Motivational Interviewing | Bradford VTS

Motivational Interviewing

Because telling patients what to do hasn't been working. (You may have noticed.)

Motivational Interviewing is one of the most powerful skills in a GP's toolkit — and one of the most under-used. It transforms difficult consultations into genuine conversations, and replaces verbal wrestling matches with something that actually moves people. This page gives you everything: the theory, the techniques, the phrases, and how to use it in a real 12-minute GP consultation.

💬 For Trainees, Trainers & TPDs 🎯 High-yield tips for SCA 💡 Knowledge not found elsewhere

📅 Last updated: April 2026

FOUNDATIONS 📥 Downloads 🌐 Web Resources ⚡ Quick Summary 🩺 Why It Matters UNDERSTANDING MI 🔍 What Is MI? 🔄 Stages of Change MI SKILLS 🎵 OARS 🔀 4 Processes 📌 Principles & RULE ⏱ In Consultation 🏥 GP Scenarios REAL-WORLD 🔮 Insider Wisdom ⚠️ Pitfalls 🧠 Memory Aids TEACHING 👩‍🏫 For Trainers 🎬 Videos ❓ FAQ SCA & EXAM 🎯 SCA Tips 🗣 Phrases ↔️ Ram's Language Swap 🕺 Resistance 😤 Microaggressions CLOSING 🏁 Take-Home

📥 Downloads

Handouts, mindmaps, presentations, and practice cases — all ready for learning, teaching, or a last-minute consultation rescue.

path: MOTIVATIONAL INTERVIEWING

🌐

Web Resources

A hand-picked mix of official guidance and real-world GP resources. Because sometimes the best pearls are not hiding in the official documents.

📘 Core MI Reference

🌟 MINT — MI Resources LibraryThe definitive resource hub from the Motivational Interviewing Network of Trainers 📗 MI as a Counselling Style (NIH)Evidence-based background, principles & application in healthcare 📖 MI in a Nutshell (Physio-pedia)Clear overview of MI theory, skills and process 💳 The MI Reminder CardQuick-reference pocket card — print it out

🩺 MI in General Practice

🏥 MI: Background & Application in HealthcareNursing Times — background, principles and healthcare application 💊 MI Do's and Don'ts (NIDDK)Practical dos and don'ts for MI in clinical settings 🩸 MI in Diabetes (PMC)Great paper — directly applicable to GP consultations 💬 OARS — Example QuestionsGreat example questions for each OARS skill

🎓 Skills & Training

🧠 17 MI Questions & SkillsPositive Psychology — practical skills with examples 🎯 10 MI Strategies in HealthcareHealth Catalyst — ten practical clinical strategies 📊 MI Workshop Development & AssessmentMINT — how to develop and assess MI training 🔄 Behavioural Change ModelsStages of change in addiction recovery — well explained

📚 Further Reading

📕 MI Handbook (SAMHSA)Excellent generic examples — great for GP training 💻 eLfH — Using MI to support return to workRelevant to occupational health consultations in GP

⚡ Quick Summary — If You Only Read One Thing

MI is a collaborative conversation style that draws out a person's own motivation to change — rather than telling them what to do
The fundamental principle: ASKING, not TELLING. The patient's own words are more powerful than yours
People change when they tell themselves they need to — not when someone else tells them. Your job is to create the conditions for that
Core skills: OARS — Open questions, Affirming, Reflecting, Summarising
Core spirit: PACE — Partnership, Acceptance, Compassion, Evocation
The change cycle (Prochaska & DiClemente): patients are at different stages. Match your approach to their readiness, not your preferred outcome
When patients resist, don't push back — reflect, explore, and roll with it. Fighting creates more resistance
In the SCA: MI skills are assessed under Interpersonal Skills (Relating to Others). A consultation that sounds like a lecture will not score well
MI works for far more than addictions: weight, exercise, medication adherence, referral decisions, lifestyle change, difficult conversations
The goal is not compliance. The goal is autonomy-supported change that sticks

🩺

Why MI Matters in General Practice

A significant proportion of GP workload involves behaviour change. Smoking, weight, alcohol, medication adherence, exercise, sleep, diet — these make up the bread and butter of everyday surgeries. And most of us were trained to deal with them in the same way: explain the risks, give the advice, hope something sticks.

It doesn't work. Not because the advice is wrong. It's because nobody changes because someone told them to. People change when they feel ready, when they feel understood, and when they find their own reasons.

MI gives you a different way into the same conversations. It replaces verbal wrestling matches with genuine dialogue. It turns a 10-minute battle of wills into something that's actually useful for the patient — and considerably less exhausting for you.

📊

Does MI Actually Work?

Yes — and the evidence is consistent. Clinical trials show that patients exposed to MI (compared to standard care) are more likely to:

✅ Enter and stay in treatment — and complete it

✅ Attend follow-up appointments

✅ Reduce alcohol and illicit drug use

✅ Successfully quit smoking

✅ Improve medication adherence

✅ Achieve better blood pressure, weight, and blood sugar control

Across multiple studies and conditions, MI strategies produced an average 10–15% added benefit in patient outcomes compared to standard care. No studies have reported MI to be harmful or to cause adverse effects.

💡

Not Just for Addictions

MI works with any consultation involving ambivalence. Worried about that referral? Reluctant to start a new medication? Feeling guilty about not exercising? MI helps with all of it.

"Recently I used MI techniques with a 76-year-old lady who was looking after her grandchild every day from 6am to 5pm. She was extremely reluctant to say anything to her daughter and felt guilty for not doing her 'grandma duties'. Through neutral dialogue, she came to the realisation herself — she wasn't saying no to looking after her grandchild, just not every day for 11 hours. Once you know MI techniques, you'll see how you can apply them in all sorts of ways." — Dr Ramesh Mehay, Bradford VTS

The fundamental principle of Motivational Interviewing is ASKING, not TELLING.
The solutions lie within the patient — your job is to help them find it.

🔍

What Is Motivational Interviewing?

Motivational Interviewing (MI) is a collaborative, person-centred conversation style for strengthening a person's own motivation and commitment to change. Developed by William Miller and Stephen Rollnick, it evolved from Carl Rogers' person-centred therapy and was first described in 1983.

MI uses a guiding style — neither directing (telling) nor following (purely listening) — to engage people, clarify their strengths and aspirations, evoke their own motivations for change, and promote autonomy in decision-making. (Rollnick et al., 2008)

🧱 Core Assumptions

HOW we speak matters as much as WHAT we say Being listened to is part of the change process The person with the problem has the answer People change when they feel ready — not when told Self-found solutions are the most enduring The doctor doesn't need to be the expert in the patient's life

🚫 What MI Is NOT

Arguing with the patient about why they need to change

Giving unsolicited advice or prescribing solutions

Using an expert stance that leaves the patient passive

The doctor doing most of the talking

Imposing diagnostic labels or moral judgements

Coercive or manipulative behaviour

🥊 Why MI Feels Better Than Arguing — For Everyone

Think about the last time you tried to persuade a patient to change something they weren't ready to change. How did it feel? Probably like pushing a very large boulder uphill. That's the righting reflex at work — and it exhausts both doctor and patient without moving anyone forward.

