Personal development

Motivational interviewing with patients 1: what is it about?

Motivational interviewing is a technique which can be useful when discussing lifestyle advice and possible changes with patients. This, the first of a two-part series, looks at the ‘why’ of motivational interviewing. The second part will look at ‘how’ this is done in practice.

A major factor in promoting self-care for patients relates to lifestyle advice. There is good evidence that maintaining a healthy body weight, stopping smoking, stopping or reducing the intake of alcohol, and eating a balanced diet will be beneficial for patients. However, almost more important than discussing this with a patient is understanding how you engage with them about this.

Motivational interviewing

One way to approach this is a technique called motivational interviewing, which involves allowing patients to think about their issues and develop a plan which works for them. It is ‘a particular way of talking with people about change and growth to strengthen their own motivation and commitment.’ (Miller and Rollnick, 2023). Motivational interviewing seeks to build a partnership with the patient, and can promote positive change by strengthening the person’s own motivation to change (Day et al, 2017).

With motivational interviewing, change happens because the person involved sees its relevance to their own values and concerns. Miller and Rollnick (2023), who developed the concept of motivational interviewing, state that it is about guiding the person rather than directing them. They describe four elements of the guiding spirit of motivational interviewing:

Partnership
Acceptance
Compassion
Empowerment.

Partnership

Professional expertise is often part of what people seek from healthcare professionals; yet in the clinician–patient relationship the clinician is not the only one with expertise – people are experts on themselves. If a conversation involves a change in somebody’s behaviour or lifestyle, then their expertise is needed to feed into this discussion.

Acceptance

Paradoxically, acceptance is shown by what you are not doing: judging, disapproving, criticising, or shaming. When people feel accepted as they are, it becomes possible for them to change, whereas feeling unacceptable can make it difficult to engage. Motivation for change is rarely stimulated by feeling sufficiently bad about oneself – guilty, ashamed, or worthless. Non-judgmental helping involves taking an interest in and understanding the person’s unique experience, whatever that may be.

Compassion

In the context of motivational interviewing, compassion is not about feeling sympathy, but about an intention to prioritise the health and wellbeing of the person you are working with, to alleviate suffering and support positive growth. Motivational interviewing is not about getting people to do things that you want them to do, rather it is about what is in the best interests of the person who you are working with.

Empowerment

Empowerment involves helping people to realise and use their own strengths and abilities. The spirit of motivational interviewing is that people already have within them much of what is needed and the role of the healthcare professional is to help them bring that out. From this perspective it is particularly important to focus on and understand the person’s own strengths and resources.

Conclusions

The ideas behind motivational interviewing can tie into many discussions that healthcare professionals have with patients. Understanding how these aspects can support patients in changing behaviour can make it easier to bring about that change. The second part of this series will look at how healthcare professionals can put motivational interviewing into practice.

References

Day P, Gould J, Hazelby G (2017) The use of motivational interviewing in community nursing. J Community Nurs 31(3): 59–63

Miller W, Rollnick S (2023) Motivational Interviewing: Helping People Change and Grow. 4th edn. Guilford Press, New York