Motivational interviewing isn't difficult, nor is it time consuming. It does, however, produce big effects in Return To Work. Read on to learn what it's all about.

What is it Motivational Interviewing?

Motivational Interviewing is a way of communicating through directed question-asking to assess a person's willingness or readiness to change and then help them make those changes. It is aimed at enhancing a person's self-motivation by determining the reasons for any ambivalence or resistance to change, and targeting these reasons through a specific recovery plan.

Counsellors, medical practitioners, employers, return to work coordinators and case managers can all be ‘the interviewer' in a motivational interview.

The interviewing is person-centred and involves facilitating trust and asking specific questions to highlight the desire for change and identify causes of resistance. The discussion helps the person identify where they are, where they'd like to be, and why they think they aren't there. In the process of the discussion a person who is ready to change can be supported to accept a level of self-responsibility for their recovery.  

Identifying the gap between where they are and where they would like to be can lead to behavioural change because humans do not like to have this disconnection in their lives. Once it's recognised they are more likely to take necessary steps to resolve it.

The goal is to assess a person's self-motivation and willingness to change and to recover and to use this assessment to develop strategies to address resistance to change.

Why is Motivational Interviewing so important?

By undertaking Motivational Interviewing effectively, an interviewer can improve a person's motivation and self-management of illness or injury.  These improvements can be long-lasting and make it more likely that a person will stick to an agreed plan.

What is it used for?

It was originally developed for use in the treatment of problem drinkers. Now it is used across the board, and its use continues to increase. Motivational interviewing can help people who are trying to stop smoking, drinking or overcome other drug problems, change their diet or increase their exercise, and, of course, it can be used to great effect in the return to work process. 

How does it work?

Motivational interviewing is about assessing and increasing a person's willingness to change or improve their own situation. Assessment occurs through the asking of directed strategic questions. This allows the interviewer to discuss a recovery plan pitched at the person's precise level of readiness – not taking the time to assess this can be counterproductive.

Before a person is ready and willing to change, efforts on the part of the case manager, RTW coordinator or others to try to incite change in the person will be to no avail. In fact arguments to change when the person isn't ready may damage rapport.

What is the role of the interviewer?

The person interviewing and leading the discussion plays a pivotal role. Their job is to address the person's level of motivation and to pinpoint why it's at that level. The interviewer can then develop appropriate strategies to improve it. The interviewer is responsible for communicating and working collaboratively with a whole team – including the person, employers, medical practitioners, rehabilitation providers – who will together work towards the person's successful and appropriate return to work.

An interviewer should:

• Listen. To gain the information required to tailor strategies towards increased motivation, it's important to listen. This is how an interviewer can learn at which stage a person is at – is the person about to regress? Or steam ahead? etc – and match actions with the person's frame of mind.
• Build and maintain rapport with the person. MI cannot work without trust from the person, who must feel comfortable and safe enough to give honest detailed information about how they're feeling.
• Spend less time giving advice and more time asking questions. Questioning can lead to a degree of understanding about the person's level of ambivalence or resistance to changes in behaviour that are necessary to achieve change or a given goal.
• Support self-efficacy. If the person mentions a positive intention, it is important to recognise this and help the person move toward the desired behaviour. Responsibility for maintaining change, after all, rests with the person alone.

[Look out next week for the second part to this article, ‘Motivational Interviewing: techniques and strategies']