Motivational interviewing in General Practice

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Motivational interviewing in General Practice

• How to get people to change their behaviour

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Aims and objectives

• Increase our understanding of behaviour change
• Introduce suggestions for motivational
  interviewing
• So we can
• Increase our effectiveness in helping people
  change their behaviour
• Reduce frustration for both ourselves and
  patients

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Session plan

• Interactive presentation on behaviour change
• DVD on motivational interviewing
• Practise techniques in small groups
• Reflection and summary of what weve learned
• Evaluation

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Helping people change behaviour - your experience

• Think of a patient whom you tried to help to
  change
• What did you try?
• What worked?
• What didnt work?
• Any ideas about why it worked/didnt work?

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Change

• Change isnt a simple discrete event, its a
  process
• Sometimes a crisis can precipitate a sudden
  change
• Stages of Change - precontemplation,
  contemplation, change
• Change usually involves loss as well as the
  perceived gain

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Our role

• Traditional advice-giving isnt useless but
  absolutely depends on timing
• Need to understand the behaviours meaning for
  the patient - how do they see the benefits and
  problems of the change?
• Help patient prepare for change
• Encourage to experiment with small steps
• Provide information when the patient is receptive
• Accept that people have relapses (and help
  patient accept this too)

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Principles of motivational interviewing

• We need to enable the patient to
• Believe that change is important
• Have confidence in their ability to change
• Dancing vs wrestling
• Start positive

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Some tools

• The dinner plate, to let them choose which
  behaviour to change first
• Scaling questions
• How important is this change to you on a 1-10
  scale? Why is it in that position on the scale?
• If you were decide to change, how confident are
  you that you could do so? Why is it in that
  position on the scale?

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Some more tools

• Use Elicit - Provide- Elicit technique
• What do they know/want to know?
• What additional information can you provide?
• What do they see as their options?
• What might their family and friends think?
• What do they think?
• Help them set realistic goals/targets
• What do they think will work?

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Patients potholes on the road to change and how
to get past them

• Helplessness
• Agree its hard, empathise
• Help them recall past successes
• Resistance
• Summarise what theyve said (instead of getting
  into an argument)

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Clinicians potholes on the road to change and
how to get past them

• Lecturing
• Go back to asking questions about the patients
  point of view
• Cheerleading
• Bring the focus back to the patient

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Practising the techniques

• Choose patient and doctor
• Either -
• Act the part of the patient you described earlier
  OR
• Patient come to ME for scenario
• Play the consultation as realistically as
  possible
• Other group members observe techniques used,
  write down?
• Doctor say how it went for them
• Patient give feedback on how it felt
• Rest of group give observations
• Or choose another doc and pt and start again

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Dance, dont wrestle

• Help patient believe change is important
• Help them get confidence they can change
• Start positive
• Dinner plate
• Scaling questions
• Elicit-provide-elicit
• Help patient set realistic target
• If pt helpless, empathise,remind of past success
• If pt resistant, summarise what theyve said
• Stop lecturing and get back to pts point of view
• Stop cheerleading, get back to pts point of view