Interviewing in Health Psychology

Motivational interviewing is an empathetic counselling approach centered on the patient
and prepares them for change by enhancing intrinsic motivation, resolving ambivalence, and
building confidence to adopt change (Kraybill and Morrison, 2007). It provides a foundation for
helping people develop the rationale to adopt change in their lives. Motivational interviewing is
an egalitarian “way of being” that employs a communication style characterized by shared
decision-making, reflective listening, and change talk (Dasgupta et al., 2012). It is used in non-
clinical care settings to help people improve diet quality, physical activity and adhere to a
medication regimen. This paper provides a transcript of a conversation that I would have as a
health coach in a community health center with a 15-year-old female, who we will call Anna for
purposes of this paper, who recently has trouble adhering to her medication regimen.
Script
Health coach: Good afternoon, Anna, how are you doing today?
Anna: I am doing fine, how about you?
Health Coach: I am good, thank you. I understand that you have been having difficulty taking
your medication. Is that something you would like to talk about?
Anna: Aaaah, yes. I have for a long time not been in charge of my medication. My parents
always helped me with that until two years ago.
Health Coach: Okay.

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Anna: So, two years ago, my parents decided I was mature enough to be in charge of my
medication. I did not have an issue with that and have been taking the drugs well for over two
years now.
Health coach: You say that you have been taking the medication well for two years now. What
has changed?
Anna: Yes, I faithfully took the drugs until about four months ago when I realized I did not want
to live like this anymore.
Health Coach: You did not want to live like this? What do you mean “like this?”
Anna: I mean, I felt that my life depended on drugs. I wanted to live without having to take drugs
every day. Since I was a child, and for as long as I can remember, I have been on medication.
This is not the life I want for myself.
Health Coach: But you were in self-management care where you administered the drugs yourself
for two years without fail. What has changed, and now you do not want the drugs anymore?
Anna: I got tired of the routine. All of a sudden, the thought of taking drugs drained me, and I
felt that I wanted something else for my life.
Health coach: What” something else” did you want?
Anna: I want a healthy life. My friends do not take drugs as I do, and they are doing just fine. For
once, I wanted such a life.
Health Coach: Having friends who seem like their health is better than yours made you feel like
you should also stop taking medication?
Anna: Precisely.

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Health coach: And has the feeling changed?
Anna: yes.
Health Coach: How so?
Anna: I realized that to be healthy, I needed my medication.
Health coach: what made you realize that?
Anna: I got a report from the doctor that I have some symptoms of wheezing. Although I feel
and appear perfectly fine, I still need my medication to be absolutely fine.
Health Coach: during this session, we will look at some strategies that will help you get back to
your medication regimen and adhere to it. Are you okay with that, or have you since changed
your mind?
Anna: I am absolutely fine with it. I have tried getting back to it on my own, and that has proved
futile. I acknowledge that I need help to change and get back to the medication regimen. Insert a
comment with the following words: Anna is at the contemplation stage (Rollnick et al.,
2008). She is thinking of change. Although she enjoys not taking medication like her peers,
she understands the complications that may arise from that.
Health Coach: what makes you think that you are ready to get back on track and faithfully take
the drugs?
Anna: I want to be healthy, control the asthma symptoms and reduce my visits to the doctor.
Health coach: On a scale of 1-5, how important are these changes to you right now?
Anna: I would say a 5.

