Motivational Interviewing (MI)

Motivational interviewing (MI) is a powerful technique used by psychiatrists and other healthcare professionals, often in the context of encouraging a person to recognise his alcohol or drug problem and of ‘motivating’ him to reduce his substance use. However, the technique has very broad applications. In our private life, we often feel compelled to offer advice to our near and dear, but the better the advice, the more likely it is to be ignored, resisted, or opposed. This can have unfortunate consequences, not only for the problem in hand but also for the warmth or quality of the relationship. Such problems can be avoided by using the principles and techniques of MI. In short, MI involves a sort of empathetic Socratic questioning aimed at determining a person’s readiness for change and, if possible, at encouraging him to recognise the full import of the problem and then at guiding his reasoning so that he appears to come to a solution all by himself. This not only lends him a sense of ownership and empowerment, but also strengthens the relationship or, in the professional setting, the ‘therapeutic alliance’ – as illustrated below.

Scenario A (without using motivational interviewing)
Doctor: According to your blood tests, you’re drinking too much alcohol.
Patient: I suppose I do enjoy the odd drink.
Doctor: You’re probably having far more than just the odd drink. Alcohol is very bad for you, you need to stop drinking.
Patient: You sound like my wife.
Doctor: Well, she’s right you know. Alcohol can cause liver and heart problems and many other things besides. So you really need to stop drinking, OK?
Patient: Yes, doctor, thank you. (Patient never returns.)

Scenario B (using motivational interviewing)
Doctor: We all enjoy a drink now and then, but sometimes alcohol can do us a lot of harm. What do you know about the harmful effects of alcohol?
Patient: Quite a bit, I’m afraid. My best friend, well he used to drink a lot. Last year he spent three months in hospital. I visited him often, but most of the time he wasn’t with it. Then he died from internal bleeding.
Doctor: I’m sorry to hear that, alcohol can really do us a lot of damage.
Patient: It does a lot of damage to the liver, doesn’t it?
Doctor: That’s right, but it doesn’t just do harm to our body, it also does harm to our lives: our work, our finances, our relationships.
Patient: Funny you should say that. My wife’s been at my neck…
(…)
Doctor: So, you’ve told me that you’re currently drinking about 16 units of alcohol a day. This has placed severe strain on your marriage and on your relationship with your daughter Emma, not to mention that you haven’t been to work since last Tuesday and have started to fear for your job. But what you fear most is ending up lying on a hospital bed like your friend Tom. Is that a fair of summary of things as they stand?
Patient: Things are completely out of hand, aren’t they? If I don’t stop drinking now, I might lose everything I’ve built over the past 20 years: my job, my marriage, even my daughter.
Doctor: I’m afraid you might be right.
Patient: I really need to quit drinking.
Doctor: You sound very motivated to stop drinking. Why don’t we make another appointment to talk about about the ways in which we might support you? (…)

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