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4 Principles of Motivational Interviewing – "REAL" R – L – E – A

R – Righting Reflex / Resistance
Doctors are trained to diagnose and then make things right. We want to tell patients what to do in order to fix them ("righting reflex"). When you feel yourself doing this and/or you feel the patient’s resistance, think Motivational Interviewing. Recognize the patient is in control. One way to do this is to ask for permission: "Would you be willing to discuss your smoking?"

L Listen in order to Understand and Empower
Take 5-15 minutes to turn away from the computer and actively listen to the patient and her/his story. Use this understanding to offer sincere empathy and generate rapport. Use Reflective Listening: "What I hear you saying is that drinking helps you manage your stress."

E Effortless Empathy
Express empathy with sincerity. By hearing the patient's story and understanding her/his plight on a deeper level, this allows the doctor to build trust and collaboration, generate rapport, and to appear sincere.

A – Ambivalence
Through active listening, uncover discrepancies between the patient’s behavior and values and reflect them back to the patient. This helps patients figure out what they are doing vs. what they want to be doing.

Author(s): Wayne Altman, M.D.
Created: Thursday October 25, 2012
Modified: Friday December 14, 2012

Copyright Information: Copyright 2012, Tufts University

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