Important elements of motivational interviewing

Adapted from Miller and Rollnick, 2002.¹⁵⁸

Portraying empathy

• use of open ended questions and avoiding premature closure
• respect for individual differences
• reflective listening so that patients sense you are trying to “get on their wavelength”
• expressing interest/concern
• acceptance that ambivalence is normal.

Developing discrepancy

• patients are helped to see the gap between the drinking and its consequences and their own goals/values - the gap between “where I see myself, and where I want to be”
• enhancing their awareness of consequences, perhaps adding feedback about medical symptoms and test results: “How does this fit in?” “Would you like the medical research information on this?”
• weighing up the pros and cons of change and of not changing
• progressing the interview so that patients present their own reasons for change.

Avoiding argument (“rolling with resistance”)

• resistance, if it occurs (such as arguing, denial, interrupting, ignoring) is not dealt with head-on, but accepted as understandable, or sidestepped by shifting focus
• labelling, such as “I think you have an alcohol problem” is unnecessary, and can lead to counterproductive arguing.

Supporting self efficacy

• encouraging the belief that change is possible
• encouraging a collaborative approach (patients are the experts on how they think and feel, and can choose from a menu of possibilities)
• the patient is responsible for choosing and carrying out actions towards change.

Facilitating and reinforcing “self motivating statements”

• recognising that alcohol has caused adverse consequences
• expressing concern about effects of drinking
• expressing the intention to change
• being optimistic about change.

A tenet of motivational interviewing is “People believe what they hear themselves say”.