Definition of Motivational Interviewing (MI): Patient-centered communication style for eliciting behavior change by helping patients explore and resolve ambivalence.
Indications for Use: There’s NEVER a bad time. But most useful when you sense that YOU have a greater motivation for change than the PATIENT does her/himself.
Basic Principles of Motivational Interviewing:
- Don’t tell patients what to do
- Listen instead
- Let the patient tell you they need to change
- Help patients choose to change. If contrast between two choices is brought out, patients feel an urge to resolve the conflict by making a choice
- Help patients feel confident before they try to change
- Treat ambivalence around tough choices as normal
Four Goals in using Motivational Interviewing for identifying and suggesting treatment for substance use problems:
(This example features using MI in a potential problem drinking situation but could apply to the misuse or overuse of any substance.)
- Get permission to begin a conversation with patient after conducting a screening:
DON’T TELL: It looks like you have a drinking problem.
This is heard as, “You’re a drunk and aren’t you ashamed!”
ASK: “Is it okay if I give you feedback on the screening we just did about your alcohol use?”
If YES: give feedback in neutral, generalized way, for example, say, “The guidelines indicate that more than ___ drinks per day or ___ drinks per week can indicate problem drinking for (insert patient’s gender). Your answers indicate you may fall into that range.”
If NO: “I understand. This is something that is difficult for most of my patients. Can you share why it may be difficult for you?” Engage in empathetic listening. Then summarize what you’ve heard and ask, “Am I hearing you correctly.”
- Develop discrepancy between the patient’s goals or values and their current behavior.
“What are some of the things you like about drinking?”
“Are there any concerns you’ve had about your drinking?”
“Tell me about a time that your drinking had a negative effect on your health or job or family life.”
“Does this match up with how you want to take care of yourself?
“Does this match up with how you make other decisions in your life?”
“It sounds like there are some reasons to make changes but you also don’t want to give up something you enjoy? This is entirely normal.”
Again, just listen and then summarize as in the prior step.
- Avoid argument or direct confrontation and adjust to resistance rather than opposing it directly.
“Not everyone is able to face making changes in long term habits.”
“It’s pretty normal to have mixed feelings about changing long term habits that we’ve enjoyed, even though they affect our health.”
“Some people try a few AA meetings or just a first appointment with the County Substance Abuse program to see if one of them is right for them.”
Give suggestions in a generalized, non-judgmental, off-hand manner.
“Can I give you this resource information in case you would like help in making changes later on?”
Hand them written information on local Treatment Resources such as County SUD program phone number or AA hotline number, and/or handout on effects of problem drinking on health.
For free copies including shipping and handling, of RETHINKING DRINKING: Alcohol and Your Health in English or Spanish go to: http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/OrderPage.htm)
- Support self-efficacy and optimism.
“Not everyone is able to be as open as you have been today.”
“Not everyone is willing to do the screening, much less discuss the results.”
“Even if you’re not ready to make changes now, I can always help you when you are ready.”
“Confidence in making tough choices comes over time and with talking things out with trusted friends or family.”
“I know you care about your health and have the ability to make good choices by the fact that you came in for this appointment today.”
Always end discussion on this upbeat, confidence-building note.
Karen Stephen, Ph.D., Mental Health Clinical Director