MOTIVATIONAL INTERVIEWING TECHNIQUES

Principles of Motivational Interviewing

• Expressing empathy• Developing discrepancy• Rolling with resistance• Avoid argument• Eliciting self efficacy

Acceptance

• Accept patient is ambivalent• Accept that therapist is influencing

patient in positive and negative way• Accept that patient can change

Resistances• Being late• Not turning up• Unfocused• Changing the subject• Interrupting• Arguing• Denying• Ignoring• Patient avoiding risk i.e going out; not exercising; not

doing homework; • Clashing of agenda’s (therapist trying too hard)

• Patient says• “you don’t understand”• “how do you know this will work for me”• “I have tried this it didn’t work”

• Talking about symptoms endlessly

Resistances

• Fears• fear of not getting it right or doing enough• there’s no point in doing it at all if this is all I can do • fear of making symptom worse

• Patients assumptions / thinking style e.g. I am a successful person leads to resistance in acknowledging difficulty

• Low mood – no expectation

Why the resistance?

• Open ended questions• Listen reflectively – check out understanding • Affirm i.e compliment• Summarise• The opposite of confrontation – think before

speaking• Explore goals 

Motivational Techniques

• More empathy / compassion

• Ask person what’s important to them

• Ensure therapist and patient have shared goals

• Develop discrepancy • e.g. examine what they are doing now and find out

what’s of value to person (personal goal) and discuss the gap

Possible Responses

• Ask patient what their views are about what’s stopping them from moving forward• “It sounds like you have thought a lot about that”

• What would need to happen to make you feel more confident (skill, change of expectation in self)

• Ask permission before advising, discussing, hypothesising

• Involve significant other who may be metaphorically or more literally standing in the way of change

Possible Responses

• Accept that patient may not be ready to change ….right now (but could with the right help and usually people rise to challenge)

• Professionals beliefs will be influencing the relationship – he/she needs to know what the beliefs are and what to do with them

• e.g. I must get this patient better, this person doesn’t want to change, I must do this perfectly

Health Professional Factors

• optimistic• honest• genuine• tenacious• flexible• curious• warm• Intuitive but be willing to admit when you get

something wrong

Therapeutic responses…be

• Optimism• Empowerment• Independence• Self confidence • Success• Optimises people’s potential• Increases confidence and competence in health

professional

MI Fosters