⚔️ The Old Approach

You tell the patient what they need to do
Patient becomes defensive
You repeat yourself more emphatically
Patient argues back, disengages, or shuts down
Doctor leaves feeling frustrated
Patient leaves unchanged — or worse, resistant

Result: hard work for the doctor. No change for the patient.

🕺 The MI Approach

You invite the patient to explore their own thinking
Patient voices their ambivalence freely
You reflect, affirm, and follow their change talk
Patient begins to make their own case for change
Doctor listens more, talks less — and feels less drained
Patient leaves having reached their own conclusion

Result: lighter for the doctor. More lasting for the patient.

🔵 MI Differs Substantially from Aggressive or Confrontational Styles

This is not about being passive or endlessly accommodating. It is about being strategically collaborative. Specifically, MI does not involve:

✗ Confronting the patient about their problem and telling them they need to change

✗ Offering solutions without the patient's permission or without encouraging their own choices

✗ Using an expert stance that leaves the patient in a passive, receptive-only role

✗ The doctor doing most of the talking — or only giving information

✗ Imposing a diagnostic label or moral framework on the patient's behaviour

✗ Any form of coercive, pressuring, or scare-tactic communication

"My sister once told me I needed to lose weight because I was looking a bit chunky. My immediate reaction was defensive. A few months later, I stepped out of the shower, looked in the mirror and said to myself: 'My goodness, you do need to lose a bit of weight.' Isn't it odd how readily we accept what we say to ourselves — and not what others say — even when the message is the same?" — Dr Ramesh Mehay, Bradford VTS (illustrating why self-generated change talk is more powerful)

"A few well chosen words or a thoughtful question can be worth more than many mouthfuls of busy talk."

— Professor Stephen Rollnick, co-developer of Motivational Interviewing

🌀 The Spirit of MI — PACE

The "spirit" describes the mindset and attitude of MI — how you show up in the room. Without the spirit, the techniques feel hollow.

Partnership

Collaboration between equals. You bring clinical expertise; they bring expertise about their own life. Neither is more important.

Acceptance

Unconditional positive regard — not approving of behaviour, but respecting the person's autonomy and worth absolutely.

Compassion

Actively promoting the patient's wellbeing. Putting their interests first — not pursuing your clinical agenda.

Evocation

Drawing out the patient's own motivation. The resources for change lie within them — your job is to evoke, not install.

💡

Insider Tip

PACE is what separates MI from a box-ticking exercise. Trainees who learn the OARS techniques but forget the spirit tend to sound scripted. Examiners can tell the difference. Be genuinely curious about your patient, and the rest follows more naturally than you'd expect.

🙋

"But I don't want to change my consultation style..."

Completely understandable — and nobody is asking you to. Here's the reassurance:

✅You're not starting from zero. Many MI techniques are things you're already doing naturally in good consultations.

✅MI is an addition to your existing skills — not a replacement for them. Think of it as extending your toolkit.

✅You don't have to "do MI" in every consultation. Use it where it genuinely fits — where there is ambivalence, resistance, or the need for patient-driven change.

✅Even adopting one MI habit — asking permission before giving advice, or asking one more open question — can shift a stuck consultation.

The goal isn't perfection. It's integration — weaving MI principles naturally into how you already work, rather than bolting on a new script.

🔄

Stages of Change

The Stages of Change model (Prochaska & DiClemente, 1983) describes how people move through change. Understanding where your patient is in the cycle is essential — it determines which MI approach to use. The biggest mistake GPs make is pushing "action" strategies on patients who are still in pre-contemplation.

1. Pre-
contemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

Pre-contemplation "I don't have a problem" / "Everyone does this" 🎯 MI goal: plant a seed of doubt — don't lecture. Raise awareness gently.

Contemplation "Maybe I should think about this..." 🎯 MI goal: explore ambivalence. Develop discrepancy. Tip the balance.

Preparation "I'm thinking about making a change soon" 🎯 MI goal: help plan. Strengthen commitment. Address barriers.

Action "I've started making changes" 🎯 MI goal: support the effort. Affirm. Problem-solve setbacks.

Maintenance "I've been doing this for months now" 🎯 MI goal: reinforce. Develop relapse-prevention strategies.

↩️ Relapse is normal — not failure. Help the patient re-enter the cycle at a higher point than before.

⚠️

The Most Common GP Mistake with the Change Cycle

Using action-stage strategies (giving advice, making plans, setting targets) on patients who are still in pre-contemplation. This almost guarantees resistance. Match your approach to their stage, not the stage you wish they were at.

💎

The "Crystallisation of Discontent"

Sometimes a single moment causes a sudden shift — a patient who has been in contemplation for years suddenly decides to quit smoking after a health scare. This is the crystallisation of discontent: the last straw that resolves ambivalence. You can't always engineer this, but you can create the conditions for it through MI.

🎵

The OARS Framework

OARS describes the four basic skills of MI. Think of them as the instruments in your consultation orchestra. Used well together, they create a sound that patients want to listen to. Used badly, it's just noise.

Open Questions

Questions that can't be answered with yes or no. They invite the patient to speak freely and reveal their own thinking.

"What's your own sense of how things have been going?"
"What's been most difficult for you about this?"
"How do you feel about making a change?"
"What would have to change for you to think about this differently?"
"What are the things you enjoy about it — and what, if anything, concerns you?"

💡

A good rule of thumb: one open question, then 2–3 reflections. Don't pepper the patient with question after question.

Affirming

Genuine statements that acknowledge the patient's strengths, efforts, and worth. Not empty praise — specific, honest affirmation.

"It took courage to come in and talk about this today."
"You've clearly been thinking about this a lot — that matters."
"Even cutting down a little shows real effort."
"You've managed difficult things before. That resilience is still there."
"The fact that you're here shows you care about your health."

⚠️

Don't confuse affirmation with hollow praise like "well done!" — patients can sense inauthenticity immediately. Make it specific.

Reflective Listening

Reflecting back what the patient said — not just parroting, but interpreting, deepening, or continuing the thought.

Types of reflection:

Simple: "So you've been struggling with this for a while."
Amplified: "Sounds like quitting completely is off the table for now." [patient may then moderate]
Double-sided: "So on one hand, you enjoy it — and on the other, you're worried about what it's doing to you."
Reframe: "You're not someone who gives up easily — that works both ways."

💎

Double-sided reflections are the secret weapon for ambivalence. They hold both sides without judgment, and often cause the patient to lean toward change themselves.

