Context: Motivational Interviewing is a patient-centred counselling approach, developed from the Stages of Change model, designed to enhance intrinsic motivation by resolving ambivalence.
🔄 Stages of Change Model
Stage
Description
Precontemplation
Not yet considering change; unaware or resistant
Contemplation
Ambivalent; considering pros and cons of change
Preparation
Getting ready; planning and setting intentions
Action
Actively making changes
Maintenance
Sustaining change; preventing relapse
Relapse
Return to old behaviours; seen as part of the learning cycle
✅ Effectiveness of MI
Demonstrated efficacy equal to or greater than CBT or pharmacotherapy in:
Substance use disorders
Smoking cessation
Diabetes self-management
Sexual health risk behaviours
Medication adherence
Applicable across healthcare settings: primary care, HIV care, addiction medicine, chronic disease, mental health, etc.
🌱 Core Philosophy: The Spirit of MI
Collaboration: Partnership rather than expert-recipient dynamic
Evocation: Eliciting the patient’s own motivations for change
Autonomy: Respect for the patient’s right to choose
🎯 Structure of MI in Practice
Two Phases:
Building Motivation (through rapport and exploration)
Strengthening Commitment (developing a change plan)
Core Techniques (OARS):
Open-ended questions
Affirmations
Reflective listening
Summarising
Key Strategy: Elicit change talk → Plan for change
🧭 Guiding Principles – RULE
Principle
Description
Resist the righting reflex
Avoid the urge to correct or persuade; support autonomy
Understand motivations
Explore the patient’s own reasons for change
Listen with empathy
Active, reflective listening that validates the patient’s feelings
Empower the patient
Build confidence in their ability to change
🔍 Expanded Principles (Miller & Rollnick)
Express Empathy: Through non-judgmental reflective listening
Develop Discrepancy: Highlight the gap between current behaviours and personal goals/values
Roll with Resistance: Don’t confront resistance; explore and reframe
Support Self-Efficacy: Reinforce belief in capability to change
⛔ Barriers to MI in General Practice
Barrier
Description
Time Constraints
Limited consultation time in standard appointments
Role Conflict
Shifting from a directive expert role to a facilitative, collaborative one
Skill Development
Requires training in reflective listening and MI techniques
💡 Tips for General Practice & OSCEs
In OSCEs:
Start with open-ended questions to explore ambivalence.
Use reflective statements to summarise patient concerns.
Include elements of OARS and ask for permission before offering advice.
Use phrases like “What would make this worth it for you?” or “What concerns you most about staying the same?”
In General Practice:
Use MI selectively—for patients with resistance, ambivalence, or chronic conditions (e.g., smoking, weight, alcohol).
Even brief MI techniques (1–2 minutes) can be effective if used skillfully.
Tailor your language to the patient’s stage of change.