Motivational Interviewing

Motivational Interviewing (MI)

What is Motivational Interviewing?

Motivational Interviewing is a collaborative, person-centered counseling approach designed to strengthen motivation for change. Developed by William Miller and Stephen Rollnick, MI is particularly effective for addiction treatment.

The Spirit of MI

MI is defined by its spirit more than its techniques:

Partnership

Collaborate WITH the patient, not ON them
Expert on addiction + Expert on their own life
Avoid the "expert trap"

Acceptance

Absolute worth of the person
Autonomy—their right to choose
Accurate empathy—understanding their perspective
Affirmation—noticing strengths

Compassion

Prioritize the patient's welfare
Their best interests guide the conversation
Not about your agenda

Evocation

Draw out their own motivation
They have the answers within
Your job is to help them find it

Core Skills: OARS

O - Open-Ended Questions

| Closed | Open | |--------|------| | "Do you want to quit?" | "What concerns do you have about your use?" | | "Have you tried before?" | "Tell me about your previous experiences with change." | | "Is your family supportive?" | "How does your family feel about your situation?" |

A - Affirmations

Recognize strengths, efforts, and values:

"It took courage to come here today."
"You've shown real dedication to your family."
"Despite everything, you've kept trying."

Tip: Affirm the person, not just the behavior.

R - Reflections

Mirror back what you hear to show understanding:

Simple Reflection: Repeat or rephrase

Patient: "I know I should stop, but it's so hard." Provider: "It's been really difficult."

Complex Reflection: Add meaning or feeling

Patient: "I know I should stop, but it's so hard." Provider: "Part of you wants to stop, and part of you isn't ready to let go of what it gives you."

S - Summaries

Collect what's been said:

"Let me see if I understand..."
Include both sides of ambivalence
End with an open question

Change Talk vs. Sustain Talk

Change Talk (DARN-CAT)

Desire: "I want to..." Ability: "I could..." Reasons: "I would feel better if..." Need: "I have to..." Commitment: "I will..." Activation: "I'm ready to..." Taking Steps: "I already started..."

Your goal: Elicit and strengthen change talk.

Sustain Talk

Arguments for the status quo:

"I can't imagine life without it."
"It's not that bad."
"I've tried before and failed."

Your response: Don't argue. Reflect, then gently redirect.

The Righting Reflex

Healthcare providers naturally want to fix problems. But arguing FOR change often pushes patients AWAY from change.

The Righting Reflex in Action:

Patient: "I don't think I'm ready to quit." Provider: "But think about your health! Your family!" Patient: "It's not affecting them that much..."

MI Approach:

Patient: "I don't think I'm ready to quit." Provider: "You're not sure this is the right time. Tell me more about that." Patient: "Well, I am worried about my job..."