{"id":5799,"date":"2010-01-24T22:19:51","date_gmt":"2010-01-24T21:19:51","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=5799"},"modified":"2010-01-26T12:19:07","modified_gmt":"2010-01-26T11:19:07","slug":"motivational-interviewing-can-yield-excellent-results-and-the-basic-skills-and-techniques-are-easy-to-learn-dr-malcolm-thomas-sets-out-the-basics-of-promoting-behaviour-change","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2010\/01\/motivational-interviewing-can-yield-excellent-results-and-the-basic-skills-and-techniques-are-easy-to-learn-dr-malcolm-thomas-sets-out-the-basics-of-promoting-behaviour-change\/","title":{"rendered":"Motivational interviewing"},"content":{"rendered":"


\nMotivational interviewing can yield excellent results and the basic skills and techniques are easy to learn. Dr Malcolm Thomas sets out the basics of promoting behaviour change<\/p>\n

Helping patients or clients to change their behaviour can be frustrating. As professionals, we can get into a cycle of giving advice and making suggestions, only to feel that everything we suggest is being rejected. Specialist workers often have some training in more effective techniques \u2013 this article is aimed at frontline staff, most of whom will not have had such training.
\nThere is now rather compelling evidence that the approach known as motivational interviewing produces better results than standard care (also called \u2018business as usual\u2019 or \u2018finger wagging\u2019). A full motivational interview takes between
\n45 and 60 minutes. The necessary training takes two, three or more days so it\u2019s not surprising that this has been the preserve of specialists. However, the insights and techniques of motivational interviewing are available to \u2018ordinary\u2019 practitioners. I work for a training company and it\u2019s our contention that everyone whose job includes counselling patients or clients regarding behaviour
\nchange can enhance their professional effectiveness with some understanding, and judicious use, of relevant techniques.
\nEach of the following techniques takes no more than a few minutes to use and frontline practitioners can use them flexibly in relevant professional conversations. Regard the list as a toolkit from which the relevant tool can be unpacked as needed.<\/p>\n

Many clients exhibit two or more behaviours that may profitably be changed, such as alcohol, drug use and diet. Usually it\u2019s the professional who chooses which one to talk about, but allowing the client to choose the focus may enhance motivation. This can be achieved by running verbally through the options as the professional sees them and inviting the client to choose, such as:
\n\u2018It looks there are three things we could talk about today. Firstly your drug use, secondly your drinking and thirdly your diet. Does that sound right?\u2019 Then, if the client agrees: \u2018OK, so which would you like us to focus on today?\u2019 People can be a bit vague about their habits. A typical answer to \u2018how much alcohol do you drink\u2019 is likely to be something like \u2018Well, that\u2019s a good question. It\u2019s hard to say. Depends on this and that.\u2019 It\u2019s usually profitable to clarify what is going on at an early stage in your
\nprofessional relationship. A recommended technique is the \u2018typical day\u2019 question. For example, \u2018I wonder if I could spend a couple of minutes learning more about your drinking? Can I ask you to talk me through a typical day, starting when you wake up
\nand finishing when you go to bed? Tell me where you go, what you do and where your drinking fits in.\u2019 Variations on this include asking about a specific day (yesterday, last Saturday) or a typical week (which can be better for some behaviours). It\u2019s normally very helpful to gauge the client\u2019s readiness to change or consider changing. This may be apparent from things they have said and it certainly can emerge naturally from the conversation, but this is not always the case. While it\u2019s rare for there to be no real clue, it can often be very unclear just how much readiness there is to change. It\u2019s helpful to break readiness to change down into two components \u2013 importance and confidence. One strategy is to ask specifically about these in turn, using \u2018scaling questions\u2019. For example, \u2018Can I just ask you a couple of questions? On a scale of one to ten, how important is it for you to cut down your drug use?\u2019 Say the client responds with \u2018Oh, I don\u2019t know. Maybe around a three,\u2019 your response could be \u2018I see \u2013 thanks. Can I ask a similar question? On a scale of one to ten, if you decided to cut down, how confident would you be that you could make the change?\u2019 Their response might be: \u2018That\u2019s a good question. Maybe six-ish. I cut down quite well for a while once. I think I could do that again.\u2019<\/p>\n

