Motivational interviewing

Try to understand your client’s point of view and demonstrate that you acknowledge their experience. If helps them feel understood and can facilitate a deeper connection that encourage them to share more of their experience.

Example: “You may be a little fed up with people lecturing you about …… I’m not going to do that, but it would be really helpful if I understood how you feel about….””

The 5 stages of behaviour change can be used to identify how ready your client may be to change a particular behaviour. You can also ask some questions to do this.

Example: “Tell me what you think about exercise”

“What would you like to change about your current activity level?”

A 10 point scale can be used to assess your client’s conviction, motivation and confidence to change.

• If a client’s confidence is low (for example, they have rated themselves as  4 out of 10 ), you can ask why they have not chosen a lower number instead (a 1 or 2). This encourages them to be aware of their own strength.
• You can also ask about previous successes, highlight skills and strengths the patients have to build their confidence and self-efficacy.

Example:

“On a scale of 1-10, if 1 is no interest in doing exercises, and 10 is totally interested in doing exercises, what number would you give yourself now? What would you need to get that to 7 or 8?” or “Why did you say 4 and not 2?”

“If you decided to try to walk for 10 minutes 3 times a day, how confident are you that you would be successful?”

“How do you feel that exercise would benefit you?”

Motivational interviewing should be seen as a “dance” with the client, instead of a “wrestle” . Don’t confront the client when resistance occurs. Instead focus on the patient coming up with their own suggestions and solutions when barriers appear. Respect the client’s freedom of choice, personal control and ability to make their own decisions. Invite them to consider other alternatives and develop solutions.

This method allows them to feel accepted and consider change instead of defending against it.

Example: Instead of “You need to lose weight because it will help you”, you can ask them about “What have [you] heard about weight and your health/knee pain/arthritis?”

Encourage the patient to say what could work. If they don’t have any ideas, ask permission to offer suggestions.

Example: “Are you interested in hearing some of the benefits of exercise on knee osteoarthritis?”

Ask the client what they are going to do next. Ideally, they may form goals in SMART format.

Open ended questions allow the person to elaborate more of their perspective on a topic, rather than be led in a specific direction. By asking open-ended questions, the clinician is given the opportunity to learn more about the client’s values and goals.

Open ended questions are the opposite of close-ended questions (those that elicits a yes or no answer)

Example: “I understand that you have some concerns about your weight and its impact on your knee arthritis. Can you tell me more about that?”

Versus: Are you aware of the harm that extra weight has on the arthritis in your knee?

Affirmations are statements of appreciation and understanding of the client’s efforts and situation. It’s used to validate their strength and acknowledge behaviours that lead in the direction of a positive change, regardless or how large or small it may be.

Affirmations are used to build the client’s confidence in their ability to change, but it’s also used to build rapport and demonstrate empathy and understanding. To be effective, it must be genuine.

Example: “I appreciate that you have come today to discuss the impact of your diet on your weight, and subsequently, your knee pain. I understand that it’s not easy to talk about it, but thank you for coming. It takes real courage and strength to do this”

Reflective listening involves rephrasing a statement to capture the “implicit” meaning of what the client has said.
For the client, it allows confirmation whether their perspective have been understood. It also gives them a platform to correct any misunderstanding if any occurs.
For the clinician, it ensures that they have a clearer understanding of the client’s perspective. It also assists in building rapport.

Example: “It sounds to me that you wish you could go on your daily walks, but your knee pain is just too much at the moment”

Summarising is similar to reflective listening, but it it particularly helpful in providing a stepping stone towards change. Like reflective listening, it ensure that there is clear communication between the two parties.

Example: “Correct me if I am wrong, but from what you have said, it sounds to me that by skipping the daily walks, you are able to avoid the pain in your knee because of your arthritis. But on the other hand, your are starting to worry about the effect of not going on the walks in the long terms. You’ve expressed that it may lead to weaker legs, more pain in the knee, and having less ability to walk for longer distances”