Psych · Professional — motivational interviewing
Motivational interviewing
Also known as MI · Motivational enhancement therapy · MET · Change talk · OARS · Brief motivational intervention · Ambivalence counselling
Exam-exhaustive fellowship reference on motivational interviewing — spirit (PACE), OARS, four processes, change vs sustain talk (DARN-CAT), righting reflex, stages of change interface, MET, substance-use and medical behaviour-change evidence (MATCH, UKATT, COMBINE, Cochrane), dual diagnosis, cultural adaptation, training and fidelity. FRANZCP-primary, globally tagged.
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Red flags
- Righting reflex (arguing for change) typically increases sustain talk and discord — reverse course
- MI does not replace emergency medical care, withdrawal management, or compulsory treatment when risk thresholds are met
- Do not use MI as sole treatment for opioid dependence when opioid agonist therapy is indicated
- Workshop-only MI without practice and feedback often fails fidelity — do not claim competence after a single lecture
- Decisional balance when the patient is already committed can dilute commitment language
- Acute intoxication, delirium, severe thought disorder, or lack of decision-specific capacity limit pure MI — stabilise first
Meet the patient
A 47-year-old miner is admitted after a seizure from alcohol withdrawal. His LFTs are twice the upper limit, he drinks a bottle of vodka most nights, and the first thing he says to you is "I don't have a problem, and you can't make me stop."[11][13]
The registrar's reflex is to list the harms until he agrees. That reflex is the single most reliable way to make him drink more, not less — and it has a name. This topic is the alternative: a conversational method that pulls his own reasons for change out of him, rather than installing yours.[1][2]
References20ShowHide
- [1]Miller WR, Rose GS Toward a theory of motivational interviewing Am Psychol, 2009.PMID 19739882
- [2]Miller WR, Rollnick S Ten things that motivational interviewing is not Behav Cogn Psychother, 2009.PMID 19364414
- [3]Burke BL, Arkowitz H, Menchola M The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials J Consult Clin Psychol, 2003.PMID 14516234
- [4]Hettema J, Steele J, Miller WR Motivational interviewing Annu Rev Clin Psychol, 2005.PMID 17716083
- [5]Rubak S, Sandbaek A, Lauritzen T, Christensen B Motivational interviewing: a systematic review and meta-analysis Br J Gen Pract, 2005.PMID 15826439
- [6]Amrhein PC, Miller WR, Yahne CE, Palmer M, Fulcher L Client commitment language during motivational interviewing predicts drug use outcomes J Consult Clin Psychol, 2003.PMID 14516235
- [7]Magill M, Gaume J, Apodaca TR, et al. The technical hypothesis of motivational interviewing: a meta-analysis of MI's key causal model J Consult Clin Psychol, 2014.PMID 24841862
- [8]Magill M, Apodaca TR, Borsari B, et al. A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change J Consult Clin Psychol, 2018.PMID 29265832
- [9]Glynn LH, Moyers TB Chasing change talk: the clinician's role in evoking client language about change J Subst Abuse Treat, 2010.PMID 20418049
- [10]Apodaca TR, Longabaugh R Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence Addiction, 2009.PMID 19413785
- [11]Project MATCH Research Group Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes J Stud Alcohol, 1997.PMID 8979210
- [12]Project MATCH Research Group Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes Alcohol Clin Exp Res, 1998.PMID 9756046
- [13]UKATT Research Team Effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial (UKATT) BMJ, 2005.PMID 16150764
- [14]Anton RF, O'Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial JAMA, 2006.PMID 16670409
- [15]Smedslund G, Berg RC, Hammerstrøm KT, et al. Motivational interviewing for substance abuse Cochrane Database Syst Rev, 2011.PMID 21563163
- [16]Schwenker R, Dietrich CE, Hirpa S, et al. Motivational interviewing for substance use reduction Cochrane Database Syst Rev, 2023.PMID 38084817
- [17]Lundahl B, Moleni T, Burke BL, et al. Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials Patient Educ Couns, 2013.PMID 24001658
- [18]Frost H, Campbell P, Maxwell M, et al. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews PLoS One, 2018.PMID 30335780
- [19]Prochaska JO, DiClemente CC, Norcross JC In search of how people change. Applications to addictive behaviors Am Psychol, 1992.PMID 1329589
- [20]Self KJ, Borsari B, Ladd BO, et al. Cultural adaptations of motivational interviewing: A systematic review Psychol Serv, 2023.PMID 35130010