Negotiating behaviour change in medical settings: The development of brief motivational interviewing

Abstract

Motivational interviewing was developed in the addictions field for helping people work through ambivalence about behaviour change. This paper describes a brief form of motivational interviewing developed in a medical setting for use in brief consultations. It is based upon the assumption that most patients do not enter the consultation in a state of readiness to change their patterns of drinking, smoking, exercise, diet or drug use; therefore, straightforward advice-giving will be of limited value and will lead to the kind of non-constructive dialogue often encountered in the addictions field: the interviewer's arguments for change are met by resistance from the patient. In contrast, this method aims to help patients articulate for themselves the reasons for concern and the arguments for change. Even if a decision to change is not made in the consultation, this time will be well spent since behaviour change itself could well occur in the near future. The method is based upon the use of a menu of strategies, with the interviewer selecting a strategy to match the degree of readiness to change of the patient. Each strategy takes 5–15 minutes to complete. Information-giving, which forms a central component, is designed as a patient-centered activity which maximizes freedom of choice for the individual. This paper contains an overview of the method and includes details of three strategies taught to trainees. It concludes with a discussion of some implications for training and health care practice.