New A pproaches for a More Effective Interview:
Applying Motivational Interviewing to Clinical Practice
Reflective listening (Exercise 1)
Goal: Listen, express interest and understand the meaning of what the patient is saying
Tasks: To be a mirror reflecting the patient (or parent)
Verbal:
· Repeat the words you have heard
· Rephrase
· Short summaries
· Reflect meaning
Non-verbal:
· Relaxed, but attentive body posture
· Open
· Non-judgmental
Comment: Reflective listening is an active process. Every reflection opens a possibility: the patient may correct, verify, add, refine.
Split yourself in half: Although it is necessary to have your attention focused firmly on the patient, you also need to have some of your attention focused on what is happening between the two of you, how the patient is reacting, and where you are going next.
Expressing empathy (Exercise 2)
Goal: Strive to understand the patient at a deeper level: emotions, thoughts, values
Tasks: Attend to and reflect the other’s expressed thoughts, emotions, and values
Verbal:
· Express understanding
o Normalize, legitimize
o Affirm-acknowledge and express respect for coping efforts
o Self-disclose when appropriate
Non-Verbal:
· Send a signal of understanding through nods, sounds, movements
· Maintain open, non-judgmental body posture, gestures
· Attentive eye contact
Comment: Through expressed empathy, the patient can experience being seen, heard, and understood
Agenda setting
Tasks:
· Elicit items patient wishes to discuss
· Raise items you wish to discuss and ask permission
· Prioritize multiple concerns
· Agree on what you will talk about
Comment: When there are multiple issues, you need to present options regarding what to talk about in that visit. While you may introduce issues, the patient determines which issue is the priority today.
New A pproaches for a More Effective Interview:
Applying Motivational Interviewing to Clinical Practice
Assessing Importance and Confidence
Goal: Understand how the patient thinks about changing their current behavior
Strategy: Scaling questions
· On a scale of 0 to 10, how important is it to you to ___?
· On a scale of 0 to 10, how confident are you that you can ___?
Follow-up questions:
· What makes you say a 5?
· What led you to say 5 and not zero?
· What would it take to move it to a 6 or a 7?
Comment: In order to move toward change, the patient may need to:
· Further explore the importance of change
· Build the confidence to undertake change
· Enhance both importance and confidence
Enhancing Importance and Confidence
Goal: Move the patient toward positive health behavior change by enhancing motivation
Strategies : Importance
· Examine pros and cons (explore changing or staying the same)
· Exchange information
Strategies : Confidence
· Recall past success
· Break it down into achievable steps
· Identify specific barriers and problem solve
Comment: Remember, when examining pros/cons, start with the positive to build rapport and place the behavior in normal context (“What are the good things about [behavior]?”; “What are the good things about changing?”)
Change talk
Goal: Use patient’s change talk to motivate and support behavior change
Strategy: Listen carefully, then acknowledge, appreciate, affirm, and express support for change talk
· Includes desire, ability, reasons, need
Comment: Change talk gives clues about the patient’s readiness to change to change behavior.
Not ready to change
Goal: Raise awareness
Tasks: Inform & encourage
Unsure about change
Goal: Build importance and/or confidence
Tasks: Explore ambivalence
Strategies: Return to pros and cons, offer help later, give resources the patient may use later
Ready for Action
Goal: Agree on action steps and strategies
Tasks: Explore if confidence or importance are barriers
Workshop Series created by Ardis Olson, MD and Pamela Lee, PhD