Motivational Interviewing in General Practice

1
Motivational Interviewing in General Practice

• Dr Katherine Teare
• GP Education Fellow

2
Background

• Interest in long term health patient thus
  behaviour change
• Myth unmotivated patient
• Conversations about change arise whenever you are
  considering changing management
• Usually no one is completely unmotivated
• Way you talk to patient can substantially change
  behaviour

3
Spirit of MI

• Collaborative
• Cooperative, patient centred and specific
• Evocative
• Discover patients goals / values / dreams
• Honours autonomy
• Clinician detaches from outcomes

4
4 guiding principles

• R resisting the righting reflex
• Natural to resist persuasion
• U understand patients motivations
• Patient own reasons more likely to trigger change
• L listen to your patient
• Find their own answers
• E empower your patient
• Encourage thinking aloud about why and how
  patient more likely to act

5
Fitting it into practice

• Three main communication styles
• Follow listen carefully and sympathetically
• Direct offer straightforward advice
• Guide middle way listen and encourage
  consideration of options, offer some knowledge
  but let them choose what to do

6
Guiding

• Well suited to help solve behaviour change
• Goal oriented
• Seeks to evoke reasons for change
• Involves clinical competence with strategies that
  can be employed to encourage change

7
Core communication skills

• Ask what do they want to achieve
• Listen to their preferences, respect their
  choice, see what makes sense
• Inform about options

8
Useful questions

• What changes would you like to talk about?
• What have you noticed about?
• How important is it for you to?
• How confident do you feel about?
• How do you see the benefits of?
• How do you see the drawbacks of?
• How might things be different if you?
• Where does this leave you now?

9
Video motivational?

• http//www.youtube.com/watch?vaUaInS6HIGo

10
Motivational interviewing is not

• Based on transtheoretical method (considers
  conceptually why and how change occurs)
• A way to trick patients
• A technique
• A form of CBT
• Simply patient centred counselling
• Easy
• A panacea

11
References

• Motivational Interviewing in Health Care
• Rollnick, Miller, Butler 2008
• BMJ 2010340c1900
• Motivational Interviewing an introduction for
  health care practitioners no details available
• Behavioural and Cognitive Psychotherapy 2009,37,
  129-140