Motivational Interviewing
Original Editors - George Prudden
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Description
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Motivational interviewing (MI) is a behavioural change intervention that is growing popularity within physiotherapy practice. Rollnick and Miller[1] 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[2]. Eighty per cent of studies have found that MI has superior outcomes when compared to tradition educational approaches[3].
Ambivalence[edit | edit source]
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.[4]
Righting reflex[edit | edit source]
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[5]
Indication
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- Initiating any behavioural change
- Exercise prescription
- Smoking cessation
- Physical inactivity
- Educating
- Giving bad news
Example[edit | edit source]
Key Evidence[edit | edit source]
- A systematic review of motivational interviewing within musculoskeletal health[6]
- A meta-analysis of motivational interviewing interventions for pediatric health behavior change[7]
- Motivational interviewing for smoking cessation: a meta-analytic review[8]
- A feasibility study investigating a physiotherapy motivational interviewing programme to reduce cardiometabolic risk in schizophrenia and bipolar disorder[9]
- Testing a path-analytic mediation model of how motivational enhancement physiotherapy improves physical functioning in pain patients[10]
Case Studies[edit | edit source]
- Obesity
- Physical inactivity (i) (ii)
- Shoulder and neck pain
- Homelessness
- Schizophrenia
- Palliative care
- Intraveneous drug abuse
Recent Related Research (from Pubmed)[edit | edit source]
References
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- ↑ Rollnick S, Miller WR. What is Motivational interviewing? Behavioural and Cognitive Psychotherapy. 1995 Oct;23(04):325.
- ↑ Chilton R, Pires-Yfantouda R, Wylie M. A systematic review of motivational interviewing within musculoskeletal health. Psychology, Health and Medicine. 2012 Aug;17(4):392–407.
- ↑ Lauritzen T, Rubak S, Sandbæk A, Christensen B. Motivational interviewing: A systematic review and meta-analysis. Review Article. 2005 Apr 1 [cited 2016 Feb 2];55(513):305–312. Available from: http://bjgp.org/content/55/513/305.short.
- ↑ Miller and Rollnick (2013) Motivational Interviewing: Preparing people for change. 3rd ed Guilford Press
- ↑ Rogers, C.R. (1951) Client-centred Therapy. Boston: Houghton-Mifflin
- ↑ Chilton R, Pires-Yfantouda R, Wylie M. A systematic review of motivational interviewing within musculoskeletal health. Psychology, health & medicine. 2012 Aug 1;17(4):392-407.
- ↑ Gayes LA, Steele RG. A meta-analysis of motivational interviewing interventions for pediatric health behavior change. Journal of consulting and clinical psychology. 2014 Jun;82(3):521.
- ↑ Hettema JE, Hendricks PS. Motivational interviewing for smoking cessation: a meta-analytic review. Journal of consulting and clinical psychology. 2010 Dec;78(6):868.
- ↑ Waugh A, Lang S, Kelleher E, Tynan D, Doherty H, Murphy N, Hussey J, Crumlish N, Broderick J. A feasibility study investigating a physiotherapy motivational interviewing programme to reduce cardiometabolic risk in schizophrenia and bipolar disorder. Physiotherapy. 2015 May 31;101:e1616-7.
- ↑ Cheing G, Vong S, Chan F, Ditchman N, Brooks J, Chan C. Testing a path-analytic mediation model of how motivational enhancement physiotherapy improves physical functioning in pain patients. Journal of occupational rehabilitation. 2014 Dec 1;24(4):798-805.
