Motivational Interviewing- Addiction Psychiatry and Beyond Part 2

In trying to answer the question- ‘ Are we doing Motivational interviewing or are we doing Motivational Interviewing?”, it is important and only logical to understand what do we actually mean by Motivational Interviewing.

For me, there are a few givens here- that is- what MI is not. And if I were to qualify this, I mean we don’t do MI TO any one but rather do MI WITH someone. The word WITH in my experience is fundamental and crucial to any form of psychotherapy. In our jargon, we call it ‘therapeutic alliance’. Let me put it another way, wouldn’t it be better if I am able to understand and see the world from your perspective and work collaboratively with you to help you achieve your desired change? What is the likelihood of success, if you don’t establish any trust in the therapist?

MI in it’s fundamental approach is seeking to look at you as the sole agent of change and me as the MI practitioner, has the role of recognising that ‘change talk’ & evoking or extracting those internal resources that you have within your own self to facilitate that change.

So in some of the conversations that we may have in sessions, which may be regarding any change- alcohol control or abstinence, smoking cessation, tackling other substance misuse or behavioural addictions to name a few, if you tell me that you WANT to change, then MI will take us through the journey of going from ‘wanting’ to change to ‘willingness’ to change and ‘taking steps’ to change and then maintaining that change.

Of course, when you are talking about Substance Misuse the role of pharmacological options- Naltrexone for Opiates and Alcohol or newer treatments for alcohol as some examples, need to be kept in mind actively as well.

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Motivational Interviewing- Addiction Psychiatry and Beyond

Just back from a 2 day update on Motivational Interviewing and an important one, that was. Really excited and fortunate to actually have the pioneers themselves delivering it in Cardiff! Yes, William R. Miller and  Stephen Rollnick themselves.

It just helped reinforce the importance of the ‘Spirit of MI’- Evocative, Collaborative and Person- centred. We talk about MI a lot in Addictions and other healthcare settings. And the question for me for a few years has been- ‘Are we doing MI or are we doing MI?’. The exciting times ahead hopefully will help us answer this and integrate the philosophy, the language, the skills and this way of communication within the various healthcare settings. Wouldn’t it be wonderful to see ‘Engagement’ of healthcare users beginning from the point of first contact and we moving to a more collaborative model of healthcare delivery? And it does not matter whether we are in General Adult Psychiatry, Addiction Psychiatry or any other Healthcare settings!

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