Theory and Practice of Contemporary Psychotherapies

Motivational Interviewing Evoking Commitment to Change Video Transcript

Dr. Marjie H: Hello, I'm Dr. Marjie Harbrecht, Medical Executive Director the Colorado Clinical Guidelines Collaborative. Changing behavior is one of the most difficult things to do. Whether it's for ourselves or for our patients. In this brief video, we will demonstrate a few motivational interviewing techniques to make your job a little easier by helping find a focus to engage patients in becoming healthier. The goal is not only to activate patients to make a needed change, but to help them sustain that change through learned self-motivational techniques.

Male Doctor: Hi John. Nice to see you again. So, tell me, how are things going?

John: Well, doc, I know you told me that I needed to lose weight. And even though the scale didn't show it today, I was able to lose about five pounds. But then, I gained it right back.

Male Doctor: Well, I appreciate you bringing your weight to forefront. Do you mind if we explore this issue further?

John: No, by all means. I know we have to discuss it.

Male Doctor: Alright. Well, it sounds like you've been struggling with your weight recently. And I understand how difficult it is to lose the weight and then have it come back again. So tell me what you did to lose that initial five pounds?

John: I started watching what I ate, and I ate less. I've been eating more fruits and vegetables. I've also been walking more. I'm walking up to 20 minutes a day now. I saw the weight come slowly off. And I felt better. But then when I watched it come back on again, I gave up.

Male Doctor: But you did have some success. Tell me how you felt when you lost the weight.

John: I felt great. I felt really proud of myself. I felt that this was something that I could do.

Male Doctor: Okay, well, it sounds like you realize that when you lost the weight, you felt better. And that's going to affect your overall health. So tell me what you think changed that caused you to gain the weight back?

John: Well, I think it's because I've been eating more fruits and vegetables. That's it.

Male Doctor: And how many servings of fruits and vegetables on average per day would you have?

John: To be honest, I have four to six glasses of orange juice a day. I have fruit for lunch and breakfast. I have usually one to two servings of a vegetable, like lettuce or broccoli, with dinner.

Male Doctor: John, it's very important that you recognize that some fruit, but especially fruit juice, can contain a huge amount of calories. Did you know that a glass of orange juice as almost as many calories as a can of cola?

John: No. I didn't know. But doesn't the food pyramid classify fruit juice as a serving?

Male Doctor: You're absolutely right. But keep in mind that the food pyramid is to be used as a guideline only. When it comes to nutrition, we have to have a more personalized approach. So I have a hunch. And that is the excess fruit that you are consuming probably caused your weight rebound. What's your impression?

John: Well, this changes quite a bit. Here, I'm thinking that my fruit intake is making me healthier and actually it's making me fatter.

Male Doctor: Indeed. Let me ask you something. Knowing what you know now, how important is it to you to lose the weight by decreasing the amount of juice that you're currently taking in?

John: Obviously, I need to cut back on the fruit juice. But boy, do I love that OJ.

Male Doctor: I understand. Let me ask you this, on a scale from 0-10, 0 meaning there's no way you can do it and 10 meaning you're 100% confidence that you can do it, how confident are you that you'll be able to reduce the amount of juice you're currently taking in?

John: Six or seven.

Male Doctor: Alright, so you're not a zero. So that tells me that you've got some confidence that this is doable. This is something that you certainly can do. Why are you not a zero?

John: I guess it's because I know that I need to do it to lose the weight.

Male Doctor: So you realize, again, that if you decrease the amount of juice you're taking in, you're going to decrease your weight, you're going to feel better, and you're going to impact your health positively.

John: Yes.

Male Doctor: But you're also not a 10. And that tells me that there may be some obstacles to your success. What would take for you to be a 10 or even an eight or nine?

John: Getting the fruit juice out of the house. Because if I know if it's there, I'll drink it. My wife does the shopping for us, so maybe if I ask her not to get the juice, that would solve it.

Male Doctor: Okay. Now if the juice was still there, can you think of anything else you could do?

John: I suppose I could replace it with low calorie drink or drink more water.

Male Doctor: Excellent. John, I get the impression that you want to stay on course with weight reduction. And the best way to do this will be to decrease the amount of juice that you're currently taking in. So I saw you in two weeks, and I asked you how much juice you're drinking and how you did it, what would you tell me?

John: I'd say I didn't have any and I substituted it with sugar free drinks.

Male Doctor: Excellent. Well, it sounds like you have a plan. Same scale. 0-10. How confident are you that you can make this happen?

John: 10.

Male Doctor: I agree. Alright, well you know what? I'm not going to start any medication today. Your labs were a little bit off, but I think we can handle this from a purely lifestyle standpoint. What do you think?

John: Great. Sounds good to me.

Male Doctor: Excellent. I'll see you in two weeks.