Motivational Interviewing + Patient Communication
Module 7 of 11 · 45 min
Deep dive on MI techniques: open questions, reflective listening, change talk, sustain talk, navigating ambivalence.
Learning objectives
- •Demonstrate the four core MI processes
- •Recognize + respond to change talk vs sustain talk
- •Use OARS techniques in clinical encounter
- •Apply MI to non-SUD scenarios (pain, lifestyle, adherence)
Four MI processes — engaging, focusing, evoking, planning
Engaging: build rapport + trust. Focusing: agenda-setting (what we'll talk about). Evoking: drawing out patient's own motivation for change. Planning: when ready, develop concrete plan. Most clinicians skip to planning too fast; the work happens in evoking. MI takes practice — start with one technique per encounter.
OARS in detail
Open questions: 'How do you feel about your drinking?' (not 'Do you want to quit?'). Affirmations: 'You've been thinking about this for a while — that takes courage.' Reflective listening: paraphrase what you heard, slightly amplified. 'It sounds like you're worried about your kids seeing this.' Reflections do most of MI's work. Summaries: tie threads together at intervals.
Change talk vs sustain talk
Change talk = patient's own words pointing toward change ('I want to stop,' 'I tried that once'). Sustain talk = arguments for status quo ('I need it to function,' 'Everyone in my family drinks'). Your job: elicit + reinforce change talk; don't argue against sustain talk (creates resistance). When patient says sustain talk, reflect it ('It feels essential right now') — paradoxically this often opens space for change talk.
Beyond SUD — broader applications
MI techniques work for: weight loss counseling, smoking cessation, exercise adoption, medication adherence, blood-pressure management, end-of-life conversations. Anywhere behavior change is needed. Strong evidence base. Compatible with brief encounter (5-15 min). Not therapy — but a way of talking that respects autonomy + builds change.
References
- · Miller + Rollnick Motivational Interviewing 4th Ed
- · MINT Network resources