Motivational interviewing in practice

Photo Cred: Freepik

By Karen Malkin

When working with patients, one of the main obstacles to them achieving their goals lies in compliance. Telling them—or pushing them—to act in a certain way rarely works. One powerful way to help people achieve positive outcomes in their health journey can be to instead invite them into a conversation that promotes reflection and inspires autonomy and action. The coaching technique Motivational Interviewing (MI) does just that.

A coaching style initially used in addiction treatment, the efficacy of MI has been shown in many randomized trials across a wide range of conditions and settings. Over the past 15 years, MI has been adapted and across various chronic disease behaviors.

As a patient-centered style for bringing about behavior change, MI helps clients evoke from within and resolve ambivalence in a focused and goal-oriented way. It is the practitioner’s job to take a guiding role to support their patient to these insights. That doesn’t mean the practitioner should be arriving at conclusions on behalf of the patient. MI relies upon identifying and mobilizing the client’s deeply-held values to stimulate behavior change.

Specific and trainable behaviors characterize MI’s style. These include:

• Seeking to understand the patient’s frame of reference via reflective listening (“I hear you saying this…”)
• Expressing affirmation and acceptance
• Eliciting and reinforcing the patient’s self-motivational statements and expressions of problem recognition, concern, desire and intention to change, or ability to change
• Affirming the patient’s freedom of choice and self-direction
• Monitoring the degree of readiness to change, and preventing resistance by not jumping ahead of the patient

It’s tempting to be “helpful” by presenting the urgency of the problem and persuading the patient about the benefits of change. However, these tactics generally increase client resistance and diminish the probability of change.

MI Example

The following prompts and scales that focus on Importance and Confidence show how you might employ MI techniques with a patient.

1. IMPORTANCE: Ask how important it is to her to undertake the health-promoting behavior.

Today, how important is it that you [reduce your sugar intake, eat more lean protein at every meal, increase your movement, meditate daily, etc.]?

Explore importance using the patient’s experiences:

• Why did you give yourself a score of ___ and not ___ [one number lower]?
• What would need to happen for your importance score to move up just a little?
• What concerns do you have about ______ [current behavior]?
• What would have to be in place before you seriously considered changing?
• If you were to change, what would your life look like?

2. CONFIDENCE: Ask how confident she is that she could do this if she decided to start today.

Enhance confidence by helping the patient recall her experiences consistent with the change:

• Why did you give yourself a score of ___ and not ___ [one number lower]?
• What would need to happen for your confidence score to move up just a little?
• What would make you more confident about making these changes?
• How can I help you succeed?
• What did you find helpful in previous attempts to do this?
• What have you learned from the way things went wrong last time you tried?
• What ways do you know about that have worked for other people?
• What are some of the practical things you would need to do to achieve this goal?
• What can you think of that would help you feel more confident?

As an integrative health coach, I use a relational approach to work with groups and individuals to address the health and wellbeing of the whole person. I form a partnership with my clients to empower and support them in achieving their personal and wellness goals. I use MI as a collaborative, goal-oriented method of communication with the focus on creating health promoting behavior.

Resources

Brown, J. M., & Miller, W. R. (1993). Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychology of Addictive Behaviors, 7(4), 211-218.

Stelter, Reinhard & Andersen, Vinnie. (2018). Coaching for health and lifestyle change: Theory and guidelines for interacting and reflecting with women about their challenges and aspirations.

Editor’s note: Photo courtesty of Freepik.