Practical motivational interviewing techniques for busy GPs

Behaviour change is rarely straightforward. Patients often can see the benefits of making a change while also recognising the barriers, costs or challenges involved.

That’s where Motivational Interviewing (MI) can help.

“Motivational Interviewing is a way of helping people identify their own reasons for change,” says Dr Kylie McKenzie, a clinical psychologist, MI trainer and researcher whose PhD explored how MI can support collaborative care in primary care settings. “It helps clinicians navigate ambivalence in conversations about behaviour change.”

Developed by psychologists William Miller and Stephen Rollnick, MI is widely taught in Australian GP training and recognised as an important approach for supporting health education and behaviour change.

Motivational Interviewing is: Collaboration, Evocation, Acceptance, Compassion

MI is built around four key principles.

• Collaboration: Working in partnership with your patient, recognising that while you bring clinical knowledge, they are the expert in their own life.
• Acceptance: Respecting the patient's perspective, autonomy and right to make their own decisions.
• Compassion: Keeping the patient's wellbeing at the centre of the conversation.
• Evocation: Drawing out a patient's own motivations, goals and values rather than trying to persuade them.

How MI Differs from Advice-Giving and Why That Matters in a Short Consultation

Patients often already know what they should do. The challenge is understanding the ambivalence that's getting in the way.

“It's unusual for people to think, 'I need to change something,' and then simply run with it,” says McKenzie. “People usually have both sides of that argument within them.”

In a short consultation, it can be tempting to focus on providing more information or advice. In MI, this is described as the "righting reflex", which is the urge to persuade the patient or convince them to change.

But when ambivalence is the real barrier, that approach may not move the conversation forward.

“Motivational interviewing is about drawing out what's important to the patient. It's quite different from advice-giving,” McKenzie continues. “A lot of doctors do this naturally already, but MI offers a way of operationalising those person-centred skills.”

The Core Skills: OARS Motivational Interviewing in Practice

Much of the practical application of MI centres around four communication skills known as OARS. The following examples are adapted from guidance published in the RACGP's Motivational Interviewing Techniques: Facilitating Behaviour Change in the General Practice Setting.

Open-ended questions

Encourage patients to reflect rather than provide yes-or-no answers. This helps patients do most of the talking and gives you a chance to better understand motivations. For example, instead of asking "Are you concerned about your drinking?", ask "Can you tell me more about your concerns around drinking?"

Affirmations

Recognise a patient's strengths and efforts, helping build rapport, confidence and self-efficacy. You could say: "It took a lot of courage to talk about this today" or "You've shown a lot of resourcefulness in managing these challenges."

Reflective listening

This involves rephrasing what a patient has said to capture both the meaning behind their words and encouraging further exploration. For example: "Alcohol helps you unwind after a stressful day, but you're also beginning to worry about the impact it's having on your health."

Summaries

Bring together key points from the conversation, check mutual understanding and highlight discrepancies between a patient's current situation and future goals. You might say: "Let me check I've understood. You're concerned about your drinking and the impact it's having on your health, but previous attempts to cut back haven't been easy?”

Recognising Change Talk and Sustain Talk

Patients often express reasons both for and against change within the same conversation. In Motivational Interviewing, these are called change talk and sustain talk.

What Change Talk Sounds Like — and How to Draw It Out

"Change talk is any statement a patient says that is in the direction of the change that comes from the person," says McKenzie.

This might sound like:

• "I'd like to quit smoking."
• "I want to be able to run around with my kids."

Sustain talk is the opposite. It reflects the reasons a patient gives for staying the same.

• "Smoking helps me manage stress."
• "I don't have time to exercise."

Use open-ended questions to elicit change talk and explore a patient's own motivation for change.

Responding to Resistance Without Confrontation

The goal isn’t to argue against sustain talk but to create opportunities for patients to express their own motivations for change.

"The more you try and convince somebody to do something, the more they're weighing up the arguments inside of them," McKenzie says.

Patients may push back when they feel unheard, judged or pressured. Instead of responding with more advice or trying to correct them, MI encourages clinicians to acknowledge and reflect on their perspective.

McKenzie recalls observing a trainee psychologist conducting a pain assessment when a patient responded: "What would you know? My pain's older than you."

Instead of becoming defensive, the trainee replied: "You're wondering whether I'll be able to help you."

"When you do that, people don't hold on to that discord so much," says McKenzie.

Reinforcing patient autonomy is another way to keep difficult conversations collaborative rather than confrontational.

Using Motivational Interviewing techniques in the Brief GP Consultation

In each of these examples, the goal is to channel empathy, use active listening, and elicit change talk. This creates the foundation for collaborative goal-setting and realistic treatment plans.

While Motivational Interviewing techniques can be incorporated into routine consultations, meaningful behaviour change often requires continuity of care. Revisiting conversations over multiple appointments, or booking longer consultations where appropriate, gives patients the time and support needed to explore ambivalence and build lasting change.

Scenario 1: Smoking Cessation

A patient acknowledges that smoking is impacting their health, but says it helps them cope with stress.

Ask: "What would be different if you were able to cut back or quit smoking?"

The conversation explores both the benefits of smoking and the patient's reasons for wanting things to change.

Scenario 2: Medication Non-Adherence

A patient has been avoiding taking their blood pressure medication.

Rather than immediately explaining the risks, ask: "Tell me a bit about what's been getting in the way of taking the medication."

The conversation focuses on understanding barriers before discussing possible solutions.

Scenario 3: Weight Management and Lifestyle Change 

A patient wants to lose weight and improve their quality of life, but feels overwhelmed by the idea of major lifestyle changes.

Ask: "What opportunities do you have to move more during the day?"

Rather than focusing on what the patient should do, the question encourages them to identify their own opportunities for change and potential next steps.

Common Pitfalls of Motivational Interviewing and How to Avoid Them

One common mistake is assuming MI is the right approach for every situation. 

“Motivational interviewing techniques are less helpful when somebody comes with a really strong sense of resolve,” says McKenzie. “It’s also most useful when patients have a genuine choice. Where there is only one option or no meaningful opportunity for autonomy, other approaches may work better.”

Motivational interviewing: helping people change

"As health professionals, I think we get a little bit excited with jumping in to convince people to change," says McKenzie. "MI has its real use in helping us hold back and explore ambivalence." 

As McKenzie concludes, clinicians don't need to "take all the good lines". Instead, listen for and reinforce the patient's own reasons for change:

• "I want to..."
• "I can..."
• "I have reasons to..."
• "I need to..."

Those are the “good lines” every doctor wants to hear. 

Motivational Interviewing checklist

• Did I ask at least one open-ended question?
• Did I spend more time exploring than advising?
• Did I ask what the patient already knows before providing information?
• Did I reflect back what I heard rather than immediately moving to another question?
• Did I acknowledge the patient's strengths, efforts or successes?
• Did I listen for signs of change talk?
• Did I respond to resistance with curiosity rather than persuasion?
• Did I explore what matters most to the patient?
• Did I emphasise the patient's autonomy and ability to choose?
• Did I help the patient identify their own next step?