Motivational Interviewing

Motivational interviewing (MI) is a behavioural change intervention that is growing popularity within physiotherapy practice. Rollnick and Miller describe MI as 'a directive, client-centred counseling style for eliciting behaviour change by helping clients explore and resolve abivalence'. MI has been used across various conditions such as diabetes, asthma, cardiac rehabilitation. Eighty per cent of studies have found that MI has superior outcomes when compared to tradition educational approaches.

Key concepts

Ambivalence

A conflict between two courses of action each of which has perceived costs and benefits associated with it. An example might be going for a jog: the benefits would be all of the health gains, however, a cost might be the perceived risk of social embarassment. Unresolved ambivalence is often why clients are unable to commit to behavioural change. How a therapist handles a clients ambivalence may influence outcomes.

Righting reflex

Therapists have the desire to want to help the people under their care and this is often and unhelpfully expressed as the 'righting reflex'. Clinicians beliefs and aspirations for the patient determine the use of language and interventions used. When a therapist sees discrepancy between how things are and how they ought to be they want to fix it.

When patient ambivalence is confronted by the righting reflex of the therapist, outcomes tend to be poor. Patients can feel unvalidated, want to resist the clinician, or withdraw from the consultation. Ultimately, people want to be understood and accepted without judgement

Case studies

• Obesity
• Physical inactivity (i) (ii)
• Shoulder and neck pain
• Homelessness
  
• Schizophrenia
  
• Palliative care
• Intraveneous drug abuse