Foundation of Addiction Medicine 2019

What is Motivational
Interviewing?

A collaborative style for strengthening a person’s
own motivation and commitment to change (Miller &
Rollnick, 2013)
Helps the person realize as to why he should change

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BACKGROUND

⚫ Psychologist Dr. William Miller: “Developing
MI completely unplanned and unanticipated”.

⚫ Found empathy as the best predictor of
alcohol use reduction

⚫ Experience with cognitive behaviour therapy,
reflective listening through role play,
discussing challenges in clinical situation
helped in emergence of MI

⚫ Miller found “directive argument ineffective”
in bringing about change

Picture from https://casaa.unm.edu/wrmiller.html
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⚫ Any person is likely to change if he defends
his statements verbally

⚫ Patient and not the counselor argues for
change

⚫ MI is designed to evoke these change talks
⚫ Miller’s first description of MI published in

British journal of Behavioural Psychotherapy

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⚫ 7 years later met Prof. Stephen
Rollnick who was teaching MI in
addiction treatment programme
in UK

⚫ Together they wrote a book
“Motivational Interviewing:
Preparing People to Change
Addictive Behavior” (1991)

http://www.stephenrollnick.com/about-steve/

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When to use MI?

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Theoretical background and
Models

01 Festinger’s formulation of ● When faced with internal conflict we
cognitive dissonance tend to change out thinking

02 Bem’s reformulation of self ● People infer their values from their own
perception behaviours and words

03 Bandura’s self efficacy theory ● The stronger the individual believes in
his/her success in performing a task, the
04 Rogers’ Person Centered more likely s/he is in competing the task
approach
● Focuses on building empathy and
05 Self determination theory positive regard to establish positive
envt. which foster discussion for
behavioural change

● Emphasize on developing intrinsic
motivation and assuming responsibility
for change

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Difference between MI and
Conventional Model

Conventional Model MI

● Directive ● Responding with
● Righting Reflex empathy, supportive
● Increases patient’s
● Improves patient
resistance client relationship
● Foster patient
● Fosters patient’s
passivity intrinsic motivation
to change

● Gives autonomy to
patient

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Communication style

Directing Guiding Following

1 2 3

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Elements of Motivational
Interviewing

MI Spirit

Change Core
Talk Skills

MI Principles

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Spirits of MI (PACE)

Teaching music and not just the words

Partnership

Evocation Acceptance

Compassion

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Skills (OARS)

Open ended Affirmation
questions

Reflective Summarization
listening

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⚫ Open- ended ▪ Allow person to think before

questions answering unlike brief replies
or simple —yes“ or —no“
answers.

▪ Opposite of close ended
▪ Invite conversation on a topic.
▪ Examples:

“What brings you here today?”
“How has it impacted your life?”

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⚫ Affirmation ⚫ Statements that recognize
client’s strength and
acknowledge behaviors that
lead to positive change

⚫ Enhances engagement
⚫ Examples:

◦ “I appreciate that you came

today on time.”

◦ “You tried really hard this

week.”

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⚫ Reflective ▪ Active listening
▪ Therapist listens to stated and
listening
unstated thoughts, feelings and
meanings reflects back
▪ Various types…

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Reflective listening

TECHNIQUE EXPLANATION

Simple Reflection Acknowledge disagreement, feeling, or perception
“You feel that since I have never taken any drugs, I am
not the one who should be giving advices to you.”

Double sided Capture both side of ambivalence.
Reflection
“You made a mistake and it sounds like you feel bad
about that, but you also think that your family is asking
you to do too much.”

Amplified Reflection Exaggerate the disagreement, feeling or perception.

“So you do drugs, but you don’t think that it has ever
caused any problem in your life.”

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⚫ Summarizing ▪ It is reflection that
accumulate all things that
person told you.

▪ Advantages:
◦ Ensures that communication

has been clear.

◦ Provides new perspective to

the client

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Research on MI

⚫ Tobacco cessation, addiction
(Branscum & Sharma, 2010; Cowlishaw,
Merkouris, Anderson, Jackson & Thomas,
2012; Jiang, Wu & Gao, 2017)

⚫ Eating disorder (Macdonald, Hibbs,
Corfield & Treasure, 2012)

⚫ Hypertension (Conn, Ruppar, Chase,
Enriquez & Cooper, 2015)

⚫ Cancer (Spenser & Wheeler,2016)

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⚫ Cardiovascular (Cheng, Qu, Huang,
Xiao, Luo & Wang, 2015; Windy, Choi,
Yum & Yu, 2016)

