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Motivational interviewing

Motivational interviewing (MI) is an evidence-based practice for addressing and treating persons with substance use disorders. Providers are encouraged to use this technique during the brief intervention phase of the screening, brief intervention, and referrals to treatment (SBIRT) approach.

Elements of MI

Developed by clinical psychologists William Miller and Stephen Rollnick as a counseling technique that motivated individuals for change, the spirit of MI is based on three key elements:

  • Collaboration, not confrontation, between the counselor and client.
  • Evocation, or drawing out, the client's ideas about change.
  • Emphasizing the autonomy of the client, versus being authoritative with them.

Principles of MI

There are four principles that guide MI:

  • Express empathy with the client
  • Support self-efficacy
  • Roll with resistance, or avoid enhancing a client's resistance to change by not confronting it
  • Develop discrepancy between where the patient is and where they want to be

Skills and strategies

There are many skills and strategies related to MI, but open questions, affirmation, reflective listening, and summary reflections (OARS) are the basic skill set to learn for MI. OARS are types of responses to use with clients to elicit more change talk.

  • Open-ended questions: Ask questions that cannot be answered with a yes or no response.
  • Affirmations: Affirm the client’s strengths by reframing behaviors or concerns expressed by the client that reinforce positive client qualities.
  • Reflections: Make genuine statements back to the client to let them know they are heard and that you are empathetic to their situation.
  • Summaries: Make summarizing statements that demonstrate interest, understanding, and highlight the important aspects of the conversation.

What is change talk?

Change talk is defined as statements made by the client that show consideration of, motivation for, or a commitment to change. The goal of MI is to get the client to express change talk, because the more an individual talks about change, the more likely they are to change.

When you hear change talk from a client, use your OARS to reinforce the change.