Tuesday, May 31, 2016

A Refresher on Motivational Interviewing

Throughout our lives, we may often find ourselves trying to help someone make a change.  At times like these all of us hope to have a positive impact and support others in achieving their goals.

But how? What is the best way to show our support?

In 1991, Miller and Rollnick wrote the first of many books on a new way of talking to people about change:  Motivational Interviewing (MI).1 MI involves techniques for discussion with those who are ambivalent, to elicit and strengthen their personal motivation for change. 2

To guide an interaction based on MI theory, the situation must first be assessed.  How does the person themselves feel about changing? For this assessment, Rollnick created the readiness ruler a simple method for determining readiness to change by asking where a person falls on a scale of 1 to 10.3,4

Figure 1: Readiness rulers (adapted from Miller & Rollnick 1991; Keller & White 1997)

The readiness rulers are a useful tool to initiate any discussion surrounding change. With information on conviction and confidence, we can then apply appropriate strategies for different degrees of readiness.3

Keller and White (1997) found readiness involves two distinct scales: conviction and confidence.5

Figure 2: Factors influencing ambivalence (adapted from Keller & White 1997)

Is the person skeptical? 
Help them explore the pros and cons of change! 

Are they frustrated? 
Guide them to discover their personal strengths!   

Always tailor the discussion to the individual!

Our goal as healthcare professionals is to evoke change talk, to help others recognize the need for change and to help them believe it is possible. 1  That being said, the most important point to remember is that MI is a partnership – two people working in a respectful, collaborative way.  

While there may be little time for pharmacists to have long discussion, we are still the most accessible health profession. As such it is imperative to communicate effectively in the time we have – I hope this helps!


1.           Miller, W. & Rollnick, S. Motivational interviewing: preparing people to change addictive behavior. (New York : Guilford Press, 1991).
2.           Foxcroft, D. & Al., E. Motivational interviewing for alcohol misuse in young adults. Cochrane Database Syst. Rev. 8, CD007025 (2014).
3.           Najavits, L. M. Treatment Improvement Protocol Series: Enhancing Motivation for Change in Substance Abuse Treatment. Subst. Abus. Ment. Heal. Serv. Adm. Cent. Subst. Abus. Treat. 1–27 (1999).
4.           Hesse, M. The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers. Harm Reduct. J. 3, 3 (2006).
5.           Keller, V. F. & White, M. K. Choices and changes: A new model for influencing patient health behavior. J. Clin. Outcomes Manag. 4, 33–36 (1997).