Summarising

Pulling together what's been said. Summaries show you've been listening, and they give the patient a chance to hear their own thoughts reflected back — often a turning point.

Types:

Collecting summary: "So today you've mentioned X, Y, and Z."
Linking summary: "The tiredness you mentioned earlier — I'm wondering if that connects to what you've just said about your sleep."
Transitional summary: "Let me just pull together what we've covered, and then we can think about where to go from here."

💡

End a summary with an open question: "Does that capture it — have I missed anything important?"

🔀

The 4 Processes of MI

Miller & Rollnick (3rd edition) describe MI as having four overlapping processes. They're not rigid stages — you may revisit earlier ones multiple times in a single consultation.

Engaging

Building rapport. Establishing a working relationship. The foundation for everything else.

Focusing

Finding a shared direction. What do we want to explore today? Agreeing on a change target.

Evoking

Drawing out the patient's own motivation. The heart of MI — eliciting "change talk."

Planning

Developing a concrete plan when the patient is ready. Commitment, action steps, follow-up.

💡

Insider Tip: Don't Rush to Planning

Most GP trainees jump to the Planning process too quickly. If the patient isn't sufficiently engaged and evoked, any plan made will be forgotten before they reach the car park. Spend more time in Evoking than feels comfortable — it's where the real work happens.

📌

The 5 Principles & RULE Mnemonic

📋 The 5 Principles

Express Empathy Through Reflective Listening

When patients feel listened to and understood, they become more open to hearing you. Empathy isn't agreeing with them — it's accurate understanding.

Develop Discrepancy

Gently highlight the gap between the patient's current behaviour and their own goals or values. Do this carefully — the patient needs to voice this, not you. "Where do you want to be? How does what you're doing now sit with that?"

Avoid Argument & Direct Confrontation

If you argue, the patient argues back. And nobody changes their mind in a fight. Resistance is a signal to change your approach — not push harder.

Adjust to Resistance (Dance with Discord)

Formerly "roll with resistance." When resistance appears, explore it with curiosity — don't oppose it. New perspectives emerge gently, not from confrontation. (See full section below.)

Support Self-Efficacy & Optimism

Belief in the possibility of change is itself a predictor of change. Be genuine — hollow encouragement is spotted instantly. Focus on past successes, strengths, and small wins.

🔑 The RULE Mnemonic (Rollnick et al., 2008)

Resist

Resist the righting reflex — the urge to fix and advise. It's your instinct. In MI, you park it.

Understand

It's the patient's reasons for change that matter — not yours. Their motivation, not your agenda.

Listen

The solutions lie within the patient. Your job is to listen well enough to help them find their own.

Empower

Help the patient understand they can change. Self-efficacy isn't just nice — it's essential.

⚠️ The Righting Reflex

The righting reflex is the clinician's instinct to fix, advise, and correct. It feels like helping. It often isn't. The moment you sense an urge to say "You really should...", that's the righting reflex. Take a breath. Ask an open question instead.

⏱

MI in the 12-Minute GP Consultation

You don't need a dedicated MI session. Even 3–4 minutes of genuine MI within a standard consultation can shift the dial. Here's how to integrate it into everyday GP practice.

🗺 The Rough Structure

1–2

Minutes 1–2: Engage & Assess Readiness

Open the consultation normally. Use an open question to invite the topic. Gauge what stage they're at before you say anything about change.

3–6

Minutes 3–6: OARS — Explore Ambivalence

Use open questions and reflective listening. Explore both sides. Look for "change talk" — any language that moves toward change. Follow it.

7–9

Minutes 7–9: Develop Discrepancy & Evoke

Use DARN questions (see below). Strengthen change talk. Develop the gap between current behaviour and their values/goals — gently.

10–12

Minutes 10–12: Plan if Ready / Bridge if Not

If they're ready: co-create a small, realistic next step. If not: summarise, plant the seed, and leave the door open. A 12-minute consultation that ends in patient-generated reflection is a success — even without a plan.

🎤 Eliciting Change Talk: DARN-CAT

Change talk is the verbal gold of MI — statements from the patient that move toward change. Use DARN-CAT to recognise and elicit it.

PREPARATORY CHANGE TALK

Desire

"I want to..."

Ability

"I could..."

Reason

"It would be good because..."

Need

"I have to..."

MOBILISING CHANGE TALK

Commitment

"I will..."

Activation

"I'm ready to..."

Taking Steps

"I've started to..."

💡

When You Hear Change Talk — Follow It

The moment a patient says something like "I suppose I do want to sort it out really..." — that's your cue. Reflect it back, deepen it, ask about it. Don't rush past change talk to deliver your information. The patient just gave you something valuable.

💬 The Readiness Ruler

A simple, powerful MI technique:

"On a scale of 1 to 10, how ready do you feel to make a change — where 1 is 'not at all' and 10 is 'completely ready'?"

Whatever number they give, the follow-up is always: "What made you choose [their number] and not something lower?" — this elicits their own reasons for change, not yours.

🏥

MI in Common GP Scenarios

MI isn't just for addictions. Here's how it looks across the GP bread-and-butter.

🚬 Smoking Cessation

Many patients have tried before. Open with curiosity rather than advice.

"What's your own relationship with smoking like at the moment? Any mixed feelings about it?"

Follow up on any ambivalence expressed. Never assume they want to stop — explore first.

🍺 Alcohol Reduction

Avoid units lectures. Explore what alcohol does for them first.

"You mentioned having a drink most evenings — what does that do for you? What would you miss if you changed that?"

The benefits matter. Only by understanding them can you help the patient weigh them honestly.

⚖️ Weight / Diet

BMI lectures rarely shift anything. Connect to what matters to them.

"What would it mean for you personally if you felt more comfortable in your own body?"

Explore the emotional and practical landscape before any dietary advice.

💊 Medication Adherence

Not taking tablets rarely means the patient doesn't care. Understand the barrier first.

"I notice the prescription hasn't been collected — can you help me understand what's getting in the way? I'd rather find something that actually works for you."

It might be side-effects, cost, fear, forgetfulness, or a belief that they don't need it. Each needs a different conversation.

🏃 Exercise & Activity

Telling someone to do 150 minutes a week rarely results in 150 minutes a week.

"What's a typical week like for you in terms of activity? What would help you feel more energetic day to day?"

Connect exercise to their own goals — not national guidelines.

📋 Refusing Referral / Investigation

Patients who say no to your recommendation often have a reason. Find it before pushing.

"The idea of a referral doesn't feel right for you at the moment — can I ask what's behind that?"

Address the underlying concern. Sometimes the resistance evaporates entirely once you've understood it.

