How does motivational interviewing work?

The consistent message of motivational interviewing is its emphasis on the patient’s freedom of choice, that it’s the patient’s personal choice and responsibility to decide how they would like to proceed.

The spirit of motivational interviewing is centered around the idea that change is initiated by the individual themselves. However, there is still room you for you as the clinician to provide information which may aid this process, in the best interests of your patient.

Miller and Rollnick advise using the “Elicit-Provide-Elicit” method when you want to provide information to an individual. An important aspect is to first ask the individual if they are happy for you to provide them with the information/knowledge. You should be prepared to stop if the individual says no.

By asking permission, we’re respecting the patient’s autonomy. As part of this process, the clinician will start by exploring knowledge gaps:

• Elicit– explore any knowledge gaps the individual might have, and ask them if it’s ok for you to provide some information, for example: “What do you already know about…?”
• Provide– give helpful information by asking for permission first, for example: “Is it ok if I share some information with you about… ”. Keep it brief and easy to understand.
• Elicit– check they understand the information that you have shared with them, for example: “What do you make of that information?” or “What else might you be interested in learning more about?” and follow up with, “What might be the next step for you?” or “How would you like to proceed?”

At this stage, the clinician is discouraged from making suggestions to the client – they should instead facilitate the individual to make suggestions themselves. This has been shown to be significantly more effective than traditional methods, whereby the clinician provides the individual with direct advice. Having said that, if the client is genuinely stuck for solutions, ask their permission to share two to three simple ideas, and then check if those solutions could work for them and their current situation. For example:

• “If you’re ok with it, I’d like to share some ideas/some of the resources that have helped other patients I’ve worked with who have had similar dilemmas. Is that okay?”
• “What do you think about this idea? How does this suggestion/idea/tip fit into your lifestyle?”

Watch:
The following video clips show an effective and ineffective approach using the example of a physician supporting a patient to quit smoking. Watch the two videos and see how the motivational techniques applied by the ‘effective physician’ help the physician raise a sensitive topic successfully, compared to the approach of giving direct advice.

Video 1 (5 mins) focuses on the ineffective physician – how not to do motivational interviewing:

Video 2 (6 mins) focuses on the effective physician and how to do motivational interviewing effectively:

As motivational interviewing is a patient-centred approach, it supports the exploration of the patient’s personal concerns. That is, what holds them back from making a positive change? What gets in the way? What makes change difficult for them?

If we don’t explore the patient’s concerns and don’t make an effort to address them or refer them to someone who can help address their concerns, there will be no change.

Watch:
Video 3 (3 mins) in particular, focusses the discussion on weight. It provides a practical example of how the conversation is framed around health and not appearance. It illustrates a number of useful motivational interviewing tips that you can put into practice:

Even if the patient is not ready to change, motivational interviewing helps to plant the seed. It helps the patient reflect on their current situation and how life could be different, if they were to make some changes.