Describes Medical Interviewing in medicine, especially in the field of psychiatry. Medical Interviewing includes being able to interview patients in the psychiatric field .........................................................................................................................

1. Motivational Interviewing 101
Emily Kline, PhD

2. Behavior change is in all of medicine

3. Why do people use drugs?

4. We’re all doing our best
● Change is hard
● When people in positions of authority tell us we need to make big changes,
we are likely to feel ashamed, defensive, and/or hopeless
● Motivational Interviewing is about being sensitive to this dynamic and
avoiding power struggles & shame so that people can actually make the
changes they need to make

5. What is “Motivational Interviewing”?
● “MI” is a communication style widely used by health professionals to
talk about making healthy changes – research shows it works!
● Developed with the goal of increasing motivation for treatment among
people with substance use disorders
● MI is based on the idea that the best way to influence another
person’s behavior is by respecting their independence and creating
space for them to explore their own motivation for change.

6. What isn’t motivational interviewing?

7. What happened here?
● How is this like being in
clinic?
● Why doesn’t it work to tell
people there’s a nail in their
head?

8. The Righting Reflex
● The impulse to help others by
○ FIXING their problem
○ GIVING them advice
○ MINIMIZING their issue

9. In order to consider a healthy choice or a change, people need to feel:
“My stepdad never assumes…
he tries to see my point of view”
“I know I can get to work on
time”
“No one can make me take
medicine – I’ll decide for myself”

10. Tool #1:
Reflections
Convey empathy and careful
listening

11. WHAT IS A REFLECTION?
• A Statement, Not a question
• Specific – not generic
• Repeat back what you heard
the person say, or guess at
the feelings beneath
• Helps the person:
• Feel understood and
accepted,
• Hear their words think a
little deeper about what
they meant.

12. Reflections Don’t Judge
● Reflections are different from
praise – they don’t evaluate
whether someone met
expectations
● Reflections don’t indicate
whether you agree/disagree

13. TYPES OF REFLECTIONS
Simple: repeat back what you heard
Complex: reflect the “gist” or overall meaning
Feeling: name the emotion you’re hearing

14. ● Double-sided reflection: On the one hand [reasons against change], but on
the other hand [reasons for change].
TYPES OF REFLECTIONS, CONT’D

15. All my friends do it. It’s not a big deal.
● Simple: You feel like it’s not a big deal.
● Complex: Smoking seems normal to you.
● Feeling: People’s concerns about can be annoying.
REFLECTION EXAMPLE 1

16. REFLECTION EXAMPLE 2
I think it’s fine to have a few drinks to relax. My wife says I get carried
away.
● Double-sided: On the one hand, it’s a nice way to relax, but on the other,
it’s causing some problems in your marriage.

17. Reflections Practice
I can’t believe they sent me here. I’m not a drug addict.
I stopped shooting up all on my own, I couldn’t live like that
anymore.
I’ve tried to quit smoking like a thousand times.

18. Tool #2: Asking
Curious
Questions
Get curious about another’s
perspective and values

19. Question
Examples
OPEN ENDED QUESTIONS
get people talking
● Hmm. Tell me more about that.
● What do you think she means
by that?
● What do you see as the pros
and cons?
I think it’s fine to have a few drinks to
relax. My wife says I get carried
away.

20. Open vs. Closed Questions
Instead of this (Closed)
● Are you feeling better today?
● Did you take your medications?
● Are you going to go to your therapy
appointment today?
Try THIS (Open)
● What did you do today?
● What’s going on with your medications?
● How has therapy been lately?
● What do you see as the pro’s and con’s of
meeting with your therapist today?

21. Questions Practice
I can’t believe they sent me here. I’m not a drug addict.
I stopped shooting up all on my own, I couldn’t live like that
anymore.
I’ve tried to quit smoking like a thousand times.

22. Tool #3:
Asking
Permission

23. Before jumping into “expert” role
● Can I share some information with you about the
research on THC and addiction?
● I have some ideas that I think would help you. Would
you like to hear them?
● Our clinic treats many patients with similar struggles.
Do you want to hear more about the services we offer?

24. When people feel Understood, confident,
and in control…
● They will usually want to hear your advice

25. 5 Step Cheat Sheet
1. Make an observation (you’re primary care doctor referred you to me to talk
about your drug use) & wait for patient’s response
2. Use reflections to show that you’re listening and learn more about their
substance use habits and attitudes (on the one hand…, on the other…)
3. Ask open-ended questions to fill in the gaps (What medications have you
already tried? What got in the way last time you wanted to quit?)
4. Seek permission before giving advice (I’ve got some ideas, can I share?)
5. Collaborate on a plan (So what do you think about trying
suboxone/CBT/supervised detox?)

26. Want to learn more?

27. Resource #1:
The MI “Bible”

28. Resource #2:
My E-Course
● FREE at:
https://handholdma.org/what-
can-i-do/the-school-of-hard-
talks-online-lessons-from-
motivational-interviewing-for-
everyday-families
● (Or just google “School of Hard
Talks Online”)
● Seven interactive 10-minute e-
lessons + take home points

29. Resource #3: Instagram
● Follow @learnaboutMILO to
see my students and I
demonstrate MI skills, see MI
skill flashcards, and learn the
results of our research studies

30. Resource #4: My Book
● Available for pre-order
● To be released in April 2023!

31. Resource #4: Stay in touch
Emily.Kline@bmc.org

32. Thank You!