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Motivational Interviewing

Laura Artim and Ben Johnson

Background

  • Motivational interviewing: an evidence-based form of patient-centered interviewing that strives to align with patient’s own strengths to encourage change in behavior via strengthening their own motivation for change

  • For inpatients, MI is most useful for encouraging medication adherence before discharge or substance use cessation as well as healthier lifestyle habits

    • Assumptions/principles:
      • Only is in state of ambivalence, whether outwardly expressed or not
      • Ambivalence is expressed with conflict between multiple courses of action

  • Patient ‘s intrinsic motivation to change may fluctuate at any given time, some patients may benefit from explaining this model of behavior change

  • Techniques to identify ambivalence:

    • Focus on reasons to change ("why") as opposed to specific actions ("how")
    • Express empathy: discussion about values, hopes, emotions, and goals surrounding behavior. Don’t shy away from verbalizing strengths you recognize in patient
    • Empower self-efficacy: ask about other times they have made changes in life
    • Develop discrepancy between current and desired behavior through reflection and summaries such as “I’m hearing that drinking helps you relax, but I’m also hearing that you are worried about its impact on your health”
    • Avoid argument and authoritarian mentality - ask for permission to give your own thoughts, don't "give advice" as an equalizer between you and patient
    • Defuse resistance to change - emphasize patient autonomy and reflect resistance

Evaluation

  • Continuing the conversation
    • OARS" interviewing skills: Open-ended questions, Affirm, Reflect, Summarize
      • Open-ended questions encourage thoughtful responses and provide flexibility on how to answer
      • Affirmations acknowledge the good, accentuate the positive, and recognize the inherent worth of another human being
      • Reflections are a guess by the listener as to what the speaker means
      • Summaries are similar to reflections and pull together several ideas
    • Simply reflecting what patient said in slightly different terms often leads to patient feeling heard and recognized
    • Most effective in conjunction with other treatments, when patients are willing, and when patients express ideas for change themselves
    • Least effective in group format and when patient feels change comes from authority - May be effective to have SMART goal setting if patient is in any stage except precontemplation: Specific, Measurable, Attainable, Realistic, Time-limited, but only once permission has been granted