Motivational Interviewing in General Practice Dr Katherine Teare GP Education Fellow

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

‘Spirit’ of MI Collaborative Evocative Honours autonomy Cooperative, patient centred and specific Evocative Discover patients goals / values / dreams Honours autonomy Clinician detaches from outcomes

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

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

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

Core communication skills Ask – what do they want to achieve Listen – to their preferences, respect their choice, see what makes sense Inform – about options

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?

Video – motivational? http://www.youtube.com/watch?v=aUaInS6HIGo

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

References Motivational Interviewing in Health Care BMJ 2010;340:c1900 Rollnick, Miller, Butler 2008 BMJ 2010;340:c1900 Motivational Interviewing: an introduction for health care practitioners – no details available Behavioural and Cognitive Psychotherapy 2009,37, 129-140`