Motivational interviewing

Motivational interviewing is a style of patient-centred counselling developed to facilitate change in health-related behaviours. The core principle of the approach is negotiation rather than conflict. In this article I review the historical development of motivational interviewing and give some of the theoretical underpinnings of the approach. I summarise the available evidence on its usefulness and discuss practical details of its implementation, using vignettes to illustrate particular techniques. Janet Treasure is Professor of Psychiatry at Guy’s, King’s and St Thomas’ Medical School (Department of Psychiatry, 5th Floor, Thomas Guy House, Guy’s Hospital, London SE1 9RT, UK. E-mail: [email protected]). She has specialised in the treatment of eating disorders for over 20 years and is Director of the Eating Disorder Unit of the South London and Maudsley Hospital NHS Trust. The unit is a leading centre in clinical management and training in eating disorders, and is also active in research and development in all aspects of this field. She acknowledges the support of the Nina Jackson Eating Disorders Research Charity in her work, which includes developing the treatment approaches discussed in this article. Box 1 The four central principles of motivational interviewing 1 Express empathy by using reflective listening to convey understanding of the patient’s point of view and underlying drives 2 Develop the discrepancy between the patient’s most deeply held values and their current behaviour (i.e. tease out ways in which current unhealthy behaviours conflict with the wish to ‘be good’ – or to be viewed to be good) 3 Sidestep resistance by responding with empathy and understanding rather than confrontation 4 Support self-efficacy by building the patient’s confidence that change is possible