March 2019 By

Motivational Interviewing (MI)

Motivational Interviewing (MI) is a psychotherapy used in substance abuse and addictions. It involves the therapist assuming a non-judgmental stance, acknowledging ambivalence about the use, focusing on the patient's motivation for change, and tolerating resistance to change.

Be curious, not an expert

Training and expertise can get in the way of our really hearing the client’s story. For example, a client says, “I don’t think my drinking is a problem.” Some of us are indoctrinated in the concept that denial is a part of the addiction problem—and in this case we might automatically interpret this statement as denial and discount what the patient has to say. An alternative approach is to really understand the patient by opening with something like, “OK, so for you, you don’t think it’s as big of a deal as other people are making it out to be?”

Listen more than you talk

It’s easy to get into the trap of telling people what to do. But the motivational interviewing approach is about the patients articulating why they think they need to change and how they think they can do it. If you find yourself talking more than your patient, then the wrong person is doing the talking. Ask questions to get the process going, but then get out of the way and listen. Use reflective statements to help move the client forward.

Find out what the patient knows before you offer information

For example, before you start talking about side effects, say, “Tell me what you know about the side effects of this medication.” If you are talking about assertiveness skills say, “What do you know about what works for you when you’re trying to deal with somebody who is being aggressive?” Or, if you’re focusing on relapse issues, you might ask, “How have you managed it in the past when you’ve experienced craving?” Find out what the patient knows, then offer targeted information.

What you pay attention to matters

If you hear some change statements from your patient, perk up and do plenty of reflecting. If you hear sustain statements, be more silent. Don’t reinforce sustain talk by giving it lots of attention—be silent or alternatively look for the change element. It is surprising how readily clients may take cues from you, and the more you can reinforce change talk, the better.

Arguing is unproductive

If you find yourself arguing with the patient, that’s a signal that something is not working and it’s time to change what you’re doing. As a clinician, you may feel that you have a really important point to get across, and you may be right, but how you say it matters the most. Arguing patients are unlikely to change their behaviour in the way you are seeking.

“The problem, often not discovered until late in life, is that when you look for things like love, meaning, motivation, it implies they are sitting behind a tree or under a rock. The most successful people recognize, that in life they create their own love, they manufacture their own meaning, they generate their own motivation.”

- Neil deGrasse Tyson

When I'm scared to tackle an obstacle, I close my eyes and pretend I'm an 80 year old man who regrets not tackling all the obstacles he wanted to in life.