2014 DBHR WA State Provider Survey
Although the survey did not inquire directly about MI, several respondents commented that low client motivation hinders participation, engagement, and success in treatment. Some respondents indicated they had received some MI training and that MI was incorporated into their treatment programs. However, they also stated that providers need more training to increase their MI skills, as well as provider follow-up and supervision. [more about the survey]
Motivational Interviewing (MI) is a counseling approach that facilitates and engages a person's intrinsic motivation in order to change behavior. It is a goal-oriented, client-centered counseling style that elicits behavior change by helping clients explore and resolve ambivalence. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing that goal, often by conscious or unconscious weighing of pros and cons of change vs. not changing3.
MI recognizes that clients approach counseling at different levels of readiness to change their behavior1. The main goals of MI are to engage clients, elicit change talk, and evoke motivation to make positive changes from the client.
Basic therapist techniques in MI include:
Note: The "Talking to Clients" training module in this toolkit contains a section with more information about using motivational interviewing techniques with clients and can be helpful for both counselors and front desk staff -- anyone who interacts with clients regularly at your treatment agency.
Why use it?
The efficacy of MI in substance use disorder treatment is well documented4,5. Furthermore, MI in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioral problems5.
Even brief MI is effective and can increase client engagement and retention early in treatment4,5, although more than one encounter with the client can increase MI's effectiveness4. Time-limited therapies have been specifically developed for substance abuse treatment, including Motivational Enhancement Therapy6. MI is recommended for both individual and group treatment7.
Some Advice from NIATx
Two success stories (from NIATx)
The Center for Drug Free Living (now Aspire Health Partners) in Orlando, FL increased continuation rates to the fourth session by 27% using MI-based approaches. They had counselors make audio or videotapes of sessions so they could review and discuss the use of MI techniques in staff meetings.
Addiction Research and Treatment Services in Denver, CO increased continuation rates through the first 30 days of treatment for their opioid maintenance outpatient population from 79% to 87% in a 3 month period. They asked clinicians to focus on using MI techniques and strategies when scheduling the second session. For more information, see the ARTS MI Competencies and their business case (from NIATx).
NIATx Resources on Motivational Interviewing
See "Use MI During Treatment" and "Use the Spirit of MI During the First Contact." Includes stories about successful implementation at real treatment agencies, lessons learned, tracking measures, action steps, and more.
NIDA/SAMHSA-ATTC Blending Team Product: Motivational Interviewing CME/CE and Patient Simulation
This package of an online training and interactive patient simulation module was designed to provide practical guidance for physicians, nurses, and other clinicians in effective MI techniques to elicit health risk behavior information from patients. Physicians and nurses can earn 1.5 hours of AMA or ANCC continuing education credits; other providers can use the "unaccredited module" to obtain the same training. New in October 2014.
Some Examples of Motivational Interviewing Techniques in Action
MINT: Excellence in Motivational Interviewing
The Motivational Interviewing Network of Trainers (MINT) is an international organization of trainers in MI. MINT's mission is to promote good practice in the use, research, and training of MI. This site includes a calendar of upcoming events and trainings, a blog written by one of the founders of MI (Stephen Rollnick), and a selection of MI resources, including materials for training, assessment and coding, research articles, and manuals.
Motivational Interviewing Glossary & Factsheet (on Scribd) by Kathleen Sciacca, MA, MI trainer
Provides a comprehensive overview of the practice and terminology of MI, including definitions of terms, associated terms, key elements of MI practice, and more.
Stephen Rollnick's official web site
Stephen Rollnick is a co-founder of Motivational Interviewing. He provides consultancy and training on the subjects of motivation, change and motivational interviewing. He is the co-author of Motivational Interviewing: Helping People Change (Miller and Rollnick, 1991; 2001 & 2012), Health Behavior Change: A Guide for Practitioners (Rollnick, Mason & Butler, 1999 & 2010) and Motivational Interviewing in Health Care: Helping Patients Change Behavior (Rollnick, Miller & Butler, 2008).
References & Readings