Question 1

What are the limitations of motivational interviewing in health care?

Stephen Rollnick · Accepted Answer

Not every practitioner will enjoy learning motivational interviewing. It requires a willingness to hold back from providing solutions for patients, and some practitioners find this not to their liking. It is not yet clear whether some patients might be unsuited to MI, and this is a possibility. Lack of time is often cited as a limitation, but ways have been found of using Mi in very brief consultations.  A challenge however is that to do MI well requires skill and practice, and not every service and practitioner will want to give priority to this.

Question 2

When do we use Motivational Interviewing in health care?

Stephen Rollnick · Accepted Answer

Motivational interviewing (MI) is used in healthcare for those scenarios where you want to talk about change with a patient that is in the best interest of their health and wellbeing. This can arise with almost any patient, in any setting, either right from the start of the consultation or perhaps midway through it. The idea is that instead of the practitioner presenting the arguments for change, the patient is guided to do this for themselves.

Question 3

What are the goals of Motivational Interviewing in health care?

Stephen Rollnick · Accepted Answer

The goals of motivational interviewing in healthcare are to connect with patients, and to encourage them to say for themselves why and how they might change, supported not dominated by your advice and information.

Question 4

What is ambivalence and how can motivational interviewing help?

Stephen Rollnick · Accepted Answer

Ambivalence means feeling two ways about something. It is common and normal to experience doubt and uncertainty, and when it comes to a change in behaviour, people often feel ambivalent. A common response from a helper or practitioner is to make the case for change, and this usually elicits reactance from the other.  Persuasion often leads to kickback. Motivational interviewing is helpful because it allows you to bypass this problem by asking the person to say for themselves why and how change might come about. They rather than you present the case for change.

Question 5

Why do people often have ambivalence about their health?

Stephen Rollnick · Accepted Answer

Ambivalence means feeling two ways about something. In healthcare this often focuses on a change that the person, someone close to them or a practitioner feels is a good idea. As people get older, problems arise, and old habits no longer serve them well, like excessive eating, heavy drinking, smoking and so on. But this often involves the person having make adjustments that have both benefits and costs.  It is really normal and very common to feel two ways about a change in health behaviour.

Question 6

Can burnout in health care be prevented?

Stephen Rollnick · Accepted Answer

There is no single solution to burnout prevention, rather a set of conditions and actions that can help.  The more practitioners feel in charge of a balanced workload that they enjoy, the less burnout will be experienced. Systems of care can be designed with this in mind. Practitioners also need to feel heard and supported - given the chance to talk about what will help them feel as balanced as possible. Then, inside the consultation, they can reflect about what is putting them under strain. Some find that they can empathise too much, others that they are too rushed and don’t really do a good job. Put simply – an environment in which their wellbeing is a top priority will generate happier and more successful practitioners.

Question 7

How can motivational interviewing help with "resistant" and "non-compliant" patients?

Stephen Rollnick · Accepted Answer

When patients react against things you say or ask them to do there is a tendency to argue back, or try to “put sense into them”. This often makes it worse. Motivational Interviewing provides an alternative, where by using listening skills they feel more understood and more ready to consider why and how they might change.

Question 8

How does motivational interviewing improve the quality of communication with patients in a health care setting?

Stephen Rollnick · Accepted Answer

Patients generally like to feel understood, respected, be able to say what they think and feel and be given a sense of choice about what to do to improve their health.  MI provides the style and skills for doing this efficiently. But it does take practice.

Question 9

What advice would you give an overwhelmed primary care physician on how to start putting Motivational Interviewing into practice?

Stephen Rollnick · Accepted Answer

Start with yourself would be my first suggestion.  Your wellbeing is the fuel that drives good or practice. There is no one way to start putting Motivational Interviewing into practice. Many practitioners find it useful to practice the switch from telling to guiding.  This takes pressure off you to solve the change problem for the patient. That can be a source of stress for you (“banging your head against a brick wall”). It also minimises that feeling of boredom, because guiding helps you to see every patient as unique, so you start to enjoy the consultations more. Other practitioners choose to get on top of using the Elicit-Provide-Elicit framework for giving information and advice; others prefer to practice improving their listening skills. Trust your own instinct about where to start, with your wellbeing centre stage.

Question 10

Can motivational interviewing be used in brief consultations in health care where time pressure is an issue?

Stephen Rollnick · Accepted Answer

Motivational Interviewing has been adapted and used in brief healthcare consultations from the late 1980’s.  It has been supported in many randomized trials among patients in a range of settings, with a range of presenting problems.  The enduring common thread running through this work is the use of a guiding style in which the patient is encouraged to say why and how they might change, supported not dominated by information and advice. This might take a little longer than simply telling patients what to do, but then time might be wasted using unskilful advice-giving, and outcomes seem like they are poorer. There is also the argument that skilful listening takes very little time.

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