Motivational Interviewing

Motivational Interviewing is a therapeutic approach intended to increase a patient's intrinsic motivation to make a behavior change. MI does not replace an EBP, but rather serves as an adjunct to help a patient decide to engage in the EBP treatment and then to continue to enhance the patient's motivation. Below you'll find forms, documents, and other resources for providers on Motivational Interviewing. If there are other forms or resources you'd like to see, let us know and we'll try to add them.

Using Motivational Interviewing Style

Facilitating motivation is a crucial aspect of all evidence-based psychotherapies. Building motivation to engage in EBPs is necessary at the outset of treatment, and maintaining patient motivation throughout treatment is vital, but often challenging. Motivational Interviewing is a popular and thoroughly researched set of techniques that may be used to prepare a client for EBPs or to sustain client engagement throughout therapy.

What is Motivational Interviewing, anyway?

  • A client-centered, directive method for enhancing intrinsic motivation to change
  • Focused on exploring and resolving ambivalence
  • The rationale is that the desire for change must be intrinsic. The therapist is unable be with the patient outside of the therapeutic setting, where the patient spends most of their time!

What are some key differences between Motivational Interviewing and other clinical techniques?

  • Collaboration vs Confrontation
  • Evocation vs Education
  • Autonomy vs Authority

How do I engage in a Motivational Interviewing conversation in my practice?

  • Gently focus on the discrepancy between the desired outcome and the present circumstances
  • Keep in mind this generally refers to the patient’s desired outcome, but there may be situations in military settings where a desired outcome is largely predetermined (e.g. substance abuse treatment)
  • Use responses designed to encourage the patient to verbalize “change talk” as much as possible. These generally include non-judgmental open-ended questions , affirmations, using reflective statements, and summarizing (known as ‘OARS’). Questions should be limited and balanced with statements and summaries.

So what is “Change Talk”?

  • Talking about disadvantages of the status quo (the present)
  • Talking about advantages of change
  • Expressing optimism for change
  • Expressing intention to change

What are some Motivational Interviewing Strategies I can incorporate into my practice?

  • The decisional balance exercise: In a box of four quadrants, explore the costs of the status quo, the costs of change, the benefits of the status quo, and the benefits of change
  • Motivation and confidence rulers: On a scale of 0-10, where 0 is ‘not at all important’ or ‘not at all confident’ and 10 is ‘extremely important’ or ‘extremely confident’, explore where patient falls using questions targeted to increase change talk (“Why not a lower score?”, ”What would it take to move you higher?”)
  • Values Clarification: Explore with patient their values and interests, how their current behavior fits with these, and how change would fit with these
  • Roll with Resistance”: Rather than taking an oppositional stance when a patient is not ready for a change or recommendation, simply reflect back the patient’s point of view. Additional strategies include reframing, emphasizing the patient’s personal control over treatment, and coming alongside (agreeing to such an extent that an opposite response may occur).

What is NOT Motivational Interviewing?

  • Question-answer back-and-forth interaction
  • Taking sides
  • Presenting the therapist as the expert
  • Labelling the patient
  • Determining the focus of treatment prematurely
  • Blaming
  • "Righting reflex" (telling the patient what to do, giving the “right answers”, correcting patient)

Want to learn more about using Socratic Dialogue in your practice? Explore CDP's resources in Motivational Interviewing using the links below:

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