Key elements:


Key skills

Stages of change

Look at how we change at the different stages

Ambivalence and the decisional balance

Self efficacy is one’s capability to organize and execute the sources of action required to manage prospective situations. It does this by influencing

The sources of self efficacy

What do we do to influence the stages of change?

The processes of change cognitively

The processes of change in behaviour strategies

The spirit of the method

Five key strategies (OARS)

  1. O Open ended questions
  2. A Affirmation
  3. R Reflective listening
  4. S Summarise
  5. Elicit self motivational statements

Open questions should


Reflective listening

What the speaker says Hearing What the listener heard
Encoding   Decoding
What the speaker means Reflection What the listener thinks the speaker means

 A good reflective listening response is a statement and the inflection should turn down at the end. You is a good word:

Beware that your expertise, wisdom and experience doesn’t keep you from listening to their individual problem. Their understanding of the problem is what matters.

Levels of reflection

  1. Repeat Adds nothing and changes nothing
  2. Reword Substitutes a synonym for one component
  3. Paraphrase Gives back perceived meaning that has not been overtly stated
  4. Emotive A level 3 response that includes reflection of feeling
  5. Summary A reflection that brings together a number of previously stated


Eliciting change talk

How do we elicit change talk? Use EVOCATIVE QUESTIONS that trigger a response

Are they ready to change? Look at the PROS and CONS of change versus no change

Set SMART GOALS and use them to look at PROCESS and OUTCOME

  1. Explore view of problems
    • "What do you see the problem as?"
    • "What about other people?"
  2. Feed back what doesn't fit together (the Columbo scam)
  3. Identify pros and cons - a balance sheet

    NOT doctors orders - must be non-judgemental

  4. Then discuss motivation

    "What do you enjoy about eating/drinking/smoking?"

    Acknowledge negative, while reinforcing positive -

    "I hear what you are saying, but..."

    Explore in detail reasons for changing behaviour -

    "Why do you want to stop?"

  5. Tackle denial - the Columbo scam

    Tackle poor motivation - "It's your choice"

    Tackle self-esteem - "Let's look at what you've acheived"


Motivational interviewing and smoking

  1. Define behavioural cycle of change
  2. Define strategies for change
    • What makes people stop smoking?
    • What makes them carry on?
    • Needs:
      • Motivation
      • Encouragement
      • Support
  3. How can we help?
    • Thinking about stopping
      • Raise the issue
      • Build up a picture of smoking habit
      • Deciding to stop
      • Reinforce the interest in stopping
      • Help the patient decide to stop
    • Stopping
      • Give practical advice on stopping
        • PLAN A DAY
        • STICK TO IT
        • PLAN LOTS TO DO
      • Work out coping strategies
    • Staying stopped
      • Maintain interest
      • Give positive encouragement


Motivational interviewing

Group work: give scenarios (in pairs):


Motivational interviewing