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Principles of Motivational Interviewing

Learn about the differences between the traditional approach and motivational interviewing

Traditional Approach vs Motivational Interviewing

The traditional approach of working with patients has been one where clinicians provide advice and tell patients what they ‘should be doing’ in order to improve their health and well-being. Such a stance, however, can often leave patients feeling resentful and disempowered, and as a result, can lead to patient defensiveness, resistance, denial, and anger.23

As there is now a growing movement towards patient-centered care, and with more patients wishing to play an active role in their own health care, motivational interviewing replaces the traditional approach of giving advice.23

Motivational interviewing’s strength focuses on collaboration.20, 21 It is, therefore, a more efficient communication style that contributes to better health outcomes for the patient, both in the short-term and long-term, as the driver for change is the patient.

A Spirit of Collaboration

The core spirit of motivational interviewing is one that is based on a partnership between the clinician and the patient. It is seen as a friendly collaboration between equals, rather than an association with a superior and authoritarian figure as such.20, 21

As the partnership is a collaborative one, motivational interviewing supports the patient’s own personal values, hopes, and goals24. It supports the client’s own ideas, concerns, and expectations. It is driven by the patient’s agenda and not by the helper/clinician’s check list23.

As motivational interviewing is based on working together with your patient towards positive change, a number of primary principles and core skills have been identified to be useful in practice.

Miller and Rollnick nicknamed the four primary principles of motivational interviewing (MI) as “The Spirit of MI” described as a philosophy of a ‘heart set and mindset’ that falls within four domains23, 25.

The Four Domains and Principles of Motivational Interviewing

These four domains and principles can be remembered as ‘PACE’: Partnership, Acceptance, Compassion, and Evocation, as demonstrated in the image below focusing on the spirit of motivational interviewing.

The spirit of MI. Partnership: The clinician and the individual should work together as two experts - the clinician as the clinical expert, and the individual as an expert of their own behaviours, motivations, attitudes and barriers. Acceptance: The clinician acknowledges that everybody has an inherent worth and provides positive appreciation of this in an unconditional manner, showing support of autonomy, empathy, and respect to the individual. Compassion: The clinician should aim to promote the individuals physical and psychological well-being. Evocation: The clinician encourages and aids the individual to generate their own action plan to change their behaviour.

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