"I love Motivational Interviewing because you can use it to 'move' people in a whole variety of clinical contexts. A patient with COPD who isn't keen on Pulmonary Rehabilitation. A patient who needs to start a new medication. A grandmother caring for her grandchild every day who feels too guilty to say no. MI works wherever there is ambivalence — which is almost everywhere in general practice." — Dr Ramesh Mehay, Bradford VTS

🔮

From the Training Floor — What Trainees Actually Find

These insights are drawn from GP trainee and GP trainer experience across UK training schemes, deanery SCA resources, trainer workshops, and clinical research with GP trainees. They capture the real-world patterns that official guidance rarely mentions.

💎

Reading About MI ≠ Doing MI

Trainees consistently report that MI theory makes complete sense when you read it — and then completely dissolves under the pressure of a real consultation. The righting reflex is hardest to suppress precisely when you're most stressed and most pressed for time. This is why you must practice it in real consultations before the exam.

💡

The "Video Yourself" Revelation

Almost universally, trainees who video their consultations are shocked at how much they talk. Many trainees believe they're listening — until they watch the recording. A useful benchmark: if you're speaking more than 50% of the time in a behaviour-change consultation, you're probably not in MI mode.

✅

The Briefest MI Works Remarkably Well

GP trainers report that even 3–5 minutes of genuine MI within a 12-minute consultation significantly changes patient engagement. MI does not require a dedicated 30-minute session. The switch from telling to asking — in any consultation — produces immediate, visible results.

⚠️

IMGs: The Direction of Travel is Different

Trainees from healthcare systems with stronger directive traditions consistently report that MI feels counterintuitive and slow at first. The turning point, almost universally, is the first time a patient says something like "I suppose I should stop, shouldn't I" — without being told to. That moment tends to convert even the most sceptical trainee.

ℹ️

The SCA Scores Better Across All Domains with MI

Trainees (and examiners) report that MI-informed consultations don't just score better in Relating to Others — they also improve Clinical Management and Data Gathering scores. Why? Because a patient who feels heard shares more relevant information, accepts a shared management plan more readily, and responds to safety-netting more genuinely.

💎

The Briefer Your Advice, the More Powerful

Experienced GP trainers note that advice delivered after genuine exploration tends to land harder and stay longer. A single well-timed piece of information — given when the patient is genuinely open — is worth more than five minutes of unsolicited health education. Wait for the invitation.

"The most radical transformation of practice might not come from adopting MI wholesale, but in learning and using the Elicit-Provide-Elicit strategy for giving information and advice. It is very simple, and with practice is easier. Start with yourself would be my first suggestion. Your wellbeing is the fuel that drives good practice." — Professor Stephen Rollnick, co-developer of Motivational Interviewing (MINT/Psychwire)

🔁 Elicit-Provide-Elicit (E-P-E)

One of the most practical MI techniques for giving information without triggering resistance. Rollnick considers it one of the most transformative single changes a clinician can make.

ELICIT

Ask what the patient already knows or thinks first.
"What do you already know about...?"
"What's your understanding of...?"

PROVIDE

Give information briefly and neutrally — only what's relevant to where they are.
"What I can tell you is..."
"The evidence suggests..."

ELICIT again

Find out what they make of it. Don't assume it landed as intended.
"What do you make of that?"
"How does that sit with you?"

💡

Why This Works

E-P-E avoids the classic information dump. By eliciting first, you avoid telling patients what they already know. By eliciting after, you avoid assuming your information was received as you intended. The patient stays active rather than passive throughout.

⚖️ The Decisional Balance

A structured tool for exploring ambivalence. Helps patients articulate both sides — and often tips them toward change through their own reasoning. Use it gently, not as a formal exercise.

🔴 STATUS QUO — Keeping things as they are

✅ Pros of NOT changing

• Familiar and comfortable
• No effort required
• Social/pleasure benefits remain
• No side effects from new habits

❌ Cons of NOT changing

• Health risks continue
• Goals remain out of reach
• Regret and guilt
• Condition may worsen

🟢 CHANGE — Making a difference

✅ Pros of changing

• Better health outcomes
• Goals become possible
• Improved wellbeing
• Reduced risk

❌ Cons of changing

• Effort and discomfort
• Loss of familiar habits
• Social disruption
• Fear of failure

Externalising both sides removes the patient's need to argue against change — they've already named the pros. The "cons of changing" are now on the table, explored and respected. Often, hearing it all laid out is itself enough to tip the balance.

⚠️

Common Pitfalls — Things That Catch Trainees Out

🎯

Theory Trap

Knowing OARS perfectly but forgetting PACE. The techniques without the spirit feel robotic.

⏱

Time Panic Trap

The righting reflex returns under time pressure. Feeling behind triggers advice-giving mode — the worst time to revert.

🎭

Performance Trap

Doing MI at the patient rather than with them. Reflecting without actually listening. Examiners and patients both notice.

🚫 The Big Mistakes

Asking "Do you smoke?" instead of "What's your relationship with smoking like at the moment?"
Giving health information before exploring what the patient already knows (skipping E-P-E)
Asking two open questions back-to-back without a reflection between them
Using MI opening phrases but immediately reverting to lecturing once the patient responds
Reflecting correctly but then adding "...and that's why you should really think about changing"
Treating every consultation the same regardless of which stage the patient is at
Moving to the Planning process when the patient has barely entered Contemplation
Finishing the consultation without a patient-generated next step or reflection
Confusing affirmation with praise: "Well done!" is not affirmation; "You've tried again despite setbacks — that's resilience" is
Being so non-directive that no direction is reached at all — MI still needs a thread

✅ What Good Looks Like Instead

One good open question followed by 2–3 genuine reflections before the next question
Noticing and following change talk — the moment the patient leans toward change, lean with them
Sitting with silence: a few seconds of silence after a meaningful reflection is a sign the patient is thinking
Asking permission before giving advice: "Would it be helpful if I shared what the evidence says?"
Ending with patient-generated language: "So what you're saying is you're not ready yet, but you can see why it might be worth it?"
Normalising ambivalence openly: "Most people feel both ways about this — it makes complete sense"
Finishing without a perfect plan — sometimes the best outcome is a patient who leaves thinking rather than complying

🧠

Memory Aids & Cheat Sheets

🎵 OARS

O — Open Questions

A — Affirming

R — Reflecting

S — Summarising

The basic skills toolkit

🔑 RULE

R — Resist the righting reflex

U — Understand their reasons

L — Listen

E — Empower

Rollnick et al., 2008

🌀 PACE

P — Partnership

A — Acceptance

C — Compassion

E — Evocation

The spirit of MI

⚡ One-Line Rules to Remember

One open question → 2–3 reflections before the next question

50:50 speaking ratio — if you're over 50%, you're in lecture mode

When you hear change talk → follow it. Don't rush past it.

The readiness ruler answer: always ask "Why that number and not lower?"

When resistance appears: change your approach, not your target

E-P-E: Elicit → Provide → Elicit. Never just Provide.

