Motivational Interviewing

The idea behind motivational interviewing is that giving people direct advice is not a good idea for a number of reasons:

• they may not have given you all the relevant information for whatever reason
• what would work for you may not work for them
• offering advice can seem condescending and judgemental
  

therefore motivational interviewers work from the premise that the person with the problem is actually in the best position to find the most ideal solution that would work for them and that the interviewer's role is to assist them to come up with their own solution.

Motivational interviewing has 4 principles: express empathy, develop patient's discrepancy, manage patient's resistance, and support patient's self-efficacy.

1. Express empathy - Listen to the patient and use your reflective listening skills so they feel listened to.
2. Develop patient's discrepancy - help the patient see the gap between what they want and how they're acting. For example, "you've told me you really want to stop smoking, but two months later you're still smoking a pack a day". The point here is to highlight the discrepancy between the patient's goals and their behaviour, not to tell them off or make them feel judged. Try to discover what it might be that is causing this discrepancy. For example, perhaps they have a partner who smokes around them? Once barriers are discovered, work with the patient to find ways around them.
   
3. Manage patient's resistance - the patient is in control. If they don't want to talk about something, don't insist - you will only piss them off.
   
4. Support patient's self-efficacy - encourage patient to come up with their own solutions. Praise any progress they make.
   

Reflective Listening

Reflective listening is where you put aside your own feelings and get really interested in what the other person has to say without giving in to the temptation of offering advice. It helps to pretend to be a reporter who is trying to get enough information from the other person, so they can write an accurate report.

There are two types of reflective listening. Simple reflective listening, where you simply repeat back what the person has said to you and complex reflective listening, where you repeat back what they said and how they feel in your own words.

Complex reflective listening builds rapport with the patient and is a good way to check that you have perceived what the patient said correctly. The patient also gets to hear what they have just said and consider if what they said is really what they meant or how they feel. This may lead to the patient questioning the beliefs that cause them to engage in unhealthy behaviour.

It is not always essential to reflect back both the content of the patient's message and their feelings. In fact, it is probably better to save this until after you have enough information to feel confident that you understand both the content and the feeling behind what they have told you. Sometimes it is better to just paraphrase the facts (content) of the patient's message and other times it may be better to focus entirely on how the patient must feel.

Examples

Paraphrase facts
"You would like to keep the tooth if possible because you can't afford an implant"
Reflect feelings
"You're upset because you've had to wait a long time to get an appointment"
Complex reflective listening
"You're frustrated because this is the second time you have had to come in to have your dentures fixed. You've already spent $500 and it's been over a month since you first came in"

Click here to read a good article on communication skills, including reflective listening.