One advantage of this approach is that you can use it as a launch pad for further exploration, such as: \u2018You told me you were at three or four for importance. So can I ask you why three and not one or two?\u2019 \u2018Well, it does sometimes get me into trouble. I\u2019d like to think I had a bit more control over it and that it didn\u2019t dominate my life quite so much.\u2019 \u2018Alright, so what would have to happen to move that score up to say five or six?\u2019 \u2018Well, if I got properly sick with it, I think that might do it.\u2019 People aren\u2019t daft. They indulge in unhealthy behaviours because there\u2019s a payoff. Being overweight is a side effect of eating, which is usually pleasurable. Substance users get some sort of \u2018high\u2019 from their substance, or a relief from withdrawal effects if dependent. Behaviours have a social context and many people enjoy doing things with friends, whether smoking, drinking or injecting.
\nAn axiom of motivational interviewing is that our client can see pros and cons to their behaviour. Rather than offering our professional opinion, we can help by allowing the client to bring these out into the open \u2013 and then feed it back to them: \u2018Can I just try to understand a bit better? Can I ask you about the pros and cons of your marijuana use? First, what are the pros of smoking it from your point of view, the things you like about smoking marijuana? \u2018Well, it relaxes me a bit, you know. And when I light up a joint with my mates, we have a good laugh. And to be honest, I prefer a smoke to a drink because you don\u2019t
\nget the hangovers \u2013 you know what I mean?\u2019 \u2018Yes, I think I see that. Ok, what about the cons? The things you don\u2019t like so much?\u2019 \u2018Well, it sometimes costs me quite a bit you know. And if I get really stoned, then I miss half the day, which isn\u2019t right. And my girlfriend isn\u2019t keen \u2013 I think she might not stand for it forever.\u2019 \u2018Can I recap then? You\u2019re telling me that it relaxes you, that you do it with your mates and that you prefer it to alcohol. On the other hand, it can cost a lot, you sometimes miss half a day and your girlfriend doesn\u2019t like it?\u2019 \u2018That\u2019s about right, yeah.\u2019 \u2018Where does that leave you today?\u2019 This can really help in our efficient use of interview time. The client response usually tells us if they are ready to go further and get involved in change talk \u2013 or alternatively it may be clear that it isn\u2019t profitable to take things any further today.<\/p>\n

At any point in the discussion, resistance may emerge. It is tempting to meet resistance with reasoned argument \u2013 pointing out all the scientific reasons on the side of a behaviour change. Unfortunately, this usually has the effect of stiffening resistance. For example, \u2018You really need to lose weight you know.\u2019 \u2018I guess so.\u2019 \u2018I think you should go on a diet.\u2019 \u2018I can\u2019t because…\u2019 This is known as negative self-talk. It has been shown that an increase in the amount of negative self-talk in an interview is associated with a lower chance of behaviour change occurring. It seems prudent to avoid provoking such statements. For example, \u2018I get the impression I may be pushing you a bit too far here. Shall we stop talking about this today?\u2019 \u2018No… It\u2019s ok, go on. It\u2019s just that this is difficult for me to get my head around.\u2019 This is known as \u2018rolling with resistance\u2019. It can be a very effective tactic to
\nprevent the emergence of negative self-talk. It demands that professionals should be on the lookout for signs of resistance at pretty much any stage in a behaviour change discussion.<\/p>\n

Most of us who work with clients develop a well-polished series of mini-lectures by way of explaining all the regular things that come up and need explaining. Unfortunately, these mini-lectures may not really be wanted. Or else, we may fail to address important questions on the mind of the client. A mini-seminar might be better. A useful way of looking at this is \u2018elicit \u2013 provide \u2013 elicit\u2019. Elicit any questions or information needs and provide answers or information in response. When it comes to action talk, it is better to provide a range of options to be chosen from. Finally, elicit a response \u2013 find out how your information has been received. An example: \u2018Can I explain anything to you, answer any questions?\u2019 \u2018Well, have you got any information about how many units are in my various drinks. And what do you think I should do to cut down?\u2019 \u2018Ok. Let\u2019s see. This leaflet is good for information about units. How does this look?\u2019 \u2018Very clear, actually. Can I have that?\u2019 \u2018Definitely \u2013 it\u2019s for you to take away. Anything catch your eye?\u2019 \u2018Yes. Look at this about glasses of wine. I had no idea there were so many units.\u2019 This approach can lead to more effective use of professional time, while again minimising the risk of negative self-talk developing. Motivational interviewing gives better results than \u2018business as usual\u2019 and many of the individual skills and techniques are easy enough to learn and can be used in routine conversations with patients or clients. I\u2019ve outlined and demonstrated a range of the most useful
\nmicro-skills, with examples of how they might fit into your conversations but a very readable and immensely practical textbook I\u2019d recommend to any DDN reader is Health Behavior Change \u2013 a guide for practitioners by Stephen Rollnick, Chris Butler
\nand Pip Mason (Churchill Livingstone) \u2013 despite the spelling, it\u2019s a British book.<\/p>\n

Dr Malcolm Thomas is director of national training provider Effective Professional
\nInteractions Ltd. www.effectivepi.co.uk<\/p>\n

Source: drinkanddrugsnews Jan 2010<\/em><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Motivational interviewing can yield excellent results and the basic skills and techniques are easy to learn. Dr Malcolm Thomas sets out the basics of promoting behaviour change Helping patients or clients to change their behaviour can be frustrating. As professionals, we can get into a cycle of giving advice and making suggestions, only to feel […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79],"tags":[],"class_list":["post-5799","post","type-post","status-publish","format-standard","hentry","category-treatment"],"_links":{"self":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/5799","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/comments?post=5799"}],"version-history":[{"count":0,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/5799\/revisions"}],"wp:attachment":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/media?parent=5799"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/categories?post=5799"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/tags?post=5799"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}