The patient's own words are more persuasive than yours. Always.

A consultation ending in patient-generated reflection = success, even without a plan

The secret of MI in one sentence:
"Your job is not to convince them. Your job is to create the conditions in which they convince themselves."

👩‍🏫

For Trainers — Teaching Pearls

🎓 Teaching MI to GP Trainees

The research is clear: workshop training alone is not enough to embed MI into practice. The critical factor is observed practice with feedback. This section gives you practical tools for teaching MI through supervised learning.

🎯 Common Trainee Blind Spots

Using open questions but not actually listening to the answer before the next question
Reflecting content but not emotion — missing the feeling behind the words
Affirming generically ("that must be hard") rather than specifically
Moving too quickly to Planning — underestimating how long Evoking needs
The righting reflex returning when the trainee feels behind on clinical content
Confusing MI with being "nice" — not the same thing

💬 Tutorial Prompts & Discussion Questions

"Watch this consultation clip — at what point did the righting reflex appear?"
"What did the patient say that could have been followed as change talk?"
"What might a double-sided reflection have looked like at that moment?"
"If the patient is in pre-contemplation, what's the MOST helpful outcome of this consultation? And the LEAST?"
"What could you have said instead of: 'You really should think about stopping'?"
"How would you rate the patient's readiness to change at the end — and what did you do to influence it?"

🎬 Tutorial Activities

The non-MI vs MI roleplay: Same scenario, twice. First run non-MI style. Then MI. Debrief the difference in how it feels as the patient.
Sentence swap: Give the trainee a list of non-MI phrases and ask them to rewrite each one. Use the Before/After table on this page as a template.
The Readiness Ruler exercise: Trainer plays patient at various readiness levels. Trainee practices the ruler technique and following change talk.
Resistance role-play: Trainer plays a difficult patient — arms crossed, dismissive. Trainee practices discord-dancing in real time.

📊 Assessment Tips for Trainers

Use the MITI coding system (Motivational Interviewing Treatment Integrity) for formal MI skill assessment
Watch for the 50:50 speaking ratio as a rough benchmark in COT reviews
Assess whether the trainee uses psychosocial information in management — not just elicits it (see GP Fluency's Find the IMP framework)
Ask: did the patient generate their own change talk? If yes — MI spirit was present. If the doctor generated it on behalf of the patient — it wasn't.

📚

Evidence Note for Trainers

A BJGP study on MI training in GP found that even a brief 1.5-day residential course significantly changed GPs' consultation behaviour — and the majority maintained this 3 years later. Crucially, GPs trained in MI reported it was not more time-consuming than traditional advice-giving once embedded in practice. The investment is front-loaded, not ongoing.

🎬

MI Video Library

A curated collection of the best MI videos — organised so you can find what you need quickly. These are embedded from the original Bradford VTS page; some may require playlist access.

Foundational lectures from the developers of MI and leading educators. Start here if you want to understand the theory deeply.

🎤

Rollnick on MI — Me, My Skills, My Setting

🔄

The Changing Face of MI by Rollnick

📚

The Theory and Practice of MI

👤

Motivational Interviewing by Miller Himself

🩺

Motivational Interviewing in Practice

🎯

Dr Jonathan Fader Demonstrates MI Skills

⚡

Five Essential Strategies in Motivating Clients

🌀

The Spirit of MI

Focused skills videos — OARS, reflections, decision balance, and more. Use these to polish specific techniques.

🎵

Core Skills in MI — OARS

🌊

OAR Skills in Practice

⚖️

Decision Balance Tool in MI

📋

Kathleen Sciacca — MI Training Video Set (Playlist)

Real clinical scenario demonstrations — the most GP-relevant videos in the collection. Watch, compare, and reflect.

🫁

Asthma

🍺

Alcohol 1

🍺

Alcohol 2

🍺

Alcohol 3

🍺

Alcohol 4

🍺

Alcohol 5

😤

Anger & Domestic Violence

😰

Anxiety

💻

Behaviour — Teenager & Computer

🧒

Behaviour — Bad Behaviour

😔

Depression 1

😔

Depression 2

🩸

Diabetes

🥗

Diet & Weight 1

🥗

Diet & Weight 2

💊

Drugs 1–4

🏃

Exercise

❤️

Hypertension

🚬

Smoking Cessation 1

🚬

Smoking Cessation 2

❓

FAQ

QDo I need to do a whole MI session in a 12-minute GP consultation?

No. Even 2–4 minutes of genuine MI within a standard consultation can shift the dial. The goal is to integrate MI principles into your consulting style — not to run a standalone MI therapy session. Most of the time, a good open question and a couple of skilled reflections is enough to change the direction of the conversation entirely.

QWhat if there isn't time to do MI properly and I need to give advice?

Use E-P-E: ask permission first ("Would it be helpful if I shared what the evidence says?"), give brief information, then immediately elicit their response. Even this small structure significantly improves how advice lands. If you really cannot do MI in this consultation, a useful close is: "This sounds like something worth thinking about. Would you be willing to come back and talk it through?" — planting the seed for next time.

QWhat if the patient wants me to just tell them what to do?

Some patients genuinely want directive guidance — and respecting autonomy means honouring that. Ask: "Would it be helpful if I just shared what I would recommend?" — and if they say yes, share it briefly and then check back: "How does that feel?" The difference is asking permission, being brief, and then checking in — rather than launching into unsolicited advice.

QIs MI only useful in lifestyle and addiction consultations?

Not at all. MI is useful wherever there is ambivalence — which means almost anywhere in GP. Mental health (exploring motivation to engage with therapy), physical health (medication adherence, referral decisions, accepting investigations), social care decisions, and end-of-life conversations all benefit from MI principles. The technique adapts to any context where a patient feels pulled in two directions.

QHow does MI come up in the SCA?

The RCGP explicitly lists MI-style consultations as one of the case types you may encounter in the SCA — including doctor behaviour cases covering lifestyle change, breaking habits, and motivational conversations. Even in cases where MI isn't the primary focus, the interpersonal skills domain (Relating to Others) assesses your ability to communicate in a patient-centred, non-directive way. MI skills are directly rewarded here.

QWhat's the best way to practise MI before my SCA?

Use real consultations in your GP surgery. Every lifestyle or behaviour-change consultation is practice. Video your consultations (with consent) and watch them back — focus on your talk:listen ratio, and on whether you follow change talk when you hear it. Role-play with your trainer using the resistance scenarios on this page. The more you do it in real practice, the less you'll have to think about it in the exam.

🎯

SCA High-Yield Tips

🎯 What Examiners Are Looking For

MI skills are primarily assessed under Interpersonal Skills (Relating to Others). MI-informed consultations also improve Clinical Management scores. The RCGP explicitly lists motivational interviewing as a case type in the SCA blueprint.

