by Gary Rose, PhD

One of the basic tenets of Motivational Interviewing holds that motivation and resistance derive from the communication between practitioner and patient. We say things, and patients respond–sometimes indicating their resistance and at other times signaling their motivation to change.

In MI parlance, when practitioners voice MI-consistent statements, they increase the probability of patients responding with change talk. Conversely, clinicians who use MI-inconsistent language often elicit resistance or counter-change talk from their patients, thereby decreasing the likelihood of progress.

What are these MI-consistent and MI-inconsistent verbal behaviors, and does the evidence suggest that they really have the power to motivate or de-motivate patients?

MI-consistent behaviors include a variety of practitioner activities that support the patient’s autonomy, acknowledge his/her personal control, and help create a collaborative relationship. These include asking permission before offering advice or information, eliciting patient ideas, opinions, and preferences, collaborative agenda setting, and providing support. Support includes demonstrating a willingness to listen to and accept any reluctance the patient may have regarding the targeted health behavior change.

MI-inconsistent behaviors include a variety of “top down” behaviors that stand in direct opposition to the MI-consistent actions. For instance, delivering unsolicited advice, confronting, arguing, exhorting, shaming, and controlling are all included herein.

Much of the evidence supporting these hypotheses comes from the work of Dr. Teresa Moyers and her colleagues at the University of New Mexico (www.casaa.unm.edu). Here are several of their observations:

Practitioners who more successfully demonstrate the collaborative patient-centered style of MI engender more trust, involvement, openness and readiness to change in their clients.

Practitioners who confront, argue, or direct engender increased resistance in their patients, and less positive change.

Clinicians who demonstrate MI-consistent behavior elicit increased change talk from their clients and patients.

Clinicians who use MI-inconsistent behavior elicit counter-change talk from patients.

Patient counter-change talk is associated with the absence of positive behavior change.

Patient change talk leads to further change talk which leads to behavior change. In other words, there is a positive snowball effect.

So, it turns out that what we say really does matter. If you want your patients to demonstrate positive behavior change, get them to talk about it. The more they talk about wanting to, being able to, or being committed to changing, the better.

A particularly effective way to elicit change talk is by bringing the spirit of MI into your consultation. Ask permission before putting on the expert’s hat. Support autonomy, empower, and remain patient-centered. Use reflective listening to demonstrate a keen interest in the client’s point of view. The result is often a process of positive movement that builds upon itself.