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 Evocative Honours autonomy
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?

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 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, `