Table of Contents
Overview – Motivational Interviewing
Motivational interviewing is a patient-centred counselling approach designed to facilitate and strengthen motivation for change, especially in the context of health behaviours and addictions. Rooted in empathy and collaboration, motivational interviewing helps individuals resolve ambivalence and enhance intrinsic motivation, making it a powerful tool for clinicians working with patients facing lifestyle-related health issues.
Definition
- A structured, goal-oriented counselling technique used to support behavioural change by resolving ambivalence and fostering internal motivation.
- Emphasises collaboration, autonomy, and patient empowerment.
The Psychology of Change
How People Change
- Patients do not change simply because they are told to.
- Ambivalence, resistance, and defence mechanisms are normal.
- Lasting change is gradual and requires:
- Cognitive/emotional shift
- Motivation
- Intention and commitment
- Planned steps
- Time
Motivational Interviewing in Practice
Key Principles
- Explore and resolve ambivalence
- Strengthen intrinsic motivation rather than imposing external pressure
- Focus on:
- Patient’s values
- Goals
- Insights
- Resources for change
Clinician Attitudes
- Be respectful, empathic, and non-judgemental
- Acknowledge that the patient is the expert on their own life
- Encourage autonomy in decision-making
- Avoid confrontation or pressure
Key Tools and Models
SNAP Risk Factors
A useful guide for lifestyle modification targets:
- Smoking
- Nutrition
- Alcohol
- Physical activity
The GRACE Model
- Generate a gap → Create discrepancy between current state and desired goals
- Roll with resistance → Avoid power struggles
- Avoid arguments → Reduces defensiveness
- Can-do attitude → Focus on strengths, small steps, hope
- Empathy → Accept and support the patient’s views while gently guiding
The 5 A’s Framework
- Ask → Identify lifestyle risk factors (e.g. smoking, drinking, diet, exercise)
- Assess → Risk level, motivation, physical health, BMI, CVD risk
- Advise → Use written info, brief intervention, “life script”
- Assist → Goal setting, pharmacotherapy, self-monitoring
- Arrange → Refer to services (e.g. ATODs, support groups, helplines) and plan follow-up
Life Scripts
- Practical templates to guide behavioural change
- Include assessment tools and questionnaires specific to each “SNAP” risk factor
- Used for structured documentation and patient self-monitoring
The 5 Stages of Change Model
- Precontemplation
- No intention to change behaviour
- Strategies: raise awareness, link behaviour to health outcomes, explore negative impacts
- Contemplation
- Acknowledging the need for change but ambivalent
- Strategies: highlight benefits, explore motivations (health, money, relationships), avoid pushing
- Preparation
- Planning to change soon
- Strategies: goal setting, acquiring knowledge and skills
- Action
- Taking specific steps to change behaviour
- Strategies: support self-efficacy, acknowledge difficulty, anticipate relapse
- Maintenance
- Sustaining behaviour change long-term
- Strategies: reinforce progress, provide encouragement, normalise setbacks
Relapse
- Common in behaviour change
- Reframe as part of the process → revisit contemplation stage
Summary – Motivational Interviewing
Motivational interviewing is an effective, evidence-based approach to help patients make meaningful behavioural changes by increasing their intrinsic motivation and resolving ambivalence. It is applicable across a wide range of lifestyle issues and clinical settings. For a broader context, see our Psychiatry & Mental Health Overview page.