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Five key skills

Motivational interviewing techniques can be used to encourage your client to talk about change and reduce their resistance to it. 

The following 5 techniques can be easily integrated into your current approach:

1. Ask open ended questions

If you use too many closed or dead-ended questions it can feel like an interrogation. “How often do you drink?" or "Did you know that smoking can kill you?" Open-ended questions allow patients to tell their stories. It encourages them to do most of the talking. Your goal is to promote further dialogue so you can reflect this back to them.

Here are some examples of open-ended questions:

  • Tell me what has happened since we last met?
  • What makes you think it might be time for a change?

2. Listen reflectively

We call it reflective listening when you listen to patients then repeat or paraphrase their comments back to them. For example “it sounds like you’re not ready to quit smoking cigarettes”. 

Reflections are a way of confirming what the client is feeling and communicate that you understand what they have said. 

When a reflection is correct, patients will usually confirm this. If you get the reflection wrong, then this gives the client an opportunity to let you know. For example, “No, I do want to quit, but I am worried about withdrawal symptoms and weight gain”. Your goal is to get your client to state their reasons for changing.

Here is a generic example of reflective listening:

  • “What I hear you saying…”

Here is a specific example of reflective listening:

  • “I get the sense that you are wanting to change, but you have concerns about the effect this will have on your family.”

3. Affirm/clarify

Affirmation shows that you understand and empathise with your client's struggles. It allows you to build on their strengths and past successes, improving their sense of well-being. They are best when focused on something your client has done.

Here are some examples of affirmation:

  • “I appreciate how hard it gets to have to hear this again.”
  • “You have been working hard on improving your diet.”
  • “I can see this is upsetting. Thanks for staying through it.”

Clarifying shows your client that you are listening and gives them an opportunity to hear what you think they said, and to respond to it. It also allows you to explain your current understanding and ask for further information if you are confused.

Here are some clarification examples:

  • 'So, what you seem to be saying is...'

It helps to summarise and consolidate what you have discussed, so you could ask?

  • Who are you going to ask to support you?
  • What date have you decided to start?
  • What treatment/programme will you use?

4. Summarise 

Summaries are used to relate or link what patients have already expressed and are an excellent way of expanding the discussion. To summarise effectively, you need to listen carefully to what the client is saying throughout the whole of the conversation. Also, summaries are a good way to end a conversation and can help get a particularly talkative client to move on to the next topic. 

Here are some summary examples:

  • “It sounds like you are concerned about smoking because it is costing you a lot of money. You also said quitting will probably mean not associating with your friends any more. That doesn’t sound like an easy choice.”
  • “Over the past three months you have been talking about exercising, and it seems that just recently you have started to recognise you are coming up with excuses for not doing it."

5. Elicit self motivational statements

It is your client that must have the confidence in their ability to change and not you. You can test this confidence by using scaling techniques such as the Readiness to change ruler. 

If your client's readiness goes from a low number to a higher number, you can ask follow up questions to see how they feel about the change. If the number is low, you can ask questions to explore what will make them ready.

Here are some examples of eliciting statements to support self efficacy:

  • “It seems you’ve been working hard to quit smoking. That is different than before. How have you been able to do that?”
  • “Last week you weren't sure you could go a day without drinking a glass of wine, how were you able to avoid drinking for an entire past week?”

These techniques are not used in isolation, but are entwined throughout the conversation. You will learn which technique to use to get the best outcome.