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Health Coach: Do you believe you can make these changes? (Add this comment: at this point,
the health coach is introducing change talk. Resnicow & McMaster (2012) state that
questions are asked to assess the importance that the client attributes to change and their
level of confidence to actually make the changes.)
Anna: Yes, I believe I can take the drugs as prescribed without failing. I have done it before, and
I can do it again.
Health coach: What do you think you should do to get back to the medication regimen?
(Comment: the practitioner promotes autonomous behavior change by involving the
client’s perspectives in the change process).
Anna: I can start by setting a reminder on my phone so that I can take them in a timely manner.
This will help ensure that I do not forget, as sometimes I find myself forgetting.
Health coach: apart from setting the reminder, what else can you do to ensure you do not skip
taking the drugs?
Anna: I can also have separate packages, one in my school bag and one at home. This will ensure
that I take the drugs even when at school, as I was doing without fail. Sometimes I forget to carry
the drugs from home, and this earns that I miss the lunch break drugs.
Health coach: That is a good plan, Anna. (insert comment: the practitioner acknowledges
Anna’s autonomous reasons for change and responds in the affirmative to confirm that the
ideas are good. DiClemente et al. (2017) assert that autonomy is critical to the change
process).
Anna: Thank you. I am positive I will stick to the new plan.

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Health Coach: On a scale of 1-10, how confident are you that you will stick to this plan and
make it work?
Anna: On this one, I would say 3.
Health Coach: why not even a 5? What do you think would make your confidence level a
number high?
Anna: well, I would say that I once tried doing it, and it still did not work. I am not very sure that
it will work this time around.
Health coach: in your opinion, why did the plan not work the first time?
Anna: I was not committed. I can say that I am to blame one hundred percent that the plan failed.
I would carry the pills to school and still skip taking them even after the reminder goes off. I had
gotten tired of taking the medication.
Health Coach: what has changed this time? Why stick to the same plan even after it failed to
work the first time?
Anna: I had a plan but lacked the willingness to implement it and make it work.
Health coach: are you ready and willing to make it work at this time?
Anna: Yes. I am very willing. This time I want it to work because I want to ensure that I restore
my health. I know that as much as I hate taking medicine, this is the only way I can be healthy
and functional optimally.
Health Coach: I can see your dedication and determination to change. I am satisfied with your
plan and commitment to change. Is there a way I can be of help?

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Anna: yes, I would like you to keep me accountable. Just once in a while, I will check in so that I
can brief you on my progress.
Health coach: I will be glad to do that. In the subsequent sessions, we will continue tracking the
progress and see what we can change or adapt to ensure the changes work.
Anna: thank you very much for your time.
Health coach: you are welcome. Just something more, I would like you to write down things you
still want to work on as pertains sticking to the plan, and we can discuss them in the next session.
Anna: Alright, I will do that. See you next time. Thank you once again.
Health coach: see you next time. All the best.
Conclusion
Overall, the script shows various motivational interviewing techniques being applied in the
conversation. The conversation progressed quite well. The girl is willing to change and has a
plan. She needs support implementing the plan and sticking to it. The health coach affirms her
ideas and triggers an autonomous behavior change. It is great when the change ideas originate
from the client, as implementing them is easier (Butterworth et al., 2006). The client is set to
implement the change plan.

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References

Butterworth, S., Linden, A., McClay, W., & Leo, M. C. (2006). Effect of motivational
interviewing-based health coaching on employees’ physical and mental health
status. Journal of occupational health psychology, 11(4), 358.
Dasgupta, K., Hajna, S., Joseph, L., Da Costa, D., Christopoulos, S., & Gougeon, R. (2012).
Effects of meal preparation training on body weight, glycemia, and blood pressure:
results of a phase 2 trial in type 2 diabetes. International Journal of Behavioral Nutrition
and Physical Activity, 9(1), 1-11.
DiClemente, C. C., Corno, C. M., Graydon, M. M., Wiprovnick, A. E., & Knoblach, D. J.
(2017). Motivational interviewing, enhancement, and brief interventions over the last
decade: A review of reviews of efficacy and effectiveness. Psychology of Addictive
Behaviors, 31(8), 862.
Resnicow, K., & McMaster, F. (2012). Motivational Interviewing: moving from why to how
with autonomy support. International Journal of Behavioral Nutrition and Physical
Activity, 9(1), 1-9.
Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational interviewing in health care:
helping patients change behavior. Guilford Press.