1. MOTIVATIONAL INTERVIEWING TECHNIQUES

2. Principles of Motivational Interviewing Expressing empathy Developing discrepancy Rolling with resistance Avoid argument Eliciting self efficacy

3. Acceptance Accept patient is ambivalent Accept that therapist is influencing patient in positive and negative way Accept that patient can change

4. Resistances Being late Not turning up Unfocused Changing the subject Interrupting Arguing Denying Ignoring Patient avoiding risk i.e going out; not exercising; not doing homework; Clashing of agenda’s (therapist trying too hard)

5. Patient says “you don’t understand” “how do you know this will work for me” “I have tried this it didn’t work” Talking about symptoms endlessly Resistances

6. Fears fear of not getting it right or doing enough there’s no point in doing it at all if this is all I can do fear of making symptom worse Patients assumptions / thinking style e.g. I am a successful person leads to resistance in acknowledging difficulty Low mood – no expectation Why the resistance?

7. Open ended questions Listen reflectively – check out understanding Affirm i.e compliment Summarise The opposite of confrontation – think before speaking Explore goals Motivational Techniques

8. More empathy / compassion Ask person what’s important to them Ensure therapist and patient have shared goals Develop discrepancy e.g. examine what they are doing now and find out what’s of value to person (personal goal) and discuss the gap Possible Responses

9. Ask patient what their views are about what’s stopping them from moving forward “It sounds like you have thought a lot about that” What would need to happen to make you feel more confident (skill, change of expectation in self) Ask permission before advising, discussing, hypothesising Involve significant other who may be metaphorically or more literally standing in the way of change Possible Responses

10. Accept that patient may not be ready to change ….right now (but could with the right help and usually people rise to challenge) Professionals beliefs will be influencing the relationship – he/she needs to know what the beliefs are and what to do with them e.g. I must get this patient better, this person doesn’t want to change, I must do this perfectly Health Professional Factors

11. optimistic honest genuine tenacious flexible curious warm Intuitive but be willing to admit when you get something wrong Therapeutic responses…be

12. Optimism Empowerment Independence Self confidence Success Optimises people’s potential Increases confidence and competence in health professional MI Fosters