Usability

Motivational Interviewing (MI) is a person-centred, counselling approach used to address difficulties in changing unhelpful behaviours (e.g. substance use disorder). MI is particularly focused on change, and applies collaborating conversation as a means of helping people build their motivation for change, and strengthen their commitment to change. At its core, MI applies the three key elements of collaboration, evocation of the patient’s ideas on change, and respect of patient’s autonomy, to facilitate the identification, evaluation, and resolution of ambivalence towards behavioural or attitudinal change. This is guided by a therapist who acts as a facilitator, and adopts a nonconfrontational approach to elicit the patient’s intrinsic resource for change. Hence, MI differs from other externally driven approaches. It does not apply coercive methods to impose change, but supports change in ways that are compatible with the patient’s beliefs and values.

In practice, the application of MI has four key tasks - engaging, focusing, evoking, and planning. These tasks are not linear but engaging is often a key first step in order to build engagement in preparation for conversations about change.

• MI includes basic counselling techniques that build motivation for change. It is represented by the acronym OARS that represent asking Open-ended questions, making Affirmations, using Reflections, and using Summaries.
• MI includes goal setting and a ‘change plan of action’ as a means of strengthening commitment to change. The strategies applied in this phase provide guidance to patients as they apply change talk (i.e. patient statements that express consideration of, motivation for, and commitment to change) as a path to change.    

Alongside the tasks above, four principles guide the practice of MI, and should be adhered to by practitioners employing it. These are; 1) the expression of empathy by applying a non-judgemental approach to understanding the patient’s perspective; 2) supporting patient’s self-efficacy for the purpose of enhancing confidence in their capacity for change; 3) rolling with resistance in a non-judgemental manner, and applying strategies that prevent resistance from interfering with patient engagement; 4) helping patients see the discrepancies between current behaviours and future goals in order to strengthen motivation for change. MI can be delivered to children, adolescents and adults.

Fidelity

Motivational interviewing is delivered by trained practitioners with ongoing supervision. Rating scales that can be used to assess fidelity to the MI approach are outlined below and details can be found at motivationalinterviewing.org;

• Motivational Interviewing Skill Code (MISC)
• Motivational Interviewing Assessment – Supervisory Tools for Enhancing Proficiency (MIA – STEP)
• Motivation Interviewing Treatment Integrity (MITI) code
• Motivational Interviewing Target Scheme (MITS)
• Behaviour Change Counselling Index (BECCI)

Modifiable Components

MI recognises the three key components of motivation, i.e. willingness to change, the confidence to change, and readiness for change. Hence, motivational strategies applied can be tailored to suit the patient’s stage of change. MI can be delivered in a variety of settings (e.g. GP surgery, mental health settings, other health care settings), and to different target groups (e.g. probation and youth offenders, pain management, stroke recovery, and child care settings).  MI has been delivered in individual and group formats (https://pubmed.ncbi.nlm.nih.gov/31821350/), and has been evaluated as a smartphone application (https://link.springer.com/article/10.1007/s41347-020-00135-w). Available evidence for MI is limited for people with substantial learning disabilities. MI can be delivered alone or integrated with CBT.

Interventions that draw on the core concepts and principles of MI include;

• Brief Interviewing (BI): This is a time-limited, structured, and goal-oriented counselling intervention to address substance use problems or other health-risk behaviours. BI can be used to prevent the development of substance use problems, protect against its progression, and help identify individuals requiring more intense intervention. BI can vary in the model used to influence change, and can adopt a range of similar yet differing techniques to achieve this. Hence, it may be entirely founded on MI core components and principles; only partly reflect MI principles and techniques; and may contain brief advice. There is also variability in BI delivery format, as it can be delivered in single or multiple sessions (e.g. one to five sessions), of varying lengths (e.g. 5-15 minutes, or 30-45 minutes), with or without written materials, or opportunities for follow-up visits. BI can include motivational interviewing, information, education and counselling on problem-solving strategies. It can commonly be delivered as an opportunistic intervention by non-specialists in primary care settings to non-treatment seeking individuals, but can also be delivered in specialist settings for substance use problems.
• Motivational Enhancement Therapy (MET): MET is a person-centred approach to therapy that is founded on the basic principles of motivational psychology. The key goal of MET is resolving or overcoming ambivalence to behaviour change. Hence, it focuses on increasing patient’s motivation to change by enhancing patient’s understanding of the problem, addressing self-defeating thoughts as it relates to the problem, and building self-confidence as it relates to the patient’s ability to change. An initial assessment is conducted prior to delivering MET for the purpose of collating information on behaviours that are associated with the problem. Following the initial assessment, MET is typically delivered over four sessions. The first two sessions focus on structured feedback (from initial assessment), future plans, and motivation for change, while the latter two sessions provide opportunities for the practitioner to reinforce progress, conduct reassessments, and provide an objective perspective on the change process. MET can be delivered as a standalone intervention or in conjunction with other psychological interventions (e.g. CBT).