Competent Novice

Motivational interviewing

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1900 (Published 27 April 2010)
Cite this as: BMJ 2010;340:c1900

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  1. Stephen Rollnick, professor1,
  2. Christopher C Butler, professor1,
  3. Paul Kinnersley, professor1,
  4. John Gregory, professor2,
  5. Bob Mash, professor3
  1. 1Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff CF14 4XN
  2. 2Department of Child Health, School of Medicine, Cardiff University
  3. 3Department of Family Medicine and Primary Care, Stellenbosch University, Tygerberg, South Africa 7505
  1. Correspondence to: S Rollnick rollnick{at}cardiff.ac.uk
  • Accepted 18 March 2010

Motivational interviewing has been shown to promote behaviour change in a wide range of healthcare settings

Key points

  • Simply giving patients advice to change is often unrewarding and ineffective

  • Motivational interviewing uses a guiding style to engage with patients, clarify their strengths and aspirations, evoke their own motivations for change, and promote autonomy of decision making

  • You can learn motivational interviewing in three steps: practise a guiding rather than directing style; develop strategies to elicit the patient’s own motivation to change; and refine your listening skills and respond by encouraging change talk from the patient

  • Motivational interviewing has been shown to promote behaviour change in various healthcare settings and can improve the doctor-patient relationship and the efficiency of the consultation

Discussion about change occurs in almost every branch of medicine, and goes beyond the “big four” lifestyle habits (smoking, excessive drinking, lack of exercise, and unhealthy diet), to also include the use of aids, devices, or medicines. Patients often seem ambivalent or unmotivated, and clinicians typically try to advise them to change, using a directing style, which in turn generates resistance or passivity in the patient (see box 1). Motivational interviewing is an alternative approach to discussing behaviour change that fosters a constructive doctor-patient relationship and leads to better outcomes for patients.1

Motivational interviewing involves helping patients to say why and how they might change, and is based on the use of a guiding style.2 A recent systematic review that included 72 studies found that motivational interviewing outperformed traditional advice giving in 80% of studies.3 With practice, time can be saved by avoiding unproductive discussion and by using rapid engagement to focus on the changes that make a difference.

How best to do it

Step 1: practise the guiding style

Among the broad communication styles commonly used to address patients’ problems are directing, guiding, and following.2 Although each is …

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