difficulty breathing. What will happen in 5
years if you continue to smoke.
Example 2:I sounds like you are not happy
with having to take you insulin. What do
you know about what might happen if you
dont take it regularly?
Tone of
Motivational Interviewing
Nonjudgmental, nonconfrontational,
empathic, supportive climate where patients
can discuss good and less good things
related to changing (insert behaviour).
Inquisitive Tone allows you to address
discrepancies between what patients say
and do without engendering defensiveness
Help me to understand on the one hand
youre coughing, having trouble breathing
and on the other hand you say cigarettes
are not causing you any problems.
RESPECTFUL APPROACH
Motivational Interviewing
Two Key Components
STYLE: How you say it
CONTENT: What you say
Critical Components for
influencing receptiveness
to consider changing
STYLE:
How You Say It
Use an Empathic,
Nonjudgmental,
Nonconfrontational,
Supportive Manner
CONTENT:
What You Say
Do you floss? vs. What are
the good and less good
things about flossing?
Why are you still smoking?
vs. It sounds like you are
ambivalent about quitting.
MI and Non-MI
Comparison Exercise
Short Role Play Exercise:
Compare and contrast
effectiveness of talking with a
smoker about quitting
smoking using two
interviewing approaches: Non
MI and MI
1st Role Play
90 seconds
Role Play #1: Divide into pairs; one
person is Health Care Provider
(HCP) and one is Patient (PT)
HCP: Read questions as they
appear
PT: Answer in any way
Then we will evaluate how it felt
DO NOT GO TO ROLE PLAY #2
Therapist/ Health Care
Practitioner
Patient seeing you for a
routine visit and you
noticed that on the medical
history form they indicated
they currently smoke
cigarettes
Patient
25 years old and married
Smoked for 10 years
Smokes about 1 pack a day
Eventually plans to quit, but
currently not worried about
smoking and it is not causing
any problems
How Did It Feel?
In One Word
Non-MI Scenario
Patient HCP
2nd Role Play
90 seconds
Role Play #2: Keep same PT
& HCP roles as 1st role play
HCP: Again read questions as
they appear
PT: Answer in any way
Then we will evaluate how it
felt
How Did It Feel?
In One Word
MI Scenario
Patient TH/HCP
MI Views Health Care Practitioner and
Patients Relationship as Collaborative