DEFINITION OF MOTIVATIONAL INTERVIEWING

Motivational interviewing (MI) is a technique that originated in the field of substance abuse
treatment [43]. The foundation of MI is a nonconfrontational, patient-based counseling approach
to behavior change [44], rather than a provider-directed approach [45]. Although MI has been used
mainly in the substance abuse realm, MI employs techniques that may be applicable to a variety
of behavior changes [43]. Recent studies have suggested the use of MI in health promotion and
disease management [46].
VanWormer and Boucher [46] suggest four guiding principles of MI. The first principle is to
express empathy. The health professional should listen to the patient with respect and expect
ambivalence and reluctance to change [43]. The second guideline involves discrepancy development
[48]. Developing discrepancy involves reviewing the pros and cons of behavior change [43]. The
health professional should call attention to a current behavior pattern and future goals, thus
increasing motivation from the patient for a lifestyle change [46]. The third principle is rolling with
resistance [46]. Although resistance should be expected, the health professional should try to steer
this resistance to motivation [43]. The health professional should try to provoke a new perspective
from the patient [46]. The fourth and final guideline is to support self-efficacy [46]. Because a
patient’s self-efficacy is one of the greatest predictors of treatment outcome [46], the patient’s
autonomy and confidence should be encouraged and supported by the health professional [43].
Some of the same principles addressed earlier in this chapter and in Chapter 14, such as selfefficacy
and readiness to change assessments, can be employed in MI.
To successfully use MI, the health professional should develop his or her interaction techniques.
These involve such skills as asking open-ended questions, affirming statements of recognition, and
reflective listening [43]. These techniques will help create an environment in which the patient
feels at ease to discuss what is important to him or her [45]. MI may be particularly useful in the
medical setting because it offers a briefer, alternative approach for intervening with patients (with
some meetings as brief as 20 minutes), compared with psychotherapy (typically a series of
50-minute settings) [43].
Consideration of psychosocial factors is a common recommendation in a comprehensive approach
to pediatric weight management. This chapter provides a framework for thinking about the different
elements encompassed within the psychosocial domain. A challenge is to appreciate that common
themes are present among many obese children presenting for weight management but that for any
one child the specific set of contributing factors is unique. Furthermore, the resources available to
make lifestyle changes as well as the barriers to change that are present must be appropriately
identified. The high prevalence of pediatric obesity and the tremendous diversity of the clinical
population require both a structured and flexible approach at the same time. Herein lies the
foundation of patient-centered care as well as a broad opportunity for future research addressing
fundamental unanswered questions.