Genuine curiosity about the patient's perspective — not going through the motions
Open questions that genuinely open — not closed questions dressed up as open ones
Responding to patient cues rather than following a rigid script
Restraint: showing the righting reflex is under control
Facilitating patient reasoning rather than providing your own
Handling resistance gracefully — adjusting, not pushing
Ending with the patient engaged, not lectured

⚠️ Common Trainee Mistakes

Launching into lifestyle advice without exploring ICE first
Asking closed questions and calling it patient-centred
Three open questions in a row without reflecting between them
Appearing to do MI but not actually listening — scripted empathy
Pushing to Planning when the patient is still in Contemplation
Folding when the patient resists — giving the advice anyway
Using scare tactics ("You're at serious risk of a heart attack")

💡 Quick Wins for Extra Marks

Ask permission before raising a sensitive topic
Name ambivalence explicitly: "Part of you wants this, part isn't sure"
Use the double-sided reflection — examiners recognise it
Follow change talk when you hear it — don't rush past it
End with a patient-generated next step, not a doctor plan
Check confidence as well as willingness
Normalise ambivalence: "Most people feel both ways about this"

🚩

Red Flags Examiners Watch For

Talking more than the patient in a behaviour-change consultation
Repeating the same point more emphatically when the patient doesn't respond
Missing emotional cues and proceeding with the clinical agenda
Providing unsolicited advice after the patient has declined
A consultation ending with the patient passive and the doctor exhausted

💎

SCA Pearl

The SCA doesn't expect you to complete the MI process in 12 minutes. It expects you to demonstrate the spirit of MI. A consultation that ends with the patient thinking rather than advised is often more impressive to examiners than one that ends with a comprehensive action plan.

🗣

Consultation Phrases — MI Style

These phrases are for use in real GP consultations and the SCA. Designed to sound human, not scripted. Read them once — then make them your own.

🚪 Opening & Asking Permission

"How can I help today? Tell me what's on your mind."

"Would it be okay if we spent a few minutes talking about [topic]? I want to understand your perspective on it first."

"I'm not going to lecture you — I just want to understand where you're at with this."

Template: "Would it be okay if we talked about [topic] today? I'd like to hear your thoughts on it first — no agenda from my side."

🔄 Exploring Ambivalence

"What's your own sense about [behaviour] at the moment? Any mixed feelings?"

"It sounds like part of you wants to change this — and part of you is unsure. Is that about right?"

"What do you enjoy about it? And what, if anything, concerns you?"

"If things stayed exactly as they are — what does the next few years look like?"

"And if you did make a change — what would be different? What would be better?"

Template: "So on one hand [reflect the sustain talk side] — and on the other [reflect the change talk side]. That's a real tension, isn't it."

⚖️ Developing Discrepancy (Gently)

"You mentioned that being around for your kids is important to you. How does [the behaviour] sit with that?"

"What matters most to you about your health? Not what should matter — what actually does?"

"Where do you see yourself in five years? What would need to change for that to happen?"

"You've said you want to feel better. What's stopping [the change] from being part of that?"

📊 The Readiness Ruler

"On a scale of 1 to 10 — where 1 is 'not even slightly ready' and 10 is 'completely ready to start today' — where would you put yourself?"

Follow-up (always): "What made you choose [their number] and not something lower?" → elicits their own change talk

Then: "And what would need to happen to move you one step up the scale?"

Confidence version: "And how confident do you feel — 1 to 10 — that if you decided to make this change, you could actually do it?"

💬 Eliciting Change Talk

"What concerns you most about things staying the same?"

"What makes you think a change might be worth it?"

"What would be the best thing about making this change?"

"If you did decide to make a change — what might that look like?"

"You said you 'might think about it.' What would it take to move from 'might' to 'will'?"

✨ Affirming (Specific, Not Hollow)

"It took courage to come in and talk about this today."

"You've clearly been thinking about this a lot — that matters."

"Even cutting down a little shows real effort."

"You've managed difficult things before — that resilience is still there."

"A hundred attempts means someone who keeps trying. That's not failure."

🔁 Reflective Listening Examples

Simple: "So you've been struggling with this for quite a while now."

Amplified: "Sounds like stopping completely is off the table for you." [patient often moderates the position]

Double-sided: "So on one hand, you enjoy it and it's part of your routine — and on the other, you're worried about what it's doing to your health long-term."

Reframe: "You've kept trying, even after setbacks. That says something about you."

Template: "So you're [reflect their main feeling] about [the topic] — and at the same time, [reflect the other side they mentioned]."

🛡 Safety-Netting (MI-Style)

"If things don't improve — or if anything changes that worries you — come back and we'll think about it together."

"I want to be clear about the signs that would mean this needs more urgent attention."

"You can always come back if you'd like to talk this through further — there's no rush and no pressure."

🚪 Closing the Consultation

"How are you feeling about what we've talked about today?"

"Is there anything you'd like to take away from today — even if it's just something to think about?"

"What feels like the most useful thing from this conversation for you?"

"Is there anything else you wanted to cover before we finish?"

💎

SCA Phrase Pearl

The most powerful closing question in an MI consultation is not "Do you have a plan?" — it's "What feels most important to you from what we've discussed?" It leaves the patient with ownership. It scores well. And it takes about four seconds to say.

↔️

Ram's MI Language Swap: non-MI to MI

The difference between MI and non-MI often comes down to the exact words you choose. Below are the phrases trainees most commonly use — and what to say instead.

💡

How to Use This Table

The left column shows what trainees naturally say — often well-intentioned, but triggering resistance. The right shows the MI alternative. Notice the MI version invites; it doesn't tell.

Situation	❌ What trainees often say	✅ The MI alternative
WEIGHT & DIET
Opening	"Your BMI is 35. You really need to lose weight — it's increasing your risk of diabetes significantly."	"How do you feel about your weight at the moment? Is that something you'd like to talk about today?"
Advice	"You should cut down on carbs, eat more vegetables, and aim to exercise three times a week."	"What would it mean for you personally if you felt better in your own body? What matters most to you right now?"
SMOKING
Opening	"Smoking is the single most damaging thing you can do to your health. You really should think about stopping."	"What's your own sense about your smoking at the moment? Any mixed feelings about it?"
Past attempts	"Well you've tried before, but this time with patches and the stop-smoking service, your chances are much better."	"It sounds like stopping isn't a new idea for you. What worked even a little those times you tried? What got in the way?"
ALCOHOL
Opening	"Your alcohol intake is well above the safe limit. At these levels you're at risk of liver damage."	"You mentioned having a drink most evenings. I'm not here to lecture — I'm curious how it feels from your side. What does it do for you?"
Scaling back	"You need to aim for no more than 14 units a week. Have you considered cutting out weekday drinking?"	"If you did decide to change something about your drinking — even slightly — what feels possible?"
MEDICATION NON-ADHERENCE
Not taking tablets	"It's really important you take your blood pressure tablets every day. Missing doses puts you at risk of a stroke."	"I notice the prescription hasn't been collected. Can you help me understand what's getting in the way? I'd rather find something that actually works for you."
EXERCISE
Giving advice	"You're not doing nearly enough exercise. Current guidelines recommend 150 minutes of moderate activity per week."	"What does a typical week look like for you in terms of being active? What would help you feel more energetic day to day?"
REFUSING REFERRAL
Pushing	"I really do think you need to see a specialist about this. It's the right thing to do."	"It sounds like the idea of a referral doesn't feel right for you at the moment. Can I ask — what's behind that?"
NEW DIAGNOSIS / LIFESTYLE CHANGE
Info-dump	"Now that you have diabetes, you'll need to change your diet, start exercising, lose some weight, and monitor your blood sugars."	"You've just had some news that's probably a lot to take in. What feels most important to you right now? Where would you like to start?"

