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Motivational Interviewing

Motivational interviewing (MI) is a patient-centred, directive method of communication used throughout self management support with the goal of enhancing motivation to change behaviour by exploring and resolving ambivalence (Miller & Rollnick, 2002). With widespread dissemination of a complex innovation such as MI it is likely that “reinvention” may take place reflecting practitioners’ particular understanding and style, and this “reinvention” may further add or remove critical elements. Miller and Rollnick (2009) provide clarity with respect to what MI is and is not, specifically:
  • MI is collaborative and person-centred;
  • MI incorporates reflective listening to guide the resolution of ambivalence about change
  • MI is intended to enhance patients’ motivation for change (“change talk”) and does not need to be based on the transtheoretical model of change (i.e., Pre-contemplative Stage);
  • MI honours the patient’s autonomy and should never be used to coerce them into doing what you think they should;
  • MI is a complex clinical skill that requires practice to increase proficiency, rather than a step by step manual;
  • MI is a method to elicit solutions from the patient, rather than providing solutions for them in the assumption that they lack something necessary to be successful; and
  • MI is not necessary if the patient is ready for change.

A recent meta-analysis by Rubak, Sandbaek, Lauritzen, and Christensen (2005) evaluated the effectiveness of using MI with patients who had various diseases. They found that MI produced significant effects in some areas (body mass index, total blood cholesterol, systolic blood pressure) but not in others (cigarettes per day and A1C levels). Lewin and colleagues (2001) recommended that motivational interviewing be used to counsel patients/families on health behaviour change. MI can be effective in brief encounters of fewer than 15 minutes, however, the “dose” of effectiveness is individualized, assuming that increased use increases the likelihood of favourable outcomes (Miller & Rollnick, 2009). As well, some studies have shown greater efficiency when combined with other treatment methods (Hettema, Steele, & Miller, 2005). MI outperforms traditional advice-giving for a broad range of behavioural problems and diseases in approximately 80% of studies (Rubak et al., 2005).

Studies show that any appropriately trained health professional (e.g., physician, nurse, psychologist and dietitian) can successfully use MI skills with their patients (Rubak et al., 2005). Miller and Rollnick (2009) recognize that most health care professionals learn about motivational interviewing through self study or in short one- or two-hour workshops and state that although this clinical method is simple, it is not as easy to master, requiring repeated practice with feedback and encouragement from knowledgeable guides to facilitate both skill and comfort of use.

Despite the promise that the technique holds for promoting behaviour change, there are few controlled studies evaluating its efficacy with health problems (Britt, Hudson, & Blampied, 2004; Burke, Arkowitz, & Menchola, 2003). This point of view is consistent with that of Bodenheimer and Grumbach (2007) that the effectiveness of MI in enhancing physical activity and managing chronic illness is inconclusive.
 
The Centre for Collaboration, Motivation and Innovation held a webinar in February, 2015 entitled "Motivational Interviewing: A Conversation Style to Improve Engagement". This 60 minute webinar introduces MI as well as touches on some of the core principles. 
 
Bodenheimer, T., & Grumbach, K. (2007). Improving primary care: Strategies and tools for a better practice. New York: McGraw Hill.

Britt, E., Hudson, M., & Blampied, N.M. (2004). Motivational interviewing in health settings: A review. Patient Education & Counseling, 53(2), 147-155.

Burke, B.L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting & Clinical Psychology, 71(5), 843-861.

Lewin, S.A., Skea, Z.C., Entwistle, V., Zwarenstein, M., & Dick, J. (2001). Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Systematic Review, (4), CD003267. doi: 10.1002/14651858.

Rubak, S., Sandbaek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice, 55(513), 305-312.
 
Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guildford Press.

Miller, W.R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioral & Cognitive Psychotherapy, 37(2), 129-140.