Abstract
Motivational interviewing (MI) is an evidence-based, person-centered communication style and set of technical skills and processes, all directed at facilitating behavioral change. The term was first coined in the early 1980s as an approach to help “problem drinkers” (Miller, Behav Psychotherapy. 11:147–172, 1983). In each decade since, the use of MI has expanded across an ever-widening array of applications and settings within and outside of healthcare (e.g., the carceral system, chronic disease management in primary care, nutrition and exercise, dental health, education, sports coaching, organizational leadership, and, most recently, vaccine hesitancy.) MI is now taught and practiced in over 50 languages all over the world. It has a robust evidence base, with more than ten thousand peer-reviewed publications and, at last count, over 1600 controlled clinical trials, more than two-thirds of which show a significant benefit relative to a control or alternative approach (Miller, Controlled clinical trials involving motivational interviewing updated 11/16/2020). Yet its use in psychiatry remains surprisingly limited, outside of co-occurring substance use issues, as evidenced by the dearth of clinical trials and publications in the psychiatric literature and its relatively limited coverage in most psychiatric training curricula.
In this chapter we will review the key concepts underlying MI, discuss aspects of MI that are particularly relevant to community psychiatry, and hopefully evoke the readers’ own motivation for further training and utilization of the technique and spirit of motivational interviewing.
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Notes
- 1.
A note on language: Throughout this chapter, the words “patient,” “person,” and “client” are used interchangeably to refer to the person receiving services and “psychiatrist,” “clinician,” and “helper” as the one in the provider role, in a manner that is somewhat context-dependent, but admittedly arbitrary.
- 2.
The importance of accurate empathy was underscored for William Miller by an observation he made in a study he had been conducting just prior to the publication of his first paper on MI in the early 1980s. Among nine substance use counselors involved in this study of different forms of outpatient treatment for people with problematic drinking, the rating of therapists’ accurate empathy in a single MI session prior to entering the study predicted a greater amount of the variance in both short- and long-term outcome, than did which arm of the study the patient was randomized into. There is something about both the desire and capacity to see the world through our clients’ eyes and to communicate that back to the client that helps people change or perhaps helps people to be more open to and make more effective use of other therapeutic resources.
- 3.
A useful guide for starting a learning community can be found on the MINT website here: https://motivationalinterviewing.org/sites/default/files/learning_communities_guidelines_june_2019.pdf
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Flaum, M. (2022). Motivational Interviewing as a Core Communication Style. In: Sowers, W.E., McQuistion, H.L., Ranz, J.M., Feldman, J.M., Runnels, P.S. (eds) Textbook of Community Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-10239-4_9
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