A word about MI

Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping patients to explore and resolve ambivalence.


Compared with nondirective counseling, it is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the health professional is intentionally directive in pursuing this goal.

What is MI?

Motivational interviewing (MI) refers to a counseling approach in part developed by clinical psychologists William R Miller, Ph.D. and Stephen Rollnick, Ph.D. It is a patient-centered, semi-directive method of engaging intrinsic motivation to change behavior by developing discrepancy and exploring and resolving ambivalence within the patient.

Motivational interviewing recognizes and accepts the fact that patients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. Remember our Stages of Change? Some patients may never have thought of changing certain behaviors and others may have thought about it but never attempted to change it. Finally, some patients may be actively trying to change their behavior and may have been doing so unsuccessfully for years.

Motivational interviewing is a non-judgmental, non-confrontational and non-adversarial approach in working with patients. The approach attempts to increase the patient’s awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternately, motivational interviewing trained health professionals help patients think about a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help patients think differently about their behavior and to ultimately consider what might be gained through change.

How are MI and SBIRT related?

SBIRT MI venn diagramMotivational Interviewing is a way of interacting with our patients. It is essentially an approach to communicating with, understanding, and attempting to change the behavior of our patients. As such, principles and strategies of MI can influence all aspects of our patient-provider interactions.

SBIRT, on the other hand, is a process for identifying and immediately addressing substance use among our patients. You will likely find yourself using the MI approach throughout your efforts to implement SBIRT in your practice.

Put another way: MI is a skill and SBIRT is a process for which that skill is an important component. Stage of change is a way to think about patients and it yields a piece of data (their stage!) you incorporate when using motivational interviewing as part of SBIRT. These get used primarily in the BI (Brief Intervention) step–when trying to change behavior–but can also be important when trying to get solid, honest, accurate information from patients (‘S’) and when getting them to accept and act upon a referral to more specialized treatment (‘RT’).

MI Core Principles

Motivational interviewing is considered to be both patient-centered and semi-directive. Motivational interviewing is based upon four general principles:

1. Express empathy
2. Develop discrepancy
3. Roll with resistance
4. Support self-efficacy

Motivation interviewing is not an approach to use with every patient that you come into contact with; however, it is a tool that can be used often. Three important goals in motivation interviewing are to build a rapport with the patient, elicit change talk, and establish a commitment.

Got the motivational interviewing approach down? Let’s look at approaches that put MI into practice….