Motivational Interviewing (MI)

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.

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

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 (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.

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..."

Resistance is information, not opposition.

Roll With It

• Don't argue
• Reflect the resistance
• Explore the underlying concern

Reframe

• Offer a new perspective
• "Your stubbornness could also be called determination."

Emphasize Autonomy

• "Only you can decide when you're ready."
• "Whatever you choose, I'm here to help."

Patient: "My wife made me come. I don't think I have a problem."

Poor Response: "Your drinking is clearly affecting your marriage. Let's talk about treatment options."

MI Response: "Your wife is concerned, and you see things differently. Help me understand your perspective on your drinking."

Ready to practice your MI skills? Try having a conversation with Dr. Arjun where you role-play as a patient. Notice how the AI:

• Uses open-ended questions
• Reflects your statements
• Avoids arguing
• Elicits your own motivation

Practice MI with Dr. Arjun →

📚 Learn More

• Practice MI conversations with ChatGPT
• Explore MI techniques with Claude