Motivational interviewing: four steps to get started

Motivational interviewing is a brief counseling technique that can be effective at helping patients overcome reluctance and make behavioral changes, such as losing weight or quitting smoking. The objective for the physician is not to solve the patient's problem but to help the patient resolve his or her ambivalence, develop some momentum, and believe that behavior change is possible.

The “OARS” acronym highlights four essential aspects of motivational interviewing.

1. Ask open-ended questions instead of “yes” or “no” questions. For example, you might begin the conversation with “What's been going on with you since we last met?” or “If you had one habit that you wanted to change in order to improve your health, what would that be?” The goal is to elicit the patient’s thoughts because behavior change must originate with the patient.

2. Offer affirmations. When you review your patients’ goals, take joy in their successes and express empathy during tough spots. Affirmation will do more to encourage patients to keep moving forward than persuasion or correction will ever do.

3. Practice reflective listening. Reflective listening involves letting patients express their thoughts and then, instead of telling them what to do, capturing the essence of what they have said and helping them arrive at an idea for change. Here's an example:

• Patient: “I wish I didn't eat so much fast food.”
• Doctor: “You eat fast food fairly often?”
• Patient: “Pretty much every day. I know I shouldn't, but it's just easier.”
• Doctor: “It's easier because you don't have to plan and cook meals.”
• Patient: “And I can just run over to the drive-through.”
• Doctor: “So you don't want to give up the convenience of fast food, but you would like to eat healthier.”
• Patient: “Right. ... I guess there are some healthy items on the menu.”

4. Summarize the visit. This involves recapping what the patient has said, calling attention to the salient elements of the discussion, and allowing the patient to correct any misunderstandings. End the summary with an open-ended statement such as “I am wondering what you think your next step should be.” This should be a specific goal, however small, that the patient is willing to accomplish, not just try. Record the goal in the chart, and let the patient know you will review it together at the next visit, or perhaps by e-mail between visits.

Read the full FPM article: “Encouraging Patients to Change Unhealthy Behaviors With Motivational Interviewing.”