Motivational Interviewing - A Post for GPs
Motivational Interviewing in General Practice: A Practical Psychotherapy Tool for Everyday Use
Motivational Interviewing (MI) is one of my favourite tools as a psychologist—and one that integrates seamlessly into the general practice consultation. While the name might conjure images of charismatic coaching à la Tony Robbins, the true spirit of MI is quite the opposite. It’s a calm, respectful, and collaborative conversation style that meets the patient exactly where they are—without judgement or coercion.
At its heart, Motivational Interviewing is about fostering change by enhancing intrinsic motivation. Developed by William Miller and Stephen Rollnick in the early 1980s in the context of substance use treatment, MI has since been applied widely across health settings. It is grounded in the transtheoretical model of change, recognising that people move through a series of stages:
Precontemplation → Contemplation → Preparation → Action → Maintenance
In clinical terms, this means that a patient’s readiness to change is dynamic, not static—and pushing for behavioural change before a patient is ready often leads to resistance or disengagement.
Why MI Belongs in the GP Consultation
General practice is often the first and only point of contact for individuals struggling with ambivalence toward behaviour change. GPs are uniquely positioned to initiate conversations that can gently nudge patients toward a more reflective stance—one that plants the seeds for change.
You may already use elements of MI without labelling it as such. But for those new to the approach, MI can be particularly useful for conversations around:
Alcohol or substance use
Smoking cessation
Medication non-adherence
Weight management and lifestyle-related change
Chronic disease self-management
Mental health engagement
Follow-through with specialist referrals or allied health plans
The Dual Focus: Importance and Confidence
Motivational Interviewing centres on two critical themes: the importance of the change to the individual, and their confidence in being able to achieve it. Exploring both of these dimensions helps patients uncover their ambivalence and begin to resolve it.
Here are some foundational MI-style questions you might incorporate in brief consultations. They are not scripts, but conversation starters, useful when you notice resistance or low engagement in a care plan. These are great questions to ask yourself if you are journaling or reflecting on change.
Exploring Importance (Why change?)
“What would need to happen for you to seriously consider making a change here?”
“Why have you given yourself a [X] out of 10 for importance, rather than a lower score?”
“What would it take for your importance score to move from [X] to [Y]?”
“What are some of the upsides to continuing things as they are? And the downsides?”
Exploring Confidence (Can I change?)
“What would make you feel more confident about giving this a go?”
“Why did you score your confidence a [X] rather than zero?”
“If you were to try, what might be your first step?”
“Do you know of anyone who’s made a similar change? What did they find helpful?”
Closing Thoughts
In a time-pressured consultation, it's not always possible to walk through every ambivalent layer. But even a few well-placed MI-informed questions can shift a patient’s internal dialogue—from resistance to reflection, from passivity to ownership. This is especially powerful in chronic care conversations, where long-term engagement is the goal.
MI doesn’t require you to fix the problem in one go. It simply asks you to hold space for ambivalence and trust that change unfolds through respectful, person-centred dialogue. As Miller and Rollnick remind us: “People are more likely to be persuaded by what they hear themselves say.”