motivational interviewing

Introduction

Motivational interviewing is counseling using directive, patient-centered techniques.

The basic elements include engagement, focusing, evoking, & planning.

• exploits patient's intrinsic motivation to change
• identifies reasons for ambivalence to change
• discusses them but does not directly confront the patient
  • patient must confront the discrepancy between his/her cuurent & desired behavior

Indications

• overall goal is to assist patients in addressing & changing unhealthy behaviors

Clinical significance

• patient chooses agenda
• provider is not in control
  • provider does not tell patient what he/she should or should not do
• provider assesses patient's sense of importance of various issues & level of confidence in making changes

Procedure

• Engage
  • understand patient's behavior (be non-judgemental)
  • confirm what the patient says
  • avoid assumptions about patient's motivation
• Focus
  • listen, encourage change as indicated
  • be positive
  • when patient speaks of sustaining current behavior
    • elaborate
    • affirm
    • reflect
• Evoke
  • help patient formulate & verbalize new goals
  • offer suggestions if patient unable to do so
• Plan
  • discuss goals*, resources, & means of monitoring progress
  • identify barriers to success & develop plan(s) to overcome barriers

* goals should be specific, achievable, realistic & time-bound

More general terms

• medical history