Motivational Interviewing (MI)

Motivational Interviewing (MI) is a psychological intervention wherein the therapist applies empathic, reflective listening to help the client recognize a discrepancy between their stated goals and behaviors and then work collaboratively to establish and execute actionable plans. First written about in 1991 by Miller and Rollnick, the treatment method is now in its third iteration, and it has been researched extensively and proven to be effective for substance use disorders, anxiety, and depression among others.

Motivational Interviewing relies on therapist application of four core skills to be most effective, known as OARS:

* Ask Open-ended questions
* Provide Affirmation
* Use Reflective-listening
* Summarize key points

The goals of Motivational interviewing are to 1) engage in a productive working relationship, 2) focus on a shared agenda, 3) evoke feelings of change, and 4) plan realistic and actionable goals for the client to use to meet their goals.

## **Processes**

There are four processes of motivational interviewing described by William Miller and Stephen Rollnick. The first process is called Engaging. This is the foundation of the interviewing process and this is when the therapist builds an alliance and a working relationship with the client. The second process is called Focusing. This is when the therapist and the client share ideas on what they will both discuss in a specific period. The third process is Evoking. This is when the therapist helps the client locate their future goals for change. This is done by asking open-ended questions, eliciting responses while evoking commitment to change. The last process is called Planning. This is when client and therapist collaboratively plan based on a client's commitment to change. This consists of assessing their commitment by asking about their level of commitment.

Motivational Interviewing for Substance Use Disorder Treatment

Individuals with substance use problems and disorders are often ambivalent about their drug and alcohol use. There may be negative consequences, however they also enjoy the positive experiences such as disinhibition and please. Understanding and resolving this ambivalence is a central goal of motivational interviewing and is accomplished through elicitation rather than persuasian . A key aspect of motivational interviewing that bodes well with this population is a non-judgemental attitude. There may be shame associated with increased substance use and the consequences of use, and approaching these patients in a warm and unbiased way has been shown to improve treatment outcomes. During motivational interviewing, the clinician and patient explore what particular changes the patient wants to make and align the patient's goals with those changes. For example, if a patient wants to spend more time with his family sober, a particular change may be to not start drinking alcohol until after dinnertime. The clinician elicits the patient's own reasons and rationale for possible changes, referred to as "change talk" .

**Further Reading:**

1. Dunn, C., Deroo, L., & Rivara, F.P. (2001). The use of brief interventions adapted  from motivational interviewing across behavioral domains: A systematic review.  Addiction, 96, 1725-1742.
2. Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., & Mash, B. (2010). Motivational interviewing. *Bmj*, *340*.
3. Miller, W. R., & Moyers, T. B. (2006). Eight stages in learning motivational interviewing. *Journal of Teaching in the Addictions*, *5*(1), 3-17.
4. Miller W.R. & Rollnick S. (2002) Motivational interviewing: Preparing people for change. 2nd ed. New York: Guilford.
5. Miller, W. R. & Rollnick S. (2004). Talking oneself into change: Motivational Interviewing, Stages of change and Therapeutic Process.” Journal of Cognitive Psychotherapy, 18, pp.299-308.
6. Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. *Behavioural and cognitive psychotherapy*, *37*(2), 129-140.
7. Resnicow, K., & McMaster, F. (2012). Motivational Interviewing: moving from why to how with autonomy support. *The international journal of behavioral nutrition and physical activity*, *9*, 19. https://doi.org/10.1186/1479-5868-9-19
8. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1007.6624&rep=rep1&type=pdf

**References:**

1. ↑ https://www.psychiatry.org/psychiatrists/education/signature-initiatives/model-curriculum-project-for-substance-use-disorders/introduction-to-motivational-interviewing
2. ↑ Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
3. ↑ Rubak, S., Sandbaek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: a systematic review and meta-analysis. *The British journal of general practice : the journal of the Royal College of General Practitioners*, *55*(513), 305–312.
4. ↑ https://www.psychologytoday.com/us/therapy-types/motivational-interviewing
5. ↑ https://motivationalinterviewing.org/understanding-motivational-interviewing
6. ↑ https://motivationalinterviewing.org/understanding-motivational-interviewing
7. ↑ 7.0 7.1 Ingersoll, K. I. (2019, March 15). *Motivational interviewing for substance use disorders*. UpToDate. Retrieved December 4, 2021, from https://www.uptodate.com/contents/motivational-interviewing-for-substance-use-disorders.
8. ↑ Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., Kunkel, L. E., Mikulich-Gilbertson, S. K., Morgenstern, J., Obert, J. L., Polcin, D., Snead, N., & Woody, G. E. (2005). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. *Drug and Alcohol Dependence*, *81*(3), 301–312. https://doi.org/10.1016/j.drugalcdep.2005.08.002