⚫ Obesity (Armstrong, Mottershead,
Romksley, Sigal, Campbell &
Hemmelgarn, 2011; Barns & Ivezaj, 2015)

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⚫ Physical activity (McGrane, Galvin,
Cusack & Stokes, 2015; Halloran et al.,
2014)

⚫ Diabetes (Calhoun et al, 2010;
Chapman, Liu, Merkuoris, Enticott, Yang,
Browning & Thomas, 2015; Ekoong &
Kavookjian, 2016)

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Conclusion

⚫ MI is used in both medical and
psychological conditions where behaviour

plays some role

⚫ Conversation using MI is both brief and
meaningful

⚫ MI follows guiding style
⚫ Addresses a patient’s ambivalence towards

bringing change

⚫ Spirits of MI: PACE

⚫ Skills of MI: OARS

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“People are the undisputed experts on
themselves. No one has been with them longer,
or knows them better than they do themselves.
In MI, the helper is a companion who typically
does less than half of the talking.”
― William R. Miller, Motivational Interviewing:
Helping People Change

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Thank you!

Any Questions???

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Motivational
Interviewing- 2

Shikha Ahuja
Clinical Psychologist
Centre for Addiction Medicine
NIMHANS

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Learning 1 Ambivalence
Objective
s 2 MI principles

33 Evoking Change talk

4
5 Responding to Sustain

talk

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Elements of Motivational
Interviewing

MI Spirit:
PACE

Change Core Skills:
Talk OARS

MI Principles:
DARES

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Journey to
Change is
not
unidirectio
nal!

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AMBIVALENCE

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Ambivale ● Should I sleep for half an hour more or
nce in go to gym today?
everyday
decision ● Should I buy a car or a bike?
making
● Should I eat Pizza or burger?

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AMBIVALE ●The state of having mixed feelings
NCE of contradictory ideas about
changing

●Statements- “Yes…but..”

●Two indicators of ambivalence
●Sustain talk favors not
changing
●Change talk favors movement
in the direction of change

Ambivalence

Status quo Change
(how things are)
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Reference: motivational interviewing implementation and
practice manual, 2015

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5 MI DDeisvcerleoppancy
Principle
s ARED AARRvSErooeugxlislpudpiwpmsrteoiaetsrhnnstctSEaeemtlifop-Enatffihcyac
S

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1. ●Evoke awareness of the gap
Develop between
Discrepan
cy ●where clients are and where they
want to be (goals)

●who clients are and who they
want to be (values)

Therapist: "How has drinking stopped
you from doing what you want to do?"

------------------------------------------------------

Therapist: “Hmm. Help me figure this
out. You’ve told me that keeping custody
of your daughter and being a good parent
are the most important things to you
now. How does your alcohol use fit in
with that?”

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Reference: 583
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Reference: 584
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Reference: 585
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

●Avoid- Getting into a trap or power
struggles

2. Avoid ●Therapist is NOT trying to prove a
Argumenta point or convince the client
tion
●Aim - “walk” along with the client
not “drag” them

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●Arises from the interpersonal
interaction between therapist and
patient

● therapist and patient are at different
stages of change

3. Roll ●Types of resistance- Arguing,
with Ignoring, Denying, Interrupting
Resistanc
e ●Signal to respond without being
confrontational

●The techniques used to deal with
resistance are Reflections

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Reference: 588
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Reference: 589
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Reference: 590
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Zoom poll Is therapist correct in telling Anna
that her drinking has caused
problems?

1. Yes
2. No
3. Not Sure

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Reference: 592
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Reference: 593
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Reference: 594
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

Zoom poll Does this fit into the Spirit of MI?
1. Yes
2. No

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NO!
Because it is also confrontation! The
responses should be evoked from
the Patient.

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Rolling with Resistance

Reference: 597
https://www.unodc.org/documents/treatnet/Basic-Volume/Modu

4. Express ●Reflective Listening is essential
Empathy
●Encourages the client to keep
talking and exploring the topic

----------------------------------------------------
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● Therapist: What do you like about
drinking? What’s positive about
drinking for you?

● Therapist: "So, if I understand you so
far, you _____________.“

● Therapist: "I can see how you might feel
really hurt at this point."

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5. ●Belief in the ability to change
Support (self-efficacy) is an important
self-effica motivator
cy
●Highlight client’s strengths

●Bring about optimism & hope

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Therapist: “It seems you have been
working hard to quit drinking.You
managed to not drink at all last week.
How were you able to do that?”

Client: “I feel if I try I can do it.” (Self
Motivational Statements)

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Elements of Motivational
Interviewing

MI Spirit:
PACE

Change Core Skills:
Talk OARS

MI Principles:
DARES

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