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 in 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]
Ambivalence is 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 client's 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 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].
Empathy
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Empathy is the ability to accurately understand your client's meaning and accurately reflect back to your client.
'Empathy is the listener's effort to hear the other person deeply, accurately, and non-judgmentally. Empathy involves skilful reflective listening that clarifies and amplifies the person’s own experiencing and meaning, without imposing the listener’s own material.' Rogers (1951)[6]
Interview - OARS
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OARS is an anagram which describes the set of core skills important to motivational interviewing.
Open questions
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Is a question that cannot be answered with a yes or no but requires a developed answer.
Examples:
- Can you tell me about your back pain?
- What's your story?
- Can you tell me about your problem?
- What are you struggling with at the moment?
Affirmation
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An affirmation is a direct statement of support provided by the therapist. The statement is focused on a positive aspect of a patient’s effort and commitment or strength. It demonstrates to the client that the therapist is trying to understand and appreciates what the patient is dealing with.
Examples:
- It shows commitment to come as far as you have
- I appreciate how open and honest you’re being with me
- That’s a very good way of expressing that
Reflective listening
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Reflective listening requires the therapist to be interested in what the person has to say and respect the client's point of view and thought processes. This is achieved by temporarily suspending assumptions and avoiding imposing them. Reflective listening allows the therapist to test a hypothesis and check their understanding of what the patient has said.
A reflective listening statement can be performed through repetition, rephrasig, paraphrasing, a reflection of a feeling, or a summary.
Examples:
- Physiotherapy hasn't worked for you in the past and you feel that it wont for you now.
- After a hard day's work all you would really like is a cigarette and that helps you relax.
Summarising
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Summarising is often used at the end of a consultation or to draw different aspects together. Meaning is inferred to what was said and reflected back with new words. Summarising adds to and extends what was actually said.
Change talk[edit | edit source]
Commitment[edit | edit source]
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[7]
- A meta-analysis of motivational interviewing interventions for pediatric health behavior change[8]
- Motivational interviewing for smoking cessation: a meta-analytic review[9]
- A feasibility study investigating a physiotherapy motivational interviewing programme to reduce cardiometabolic risk in schizophrenia and bipolar disorder[10]
- Testing a path-analytic mediation model of how motivational enhancement physiotherapy improves physical functioning in pain patients[11]
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
- ↑ 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.
