Consumer Enablement Guide

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Motivational Interviewing

Motivational interviewing is a communication technique that encourages behaviour change in an atmosphere of acceptance and compassion.1

What is 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

How does it work?

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

How to practice motivational interviewing

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

What skills do you need?

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

What is missing from the evidence?

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.

References

  1. Rollnick S, Miller WR. What is Motivational Interviewing? Behavioural and Cognitive Psychotherapy. 1995;23(4):325- 34.
  2. Romano M, Peters L. Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: A review and meta-analysis. Clinical Psychology Review. 2015;38:1-12.
  3. Romano M, Peters L. Understanding the process of motivational interviewing: A review of the relational and technical hypotheses. Psychotherapy Research. 2016;26(2):220-40.
  4. Coyne N, Correnti D. Effectiveness of motivational interviewing to improve chronic condition self-management: what does the research show us? Home Healthcare Nurse. 2014;32(1):56.
  5. O’Halloran PD, Blackstock F, Shields N, et al. Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clinical Rehabilitation. 2014;28(12):1159-71.
  6. Alperstein D, Sharpe L. The Efficacy of Motivational Interviewing in Adults with Chronic Pain: A Meta-Analysis and Systematic Review. Journal of Pain. 2016;17(4):393-403.
  7. Ekong G, Kavookjian J. Motivational interviewing and outcomes in adults with type 2 diabetes: A systematic review. Patient Education and Counseling. 2016;99(6):944-52.
  8. VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta- analysis. Journal of Behavioral Medicine. 2014;37(4):768-80.
  9. Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. New York: Guilford Publications; 2012.
  10. Lundahl B, Moleni T, Burke BL, et al. Motivational interviewing in medical care settings: a systematic review and meta- analysis of randomized controlled trials. Patient Education and Counseling. 2013;93(2):157-68.
  11. Madson MB, Loignon AC, Lane C. Training in motivational interviewing: A systematic review. Journal of Substance Abuse Treatment. 2009;36(1):101-9.
  12. Rogers CR. A theory of therapy, personality, and interpersonal relationships: as developed in the client-centered framework. In: Koch S, editor. Psychology: a study of a science. New York: McGraw-Hill; 1959. p. 184-256.
  13. Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.
  14. Draycott S, Dabbs A. Cognitive dissonance 2: A theoretical grounding of motivational interviewing. The British Journal of Clinical Psychology. 1998;37(Pt 3)(3):355-64.
  15. Copeland L, McNamara R, Kelson M, et al. Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review. Patient education and counseling. 2015;98(4):401.
  16. Shingleton RM, Palfai TP. Technology-delivered adaptations of motivational interviewing for health-related behaviors: A systematic review of the current research. Patient Education and Counseling. 2016;99(1):17-35.
  17. Miller WR, Rollnick S. Ten Things that Motivational Interviewing Is Not. Behavioural and Cognitive Psychotherapy. 2009;37(2):129-40.
  18. Hardcastle SJ, Fortier M, Blake N, et al. Identifying content-based and relational techniques to change behaviour in motivational interviewing. Health Psychology Review. 2017;11(1):1-16.
  19. Moyers TB, Martin T, Manuel JK, et al. Assessing competence in the use of motivational interviewing. Journal of Substance Abuse Treatment. 2005;28(1):19-26.

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