Motivational Interviewing (MI) by Prof S Rollnick
A consultation that leans on MI has one strong characteristic that supercedes all else: instead of adopting an expert position and using a directing style to persuade the patient why or how they might get more exercise, you adopt a guiding style. It is a more collaborative process of helping the patients to say why and how they might get more exercise. You structure the consultation and provide information (with permission) but most of the time you are eliciting their own motivation to change. This is often expressed in the form of change talk.4 The more change talk you can elicit from the patient, the better the outcome is likely to be. There is emerging evidence to support this focus on the language used by the patient.5
One useful aid might be the recently developed framework for MI6 that describes four processes in a constructive conversation about behaviour change:
They do not always emerge in a linear sequence, but the logic is this: step one is to engage with the patient and establish an agreed focus for the conversation; then the central task is evoking the patient’s own motivation to change, followed by planning if the person is ready for this. These processes are highlighted in the example below, alongside other key skills. The 2nd video is a repeat however it highlights the stages of the Motivation process.
The dialogue of the videos showing MI is based on a fictitious consultation between a 51 year old male and his doctor. He is overweight, with borderline raised BP, who gets short of breath when walking secondary to his poor cardiovascular fitness and sedentary job. He travels to work on the bus and works on the third floor of an office. By Prof S Rollnick
Doctor: OK, so that’s your tablets sorted out, and now I wanted to ask you whether it’s ok with you to spend just a couple of minutes talking about something completely different….. Would that be OK? (Asking permission will help a lot)
Patient: Yeah OK, what’s that then?
Dr: It’s about exercise. Would you mind if we chatted about that if I promise not to nag at you about it?
Pt: Yeah OK, as long as you keep to that promise (laughs). (The focus is clear. Engagement is not strong, yet.)
Dr: So rather than me talk about it, could you? Could you tell me how you feel about getting more exercise?
Pt: Hate the thought to be honest with you.
Dr: You’re not persuaded about this one (That’s a reflective listening statement, not a question)
Continue and download the full example of MI interviewing written by Prof S Rollnick for health professionals here.