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Behavior change is difficult to achieve and even more diffi- cult to maintain. Motivation is a major factor in determining whether we change our behavior. When a person seems unmotivated, it is often assumed that there is little we can do. This assumption is often false. The way physicians talk with patients can have a significant influence on their motivation for behavioral change.1,2 People do not like to be forced or coerced to change their behavior. Sometimes, merely acknowledging this autonomy or freedom not to change makes change possible.2 Physicians have been trained to provide information, but not how to help patients change their behavior. This article is an introduction to the spirit, principles, and tools of motivational interviewing (MI).
DEFINITION OF MOTIVATIONAL INTERVIEWING
MI is a "patient-centered method for enhancing intrinsic motivation to change by exploring and resolving ambivalence." 3 MI is patient-centered, not doctor-centered. This means that the physician listens to the patient's perspective on how the problem affects daily life and seeks to understand the patient's point of view without judging or criticizing the behavior. The goal of MI is to elicit the patient's motivation to change and to encourage the patient to take responsibility for his/her behavior. Ambivalence is seen as a normal stage in the process of change. An unmotivated person may have unresolved ambivalence, so ambivalence needs to be resolved for change to occur. One of the effects of MI is to help people realize that they are being ambivalent.3-6
THREE COMMUNICATION STYLES OF MOTIVATIONAL INTERVIEWING
Three communication styles are used in motivational interviewing: following, directing, and guiding. The following style includes listening, gathering information, and obtaining a history. Techniques used in this phase include openended questions, reflective listening, agenda setting, and asking permission.
When using the directing style, the clinician tells the patient what to do and how to do it. Clinicians frequently overuse this style. Tools include building a menu, using action reflections, and discussing next steps.
In the guiding style, the clinician helps the patient to find his/her way and acts more like a tutor. The guiding style is well suited for discussions involving health behavior change. The patient is encouraged to explore his/her own motivation and goals. Techniques used in the guiding phase include discussing...