🕺

Dancing with Discord — Rolling with Resistance

💎

The Language Update: From "Resistance" to "Discord"

Miller & Rollnick's 3rd edition replaced "rolling with resistance" with dancing with discord. Discord is a product of the relationship, not just the patient. If a patient is pushing back, ask: "What am I doing that might be contributing?" Are you ahead of their readiness? Pushing when you should be listening? The dance metaphor is deliberate — both partners adjust.

When a patient pushes back, the instinct is to explain more clearly or present more evidence. In MI, you go with the resistance rather than against it.

🍺 "I enjoy a drink. I'm not giving it up." +

"Look, I enjoy a drink. It's one of the few pleasures I have left. I'm not giving it up."

"I understand, but the medical evidence is very clear — at these levels you're risking significant liver damage."

"Sounds like it's genuinely important to you — and I get that. What would you miss most if you did cut back, even a little? I'm not asking you to give it up — just curious what's at stake for you."

Reflect their position without judgment, then explore. The question "what would you miss?" elicits their own ambivalence — far more powerful than your clinical evidence.

🏃 "I have no time for exercise — I have two kids and a full-time job." +

"I just don't have time. I'm working full time, two kids, completely exhausted."

"Even 10 minutes of activity a day makes a difference. You could try getting off the bus a stop early—"

"That sounds genuinely exhausting — you're not making excuses, that's your real life. Given everything you're carrying, what would need to change for being more active to even feel possible? I'm not looking for an answer today — just thinking aloud with you."

Validate fully before exploring. The instinctive response dismisses their reality. The MI response honours it — and opens a door without pushing them through it.

💊 "Once you start tablets you never come off them." +

"I don't want to take tablets for the rest of my life. Once you start, you never come off them."

"That's not quite accurate — many people do reduce medication, especially with lifestyle changes."

"I can hear that the idea of long-term medication feels significant. What does that feel like for you — is it the idea of dependency? Or something else behind it?"

Explore the concern before correcting the belief. Once you understand what's behind it, the right response becomes obvious. And sometimes their concern is more valid than you initially thought.

⚖️ "There's no point trying. I've failed a hundred times." +

"There's no point. I've tried to lose weight a hundred times. Nothing ever works for me."

"I think with the right support and a structured plan, you'd find it much easier this time—"

"A hundred attempts. That's not failure — that's someone who keeps trying. That must be exhausting and demoralising. What happened those times? Is there anything that felt like it was working, even a little?"

Reframe their history as persistence. Then explore what worked. You're building self-efficacy and gathering information simultaneously. The instinctive response minimises their experience.

🚬 "My grandad smoked 40 a day and lived to 90." +

"My grandad smoked 40 a day and lived to 90. I'm fine."

"That's a statistical outlier — your risk is still significantly increased and it's not just about how long you live but quality of life."

"Ha — he sounds like quite a character. I'm not going to argue with your grandad. But I'm curious — when you think about your health in the long run, what matters most to you? Not what should matter — what actually does?"

Side-step the argument entirely. Use light humour, then redirect to their values. You're not fighting over statistics — you're moving somewhere useful.

💡

Key Discord-Dancing Techniques

Simple reflection: "It sounds like you're not ready for that right now."
Amplified reflection: "So quitting entirely is completely off the table." [often softens the position]
Shifting focus: "Let's set that to one side — what matters most to you about your health?"
Agreeing with a twist: "You're absolutely right — this is your life and your choice. And I'm curious what you'd want for yourself."
Reframing: "You've kept trying, even after setbacks. That's actually a real strength."

😤

Handling Passive Resistance & Microaggressions

Sometimes resistance isn't loud. It comes as a heavy sigh, a dismissive "yes yes", an eye-roll. These smaller signals are where MI shines — and where trainees often get thrown off course.

ℹ️

What Passive Resistance Looks Like

Heavy sighing or eye-rolling when lifestyle change is mentioned
Dismissive answers ("yes", "fine", "I know")
Checking phone or looking away
"You're just like all the other doctors"
"I knew you'd say that"
"There's no point talking about it"
"Oh, here comes the lecture..."
Agreeing with everything without genuine engagement

🎭 Patient trigger "You're just like all the other doctors." [frustration or resignation]

✅ MI response

"That sounds like something's felt unhelpful in the past. I'd really like to understand what that's been like — what's felt most frustrating when you've seen doctors about this?"

Why: You validate their frustration without defending yourself. You invite them to tell you what they need — which is exactly what MI does.

🎭 Patient trigger "I knew you'd say that." [dismissive, resigned]

✅ MI response

"What were you expecting me to say? I'm genuinely curious — and it would actually help me understand how to be more useful."

Why: Genuinely curious rather than defensive. Hands control back to the patient. The answer usually reveals exactly what they need.

🎭 Patient trigger Heavy sighing / eye-roll when you mention lifestyle changes

✅ MI response

"I get the feeling this isn't quite landing the way I hoped. Am I right? I'd rather know — I don't want to waste your time or mine."

Why: Naming the dynamic gently is far more effective than ignoring it. It shows self-awareness and genuine interest in the patient's experience.

🎭 Patient trigger "There's no point. Nothing ever changes."

✅ MI response

"That sounds like a really hard place to be — like the effort hasn't been worth it. Can you tell me a bit more about that? I'm not going to try and convince you otherwise — I just want to understand."

Why: You resist the righting reflex. You sit with them in their reality. Change can only start from where they actually are.

🎭 Patient trigger Agreeing with everything without meaning it ("yes, yes, I'll try...")

✅ MI response

"It feels like we've agreed on a plan — but I want to check honestly. On a scale of 1 to 10, how confident do you actually feel about making that change? I'd rather know where you really are."

Why: The confidence ruler breaks through superficial compliance. A patient who says "3 out of 10" gives you something real to work with.

