Motivational Interviewing

Motivational Interviewing teaser image
What is it and why use it?
Motivational interviewing (MI) is a patient-centred counselling strategy used to improve self-efficacy and guide positive behavioural change (1). It is often adapted to injury and/or exercise assessment protocol in clinical practise. MI is based on four principles.
  1. Empathise with ones lived experience (validate one’s concerns)
  2. Identifying discrepancies between current behaviours and patient goals (collaboration between patient and practitioner)
  3. Establishing the patient’s own perceptions and ideas for change rather than imposing them
  4. Supporting/developing patient self-efficacy and autonomy throughout
Motivational interviewing is to collaborate with a patient seeking your help to develop management or treatment strategies, that they have a sense of control over (autonomy) and are confident to effectively manage/cope with (self-efficacy) to achieve favourable outcomes they can sustain long-term.
This process can often take an amount of ‘trial-and-error’, so it is important for the patient to understand this and be willing to engage with a practitioner rather than seek a simple ‘fix’ for their presentation or complaint. Equally, as practitioners, it is vital to be open and transparent about our thoughts, recommendations and expected timeframes (if we can provide them) so that a patient’s understanding of their recovery process or management plan is as clear as it can be.

Motivational interviewing can be, at times, quite confronting for a patient if an alternative perspective is offered to a long, and strongly held belief of theirs. It is therefore important to recognise (as practitioners) whether our patient is ready to have their understandings challenged (even if imperative to their progress). In my opinion, MI is based on trust, therapeutic alliance if you will. It is therefore imperative that both patient and practitioner remain open, honest, and certainly adaptable throughout the treatment process to elicit (hopefully) effective strategies to elicit positive behavioural changes in the pursuit of recovery.
A few tips for patient’s…
  1. Be as open, honest, and accurate as you can be with your experience/complaint/reason for visit. No detail is too small, and in fact, it is often the smaller details than can be valuable in guiding your treatment!
  2. Think about short- and longer-term goals and bring these with you to your initial assessment. Be succinct. You can then discuss strategies/plans as to how you will begin to work towards these during your session.
  3. Ask questions! This will assist with important and open dialogue between you and your practitioner and will often help you both understand your lived experience more intimately.
Scott Mellish, Exercise Physiologist
  1. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol 2009;64(6):527–37. doi: 10.1037/a0016830.