Motivational Interviewing Techniques means training material (until early 2008) set out on Department of Health and Ageing website regarding 'Lifestyle Prescriptions - Lifescripts' and summarised in Annexure C(ii)(b) to assist GPs enhance their motivational interviewing skills to use the Lifescripts resources to encourage patients to self treat one of more of the Five Lifestyle Risk Factors For Chronic Diseases by adopting a healthier lifestyle. 

Motivational interviewing is a style of counselling that prepares patients for behavioural change.  Using the technique GPs encourage patients to -

*        identify lifestyle behaviours that they would like to change; and

*        articulate the benefits and difficulties of making that change.

Behaviour change is a process of distinct stages through which patients pass.  Dept of Health & Ageing's ‘Stages of Change Model’ based on the premise that behaviour change is a process and that individuals exhibit varying degrees of enthusiasm to bring on lifestyle change is drawn from "A 'Stages of Change' Approach to Helping Patients Change Behavior" (Zimmerman/Olsen/Bosworth of Wright State University School of Medicine, Dayton, Ohio of March 2000) which also covers two tools, the 'Readiness to Change Ruler' and the 'Agenda-Setting Chart', used to promote discussion with patients.

Zimmerman/Olsen/Bosworth posits that people move through Five Basic ‘Stages of Change’ from -

 

1.     being uninterested, unaware or unwilling to make a change (pre-contemplation)

2.     to considering a change (contemplation),

3.     to deciding and preparing to make a change (determination/preparation)

4.     to genuine, determined action (action) and,

5.     over time, attempts to maintain the new behaviour occur (maintenance).  

 

The below diagram highlights that the Stages of Change Model is circular rather than linear, as people can enter or exit at any point.

 

Motivational interviewing is particularly appropriate when people are at the pre-contemplation or contemplation stages but can be used whenever someone is feeling ambivalent. 

The method involves -

(a)        non-confrontational questioning;

(b)        reflective listening; and

(c)        summarising. 

Motivation emerges from the interpersonal interaction between the patient and the counsellor.

The clinician’s role is to facilitate the change process by:

• Expressing empathy: listening and reflecting the patient’s concerns, thoughts and feelings in a non-judgemental manner.
• Developing discrepancy: highlighting discrepancies between patient’s current behaviour and their other goals.
• Avoiding argumentation and rolling with resistance: not arguing when patients are defensive or resistant, instead using active listening and reflection to avoid increasing their resistance

• Supporting self-efficacy: supporting the person’s confidence in their own ability to achieve their goals.