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That’s a very lofty title for a report.  My apologies. It arises from frustration.

I have lost count of the number of enquiries I’ve had like this: can motivational interviewing be used for our patients/clients who have this condition or that problem? I was at a large meeting in Stockholm about sexual health, another about asthma, then another around sickness benefit applicants, and the same old question raised its head: can motivational interviewing be used to support behaviour change in our setting?

Specialist thinking has its drawbacks.  There’s a tendency to view our client group as a little on the unique side.  This is bound to happen if you see patients as collections of problems and pathologies.  If however you focus on commonalities rather than differences, on strengths rather than weaknesses, a different picture emerges: all people face struggles with change, whatever they are.  We all talk with other people about this.  How those conversations proceed can make a big difference.  Motivational interviewing is merely one way of having this conversation, and its momentum comes from working with peoples’ strengths and own motivation to change, whatever the issue, problem or challenge they are faced with. Its that simple.

Seen in this light, it matters less what the problems are, more how people are given some gentle space to consider change, and how you can use the privilege of your role as a helper to promote this.  One of the most clattering obstacles is the refrain, “Oh but I don’t have time to do this stuff”. That’s the subject of another posting.  All I’ll say now is that a few carefully chosen words, spoken in an atmosphere of acceptance, are probably worth more than many mouthfuls of busy talk.

Motivational interviewing gains little momentum or effectiveness if you only think about problems.  By way of illustration, consider the difference between these two accounts of the same person:

“She’s 46, female, 2 children, second marriage; chest infection; obese for many years; leads an inactive life.  She’s a moderate to heavy drinker, smokes, and has a diet that is high in fried food, with little fruit or vegetables.”


“She’s 46, an account manager and mother of two; very determined person.  Its her second marriage, and she keeps a keen eye on her children’s well-being.  It’s a happy house.  They work and play hard. She feels unwell with a chest infection.  She has lots of friends, smokes and drinks in the pub, and gets little exercise.  She likes to make sure everyone has a good filling meal, and this often means fried food.”

In one sense you have a choice about which of these two people you feel like working with.  Motivational interviewing wont get off the ground unless we allow the human spirit in the second account to grow and develop.

The questions you might ask will be less dependent on the person’s condition or problem, more on harnessing internal motivation:

  • What kind of change makes sense to you?
  • Why?
  • How might you achieve this?
  • What help or advice might you need from me?
  • How might you find a way through that feels comfortable and manageable?

All these questions lead to change talk (a positive voice for change), sometimes sustain talk too (a voice against change). Using reflective listening in reply, with a keen eye on movement towards change, will evoke more change talk, and this is the heart of motivational interviewing. It needs quiet patience more than lots and lots of time. The content of this talk will vary across people, problems and settings; the dynamic of the change conversation will be more enduring.

#motivational interviewing #mi #Stephen Rollnick #behavior change


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