An example of an MI interview with Dr Paul O’Halloran, MINT trainer:
Motivational Interviewing concepts:
Consider beginning your interview with:
“If you like, we can talk about some changes you could make to improve your health”.
“Here are some areas that can be important in controlling your lung problems that we could talk about, where people in your situation often consider changes. Are there any of these areas that you would like to talk about today? Or are there perhaps other things you want to raise that feel more important right now?”
Try to start with the patient’s priority.
Core components of Motivational Interviewing – Asking, Listening, Informing – Change Talk
What is worrying you the most today about this illness?
In what ways has this interfered with your life?
What exactly happens when you get breathless?
Tell me about your breathing problems
Tell me about a typical day… May I ask you about…?
Try to offer at least two reflections for every question you ask.
After listening, provide some facilitative responses – “I see, tell me some more about that”.
This can be followed by a summary:
shows you have been listening
clarify missing information (what else?)
The summary is followed by reflection.
Choosing what to reflect
Aim not to reflect resistance (ambivalent patients will tend to back away from resistance when you reflect it)
Reflect change talk which allows patients to explore it further
Your summary contains the person’s own motivation for change
Bringing Listening to a close
Summarize what you have understood and suggest a change in direction.
Be honest about your time limitations.
Acknowledge the value of what you have heard – “thank you, that has helped me better understand your situation…”
Phrase messages in a positive fashion – “if you stop smoking you may find that breathing is easier“, rather than “if you keep smoking it will get worse”
Ask permission to inform
Would you like to know some things that other patients have done?
Would it be OK if I tell you one concern I have about this plan?
There are several things you could do to…do you want to hear about them?
May I make a suggestion?
When you feel the need to inform
Announcing – there is something I need to tell you here…
First choice – there is something I need to tell you here, shall I do that now or is there something you would like to talk about first?
Prefacing – acknowledge autonomy and that they are free to disregard – I don’t know if this makes sense to you or not but….This may or may not concern you…. You can tell me what you think of this idea…
When you discuss options:
Offer several simultaneously
Talk about what others do – “Some people in your situation find…”
DARN statements are pre-commitment forms of change talk:
Asking for DARN statements about exercise:
Why would you want to do more exercise? (desire)
Why would you want to increase your walking time? (desire)
How would you do it, if you decided to? (ability)
What for you are the three most important benefits from doing more exercise? (reasons)
How important is it for you to do more exercise? (need)
When you seem to be eliciting arguments against change, your patient is telling you to try a different approach.
Provide message of hope in 60 secs – Where patient not ready to change, plant the seed for next time – support optimism and hope for change
Using a ruler
Rulers are only as good as the quality of rapport between you and patient but assist both the clinician and patient in moving towards change.
How strongly do you feel about wanting to do more exercise? On a scale of 1 to 10, where 1 is not at all and 10 is very much, where would you place yourself now?
How ready do you feel to do more exercise? On a scale of 1 to 10, where 1 is not at all ready and 10 is completely ready, where would you place yourself now?
How important is it for you to do more exercise? On a scale of 1 to 10, where 1 is not important at all and 10 is extremely important, where would you place yourself now?
How confident are you that you can do more exercise? On a scale of 1 to 10, where 1 is not confident at all and 10 is extremely confident, where would you place yourself now?
Why did you choose this number and not a lower number?
What would have to happen to make the chosen number go up?
Pros and Cons
Particularly useful if patient is uncertain about change – allows exploration of ambivalence.
What is good about the way things are now?
And what is the downside for you?
Where does this leave you now?
Key questions – What next?
So what do you make of all this now?
So what are you thinking about exercise at this point?
What do you think you’ll do?
What would be the first step for you?
What, if anything, do you plan to do?
What do you intend to do?
Useful for the patient who is less ready to change
What might it take for you to…..
If you did make a change, what might be some of the benefits?
Suppose you did decide to….How would you go about it in order to succeed?
Let’s imagine that you…. How would your life be different?
What would it take for you to go from 5 to 8 on importance?
How would you like things to be different?
Suppose you continue on without making any change in …. What do you think might happen in five years?
Possible if you have good rapport and patient is comfortable with the discussion
What currently impossible thing, if it were possible, might change everything?
If you were in my shoes, what advice would you give yourself about….
How has (this behaviour) kept you from moving forward?
What do you most want to be happening in your life a year from now, 5 years from now or even 10 years from now?
Give a summary of the patient’s own motivations for change, and then assess commitment by asking these questions:
What will you do?
What are you going to do?
What are you willing to do?
What are you prepared to do?
(This is different to asking questions that elicit DARN statements – eg what do you want to do/ what could you do / what do you need to do?)