Motivational Interviewing for Clinical Practice: Just Do It
Motivational interviewing (MI)—the clinical style for engaging patients in treatment, enhancing motivation to reduce substance use, and supporting adherence to recommended behavioral or pharmacological treatments—seems to be everywhere these days.
My son smokes marijuana all day—how do I talk to him? MI. My patient yeses me to death all the time but never follows up with anything—what should I do? MI. I would like to spice up my psychopharm practice with some behavioral modification tricks—can you help? MI. MI has become the psychiatric equivalent of dermatology’s corticosteroids or advertising’s social media.
MI was first described in a paper by William R. Miller, Ph.D., and later in books Miller wrote together with Stephen Rollnick, Ph.D. The technique contains simple ideas, and the basic concepts are not particularly challenging to grasp.
Instead of repeatedly asking closed questions, telling patients what to do, or confronting patients who do not follow your recommendations, MI uses a combination of open questions, reflections, affirmations, and summaries to engage the patient in treatment, as well as giving information and advice in a respectful and collaborative manner.
In Motivational Interviewing: Helping People Change, Miller and Rollnick describe how MI has been refined and expanded to also include partnership, acceptance, compassion, and evocation.
Partnership: Similar to collaboration, clinicians practicing MI approach the patient as a partner in a consultation with emphasis on working together to decide how to proceed.
Acceptance: Clinicians accept the patient “as is,” with all their strengths and weaknesses, successes and flaws.
Compassion: In MI, clinicians see compassion as a fundamental commitment to understand and pursue the best interests of the patient.
Evocation: Clinicians understand that the patient has amazing capabilities, and our goal is to draw them out.
In our everyday MI work, we structure our treatments around the four processes of engaging, focusing, evoking, and planning. These processes overlap, build upon each other, and are flexible enough to allow us to return to a previous process for reinforcement prior to continuing our MI trajectory.
Engaging: Engaging refers to establishing, building, and nurturing rapport. We continue to cultivate engagement throughout the entire treatment to solidify trust—trust that we are compassionate and knowledgeable.
Focusing: Focusing shapes the treatment toward a specific agenda, develops goals for behavioral change, and adds direction to the conversation.
Evoking: Once a direction has been identified, evoking is the process through which we elicit the person’s own motivation for changing behaviors and maintaining gains. We first explore and then hone in on the aspects of the patient’s ambivalence that are in favor of change (cultivate change talk) and resolve or soften arguments that disfavor change (soften sustain talk). We elaborate on the patient’s motivations for a healthier life and bring focus to the patient’s change-supportive statements.
Planning: Assuming there is (1) sufficient engagement, (2) a clear and shared goal, and (3) sufficient commitment to initiate behavior change, the patient-clinician partnership develops a change plan. The plan typically consists of setting clear, achievable goals; exploring options for change; deciding on a plan; and committing to the plan.
And that’s all, folks.
Well, not exactly. While there is a lot to appreciate and master in MI beyond what can be covered in this article or in any one book, we strongly believe that the fundamental MI concepts are straightforward and easily accessible to most therapists.
In 2017, MI is, arguably, the essential style for helping patients to change and maintain their new, healthier behaviors. Learn it, use it, and enjoy its delightful results! ■
