Motivational Interviewing: Tricks of the Trade

Motivational Interviewing (MI) is a great tool not only for therapists but for any clinician hoping to advocate for behavior change in their patients-- a very important skill for primary care physicians!

Lynn Massey, an LMSW skilled in brief ED interventions with substance abusers, explained many important characteristics of MI in a recent workshop I attended.  In addition to well-known approaches such as empathy and collaboration with patients, she emphasized the importance of evocation (eliciting, accepting, and understanding patients' ideas about behavior change) and respecting patient autonomy, because in the end, it is the patient's choice to change a behavior or not.

It's also important to realize that motivation, or readiness for change, is a very dynamic process that is the deciding factor when it comes to patient adherence to treatment plans, behavior change, etc.  In fact, there is a model for understanding the process of change that can be very helpful for the frustrated clinician:

source: adultmeducation.com

Notice the bidirectional arrows.  As humans prone to fallibility and relapse on any number of unhealthy behaviors, this back-and-forth process resonates with most of us.  Behavior change is clearly not a simple linear process but really an obstacle course that can be met with resistance and barriers to moving forward.

So, what can clinicians do to help patients move past roadblocks and make sustainable change in their lives?  Here are some suggestions from Lynn--

1. Roll with resistance.  Resist the urge to impose your own thoughts/reasons for change on patients.  Lynn calls this the "righting reflex" - the urge to correct behavior and be the expert.  This approach usually works against you because patients tend to resist such strong persuasion.  Instead, help them work through their own ambivalence and get unstuck.
2. Help patients identify the discrepancy between their current behavior and their broader values/goals.  Identifying that disconnect can be a powerful motivator.  Is smoking getting in the way of their goal to run a marathon?  Help them find personal reasons that come from within to realize a need to change.
3. Support self-efficacy.  There is no point to make a plan of action if patients don't feel like they can be successful.  Have patients rate their confidence in their ability to make the change discussed.  Typically, smaller changes are best to help patients build a history of success and pave the way for future successes.  Discuss with patients how they can continue to build this confidence.  
4. Use open-ended questions.  "What would have to happen for you to be motivated to lose weight?"  or "What might be reasons to cut back on your smoking?"  Giving patients space to talk through things on their own terms can shine light on key themes that can help or hurt their chances of success in behavior change.
5. Be flexible!  Different styles will work with different patients-- modify your approach from guiding to directing to following, depending on the needs of the patient.
6. Take advantage of affirmations, summarizing, and reflective listening to help patients verbalize the complexities of their struggle, and gain insight and inspiration through therapeutic dialogue. 

Helping patients recognize their own agency and capacity for change is an empowering motivational approach, and something that people of all fields can use, both in professional and personal relationships.  Try some of these strategies out on your friends or co-workers-- you'd be amazed at some of the breakthroughs you might help people achieve!