Psychiatry: treatments
Motivational interviewing
Motivational interviewing (MI) is a collaborative way of talking with people that strengthens their own reasons to change, especially when they feel two ways about it. It is a core skill for psychiatrists working with addiction, medication adherence and health behaviours.
Depth by stage, Pre-U → Consultant (details)
What is it?
Many people seeing a psychiatrist are unsure whether they want to change: to stop drinking, cut down drugs, take medicine, or lose weight. Arguing with them usually makes them defend the status quo. Motivational interviewing, developed by William Miller and Stephen Rollnick, does the opposite: it draws out the person's own reasons, values and confidence for change.
The clinician uses open questions, affirmations, reflective listening and summaries, and pays particular attention to 'change talk' (what the person says in favour of change). The spirit of MI is partnership, acceptance, compassion and evoking the person's own motivation.
MI can be delivered in a single brief conversation or as part of longer treatment. It is widely taught to doctors, nurses and counsellors in Malaysia, including in addiction and primary care services.
Why does a psychiatrist need it?
Ambivalence is everywhere in psychiatry. Psychiatrists who can use MI reduce confrontation, improve engagement and adherence, and help patients with substance use, smoking, self-neglect and physical health problems take the first steps toward change.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns basic behaviour-change theory and patient-centred communication.
- ClinicalUnderstandsPractises brief interventions such as smoking advice in OSCEs and clinics.
- HousemanshipAwareUses brief motivational conversations with patients on the wards.
- Medical officerUnderstandsApplies MI skills with patients who misuse substances or stop medicines.
- Psych traineeAppliesUses MI routinely and can demonstrate it in examinations.
- Specialist / consultantAppliesModels and teaches MI; addiction psychiatrists master it.
What are the key topics?
Spirit and principles
- Partnership, acceptance, compassion, evocation
- Resisting the 'righting reflex'
- Rolling with discord rather than arguing
- Supporting autonomy and self-efficacy
Core skills (OARS)
- Open questions
- Affirmations
- Reflective listening: simple and complex reflections
- Summaries
- Eliciting and strengthening change talk
- Responding to sustain talk
Frameworks
- Four processes: engaging, focusing, evoking, planning
- Transtheoretical (stages of change) model: precontemplation to maintenance
- Decisional balance
- Importance and confidence rulers
- Brief interventions (e.g. FRAMES approach) for alcohol
Applications
- Alcohol and drug use
- Smoking cessation
- Medication adherence in psychosis and bipolar disorder
- Healthy lifestyle and physical health in serious mental illness
- Engaging young people and reluctant patients
How is it learned and assessed?
- Communication skills teaching and OSCEs in medical school
- Workshops and supervised practice during MO and trainee years, especially in addiction rotations
- MRCPsych CASC and MMed (Psychiatry) clinical examinations often include stations about substance use or adherence that reward MI style
- Recorded consultations with feedback in some training programmes
Typical textbooks and resources
- Motivational Interviewing: Helping People Change and Grow — Miller & Rollnick
- Motivational Interviewing in Health Care — Rollnick, Miller & Butler
- WHO brief intervention materials for alcohol and substance use
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Is motivational interviewing a type of therapy?
It is a style of conversation that can stand alone as a brief intervention or be combined with other treatments. It aims to help people resolve mixed feelings about change rather than to treat a specific disorder.
Is MI only for addiction?
No. It started in addiction but is used for medicine adherence, smoking, diet, exercise and many other health behaviours.