Motivational interviewing

The therapeutic approach was originally designed for adults with substance use disorders, but it is now used more broadly in healthcare to help people prevent and self-manage chronic conditions.^{2 3 4 5 6 7}

It can be used to encourage behaviour change in areas such as:

• substance use
• blood pressure
• weight
• physical activity
• smoking.⁸

Motivational interviewing is not counselling or cognitive behaviour therapy, although it is sometimes used in combination with other strategies to help people change health behaviours. It is a partnership based on respect, where you work closely with people to strengthen their motivation and commitment to change.⁹

It can be useful in situations where you have had conversations with someone about the need for behaviour change, but they are reluctant, resistant to change or not motivated. It can also help if there are issues with people following treatment plans or maintaining contact with your service.⁹

Motivational interviewing can be delivered by health professionals from a range of backgrounds, including mental health, medicine, nursing and allied health.^{10 11} It borrows from a number of theories and approaches, including patient-centred therapy, self-determination theory, and cognitive dissonance theory.^{12 13 14}

Key aspects

• Engaging – establishing a working relationship and connection with the person.
• Focusing – developing and maintaining the direction of the conversation towards behaviour change.
• Evoking – drawing out the person’s own motivation for change.
• Planning – helping the person develop a commitment to change and a plan of action.

In a systematic review that examined how motivational interviewing affected behaviour outcomes, its mechanisms were categorised into therapist behaviours and patient behaviours.¹⁵

Therapist behaviours

• Empathy
• Mtivational interviewing spirit
• Reflections
• Open questions
• Motivational interviewing consistent behaviours
• Motivational interviewing inconsistent behaviours.

Of the therapist behaviours, motivational interviewing spirit (classified in the study as being based on three key elements: collaboration, evoking the person’s ideas about change, and autonomy) appeared to be the most promising.

Patient behaviours

• Change talk
• Sustain talk
• Self-efficacy
• Self-monitoring
• Stage of change
• Motivation, planning
• Therapeutic alliance
• Commitment strength
• Perceived behaviour of control.

Of the patient behaviours, motivation (defined as the process that initiates, guides, and maintains goal- oriented behaviours), was considered the most promising.¹⁵

Motivational interviewing is usually delivered face-to-face, although technology is often used for people living in remote locations.¹⁶ Regardless of how it is delivered, the aim is to initiate, guide and maintain goal-oriented behaviours, to help the person improve their health outcomes.¹⁵

To practice motivational interviewing, you need to acknowledge the expertise that the other person brings to the partnership, and pay attention to their language about change (known as ‘change talk’). By exploring their reasons for change, you will strengthen their motivation to change their behaviour.^{9 17 18}

Motivational interviewing involves the following actions (the first four of which are often referred to as OARS).

• Asking open questions
• Affirming
• Reflective listening
• Summarising
• Providing information and advice with permission
• Exploring values and goals
• Exploring discrepancies between values and actions.⁹

Following this process will help you:

• understand the person’s sense of self-worth
• empathise with the person’s perspective
• respect the person’s right to autonomy and choice
• affirm the person’s strengths and efforts.⁹

To deliver motivational interviewing, you will need to develop the right skills to guide the person through the process. This can be achieved with training, practice and experience.¹⁷

Your training should include education on the following.

• Motivational interviewing theories and approaches
• How to engage and collaborate with the person
• How to develop an integrated plan of action
• How to focus the direction of the conversation
• How to evoke the person’s ideas about change.⁹

After your initial training, you should receive ongoing feedback, support and observation to help you maintain your skills.⁹ There are a range of tools and resources to help you practice motivational interviewing, such as the Motivational Interviewing Treatment Integrity Scale.¹⁹

While the body of research for motivational interviewing is still growing, there are still questions about its effectiveness for a number of different outcomes, including medication adherence and screening of some

conditions. As more high-quality research becomes available, it will be easier to determine who will benefit most from these techniques.