The key principles of MI
Motivational interviewing follows these key principles which aim to avoid confrontation and promote productive discussions about change.
Express Empathy
An empathic understanding of the patients’ position, trying to put yourself in their shoes rather than judging them
Support Self-efficacy
Supporting their own self-efficacy rather than giving prescriptive advice
Roll with Resistance
Which involves side stepping barriers by allowing them to enter the conversation and be explored, and ultimately leaving the patient in control of decisions
Develop Discrepancy
Encouraging the patient to reflect on how the status quo might conflict with their own goals.
Patient Scenario: Chetan
Patient Details
- Name: Chetan Chowdhury
- Age: 35
- Ethnicity: Bangladeshi
- BMI: 29
- Waist circumference: 98 cm
- Occupation: IT worker
- Family Background: Lives with his wife and mother who has type 2 diabetes. Attends for support with smoking cessation.
- Last Appointment: Originally attended his general practice for support with smoking cessation, but arranged a further appointment to discuss his weight after a discussion around his diabetes risk.
Summary
Chetan has said the following during his consultation:
“I don’t do any of the cooking, my wife and mother do it, so I can’t change what I eat!”
How would you respond to this statement using the above four principles (enter your response and click 'Submit' to compare it with a typical motivational interviewing response).
Empathy
Here is an example model answer, notice how the healthcare professional is ‘dancing’ and not ‘wrestling’, moving with the patient rather than contradicting them.
I understand how difficult it can be refusing food from someone who is trying to spoil you!
Yes, I don’t want to offend them.
Support self efficacy
Here is an example model answer, notice how the healthcare professional is prompting Chetan to come up with his own solutions.
Is there any way you see around this?
I’ll just have to make sure they understand I’m refusing the treats because of my health, and not because I don’t want them. I think my mother will understand as she has diabetes, but I wonder about my wife.
Roll with resistance
Here is an example model answer, notice how the healthcare professional accepts the barrier, and reframes the next question to encourage more problem solving.
It sounds as though saying no to something that your wife has spent a lot of time preparing is going to be difficult, shall we talk about ways of including her in your plans?
It might help if she and I could do this together, but she’d be upset if I suggested she needed to lose weight.
Develop Discrepancy
Here is an example model answer, notice how the healthcare professional simply points out the dilemma without offering a solution.
You realise that you need to include your wife in your plans, but you are reluctant to talk to her about this.
I guess if I talked to her about my diabetes risk and how hard I find it to refuse her cooking, she’d understand.”