💡

The Universal Re-engagement Move

When the consultation feels stuck: "I get the sense we might be getting in each other's way a little. Can we start again? What would actually be most useful to you today?"
This metacommunication — talking about the conversation itself — is an advanced MI skill. Trainees who can do this in an SCA are demonstrating genuine interpersonal sophistication.

🏁 Final Take-Home Points

1MI is not a technique you bolt on — it is a different way of being in the consultation. PACE (the spirit) matters more than OARS (the tools).
2The most powerful words in a behaviour-change consultation are the patient's own. Your job is to draw them out — not generate them for the patient.
3Match your approach to the patient's stage of change. Action-stage strategies on a pre-contemplator will create resistance every time.
4When resistance appears — reflect, don't push. Discord is information: it tells you something isn't working. Change the approach, not the target.
5Change talk is verbal gold. When you hear it — follow it, deepen it, reflect it back. Don't rush past it to deliver your information.
6The readiness ruler's most powerful question is the follow-up: "Why that number and not something lower?" — it draws out the patient's own case for change.
7E-P-E (Elicit-Provide-Elicit) is the simplest single change you can make to how you give information. Try it in your next consultation tomorrow.
8A consultation that ends with a patient who is genuinely thinking is a success — even if no plan was made. Planting a seed is sometimes the most you can achieve, and it is often enough.
9MI skills improve your SCA scores across all three domains — not just Relating to Others. A patient who feels heard shares more, accepts management plans more readily, and engages with safety-netting more genuinely.
10The most important thing to practise is not the phrases — it's the listening. Read these once, then go and consult. The rest follows.

Page created by Bradford VTS | bradfordvts.co.uk | For educational use only

MI is based on these assumptions:

how we speak to people is likely to be just as important as what we say
being listened to and understood is an important part of the process of change
the person who has the problem is the person who has the answer to solving it
people only change their behaviour when they feel ready – not when they are told to do so
the solutions people find for themselves are the most enduring and effective.

In this scenario, the person makes an instant decision to quit smoking. There’s an emotional stimulus which causes a shift in perception and meaning resulting in increased readiness to change. He must have had been at a stage of ambivalence before today (i.e. wanting to stop but also not wanting to stop) and this moment has resulted in a resolution of that ambivalence and the crystallisation of discontent (i.e. the last straw).

Does MI work?

Clinical trials have shown that patients exposed to MI (versus treatment as usual) are more likely to enter, stay in and complete treatment, participate in follow-up visits, decrease alcohol and illicit drug use and quit smoking.

Look how the patient changes from an aggressive state to a change-talking state in this video clip. Prof. Rollnick uses Motivational Interviewing skills exceptionally well to work WITH the patient and not react adversely to the patients aggrievances.

(PS On a medical note – I’m more interested in the lesion on this patient’s nose!)

“A few well chosen words or a thoughtful question can be worth more than many mouthfuls of busy talk”

Compare these two approaches

Without doing any deep analysis – which is better in terms of engaging and working WITH the patient? If you were the patient – step into their shoes for a moment – which would scenario would you feel most comfortable in?

A NON-Motivational-Interviewing Approach

A Motivational-Interviewing Approach

Motivational Interviewing Videos - lectures

Rollnick on MI – me, my skills, my setting

The changing face of MI by Rollnick

The Theory and Practice of MI

Motivational Interviewing by Miller himself

Motivational Interviewing in Practice

Dr. Jonathan Fader Demonstrates Motivational Interviewing Skills

Five Essential Strategies in Motivating Clients to Change

The Spirit of MI

Motivational Interviewing Videos - specific skills

Core Skills in Motivational Interviewing (OARS)

OAR skills

Decision Balance Tool in Motivational Interviewing

Motivational Interviewing Videos - specific clinical scenarios

Asthma

Alcohol 1

Alcohol 2

Alcohol 3

Alcohol 4

Alcohol 5

Anger & Domestic Violence

Anxiety

Behaviour – teenager & computer

Behaviour – bad behaviour

Behaviour – more bad behaviour

Depression 1

Depression 2

Diabetes

Diet & Weight 1

Diet & Weight 2

Drugs 1

Drugs 2

Drugs 3

Drugs 4

Exercise

Hypertension

Smoking Cessation 1

Smoking Cessation 2

Motivational Interviewing

FOUNDATIONS — downloads, resources & core concepts

📥 Downloads

Web Resources

⚡ Quick Summary — If You Only Read One Thing

Why MI Matters in General Practice

Does MI Actually Work?

Not Just for Addictions

What Is Motivational Interviewing?

🧱 Core Assumptions

🚫 What MI Is NOT

🥊 Why MI Feels Better Than Arguing — For Everyone

🔵 MI Differs Substantially from Aggressive or Confrontational Styles

🌀 The Spirit of MI — PACE

Partnership

Acceptance

Compassion

Evocation

Insider Tip

"But I don't want to change my consultation style..."

Stages of Change

The Most Common GP Mistake with the Change Cycle

The "Crystallisation of Discontent"

MI SKILLS & FRAMEWORK — OARS, processes, principles & the consultation

The OARS Framework

Open Questions

Affirming

Reflective Listening

Summarising

The 4 Processes of MI

Engaging

Focusing

Evoking

Planning

Insider Tip: Don't Rush to Planning

The 5 Principles & RULE Mnemonic

📋 The 5 Principles

Express Empathy Through Reflective Listening

Develop Discrepancy

Avoid Argument & Direct Confrontation

Adjust to Resistance (Dance with Discord)

Support Self-Efficacy & Optimism

🔑 The RULE Mnemonic (Rollnick et al., 2008)

Resist

Understand

Listen

Empower

⚠️ The Righting Reflex

MI in the 12-Minute GP Consultation

🗺 The Rough Structure

Minutes 1–2: Engage & Assess Readiness

Minutes 3–6: OARS — Explore Ambivalence

Minutes 7–9: Develop Discrepancy & Evoke

Minutes 10–12: Plan if Ready / Bridge if Not

🎤 Eliciting Change Talk: DARN-CAT

Desire

Ability

Reason

Need

Commitment

Activation

Taking Steps

When You Hear Change Talk — Follow It

💬 The Readiness Ruler

MI in Common GP Scenarios

🚬 Smoking Cessation

🍺 Alcohol Reduction

⚖️ Weight / Diet

💊 Medication Adherence

🏃 Exercise & Activity

📋 Refusing Referral / Investigation

INSIDER WISDOM — from trainee experience, GP educators, and real practice

From the Training Floor — What Trainees Actually Find

Reading About MI ≠ Doing MI

The "Video Yourself" Revelation

The Briefest MI Works Remarkably Well

IMGs: The Direction of Travel is Different

The SCA Scores Better Across All Domains with MI

The Briefer Your Advice, the More Powerful

🔁 Elicit-Provide-Elicit (E-P-E)