motivational interviewing in social work essay

• DOI: 10.1177/1468017305051365
• Corpus ID: 143806288

Motivational Interviewing and Social Work Practice

• Published 1 April 2005
• Journal of Social Work

60 Citations

Resistance is futile exploring the potential of motivational interviewing, motivational interviewing: an approach to support youth aging out of foster care, the role of empathy in training social work students in motivational interviewing, motivational interviewing: creating a leadership role for social work in the era of healthcare reform, motivational interviewing: an evidence-based practice for improving student practice skills, motivational interviewing at the intersections of depression and intimate partner violence among african american women, impact of motivational interviewing by social workers on service users: a systematic review, the utility of motivational interviewing in domestic violence shelters: a qualitative exploration, applying motivational interviewing in a domestic violence shelter: a pilot study evaluating the training of shelter staff, problem gambling: a suitable case for social work, 58 references, motivational interviewing with problem drinkers, negotiating behaviour change in medical settings: the development of brief motivational interviewing, the use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review..

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Motivational consulting versus brief advice for smokers in general practice: a randomized trial

Motivational interviewing: an intervention tool for child welfare case workers working with substance-abusing parents., motivational interviewing: preparing people for change., motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients., motivational interviewing with problem drinkers: ii. the drinker's check-up as a preventive intervention, advanced generalist social work practice, a motivational interviewing intervention to increase fruit and vegetable intake through black churches: results of the eat for life trial., related papers.

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In This Article Expand or collapse the "in this article" section Motivational Interviewing

Introduction.

• Non-English Language Books
• DVD/Video Resources
• Online Resources
• History and Overview
• Meta-analyses and Systematic Reviews
• Active Ingredients and Mechanisms
• Training and Learning
• Implementation
• Measuring Skills and Fidelity
• Cultural Adaptations
• Adolescents
• Screening and Brief Interventions
• Alcohol and Other Drugs
• Child Welfare
• Intimate Partner Violence
• Criminal Justice
• Mental Health and Co-occurring Disorders
• Older Adults

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Motivational Interviewing by Melinda Hohman LAST REVIEWED: 22 August 2023 LAST MODIFIED: 22 August 2023 DOI: 10.1093/obo/9780195389678-0209

Motivational interviewing (MI) is a communication/counseling style that was developed initially as an alternative to the more traditional confrontational methods employed in substance use disorder treatment in the 1980s. It was based on psychologist Carl Roger’s client-centered model with the focus on demonstrating empathy to clients in an atmosphere of acceptance and collaboration and with an emphasis on client autonomy. These elements have been captured in what is called the “spirit” of MI. Other important aspects are the skills involved in creating this spirit, including the use of open-ended questions, affirmations, reflective listening statements, and summaries. In MI the practitioner listens for and highlights the client’s language of change, known as “change talk.” Listening skills are used to reflect and learn about the desires, abilities, reasons, and needs for change in clients. Emphasis is placed on evoking from the client their ideas about how change should occur, keeping the client as the expert in solving their problem. MI had been used as a stand-alone counseling method, a pretreatment method to engage clients, or in combination with other evidence-based practices. Initial publications regarding MI primarily explained the method, with early research demonstrating its efficacy in addressing substance use disorders. MI has been adopted and utilized by other fields of practice, especially health behavior change. Currently over 2,000 clinical trials of MI and over 200 meta-analyses/systematic reviews have been published, attesting to its broad reach and range. This annotated bibliography on MI provides resources for social workers, psychologists, counselors, and their educators. A review of the literature regarding elements of MI includes a section on its history, meta-analyses of research, training and implementation studies, and an overview of how MI works or its mechanisms of change and how to measure fidelity to MI skills. Other sections include Cultural Adaptations of MI, applications of MI in Screening and Brief Interventions , and MI with Adolescents , Older Adults , and in group settings. Also reviewed are areas of interest to social workers, including Social Work in general, alcohol and other drug misuse, Mental Health and Co-occurring Disorders , Criminal Justice , and Intimate Partner Violence . Included are randomized controlled trials, other study designs, qualitative designs, case studies, and conceptual articles. The research on MI has been so abundant that many meta-analyses have been conducted and most are included in this review, not only in the Meta-analyses and Systematic Reviews section but under other sections as well. Not only do they provide information from a wide swath of studies but they also point the reader to the various studies that were included in the analyses.

The following books provide a good overview of MI. Readers who are interested in learning about MI and its skill components, along with example dialogues, will find these helpful. The recent fourth edition of Miller and Rollnick 2023 is the go-to book for those interested in learning about MI as well as understanding changes in current practice. Rollnick, et al. 2023 explores MI methods in health care that include helpful conversational tools that can be applied to any context. As MI practice has evolved, other authors have applied MI concepts and skills to specific fields of practice such as mental illness ( Arkowitz, et al. 2017 ); Adolescents ( Naar-King and Suarez 2021 ); families ( Forrester, et al. 2021 ); Criminal Justice ( Stinson and Clark 2017 ); and work in schools ( Rollnick, et al. 2016 ). Hohman 2021 provides applications of MI to various Social Work settings and Schumacher and Madson 2015 examine MI in counseling with clinical examples. Wagner and Ingersoll 2013 address MI specifically in group work. All of these books could be used as textbooks in specific courses that need some skill-based material.

Arkowitz, Hal, Henny Westra, William Miller, and Stephen Rollnick, eds. 2017. Motivational interviewing in the treatment of psychological problems . 2d ed. New York: Guilford.

This edited text provides information regarding the application of MI to a variety of psychological problems, including anxiety, depression, suicidality, eating disorders, and substance use disorders, among others. Provides an updated overview of the research of MI in each area as well as clinical examples of its use. See also Mental Health and Co-occurring Disorders .

Forrester, Donald, David Wilkins, and Charlotte Whitaker. 2021. Motivational interviewing for working with children and families: A practical guide for early intervention and child protection . London: Jessica Kingsley.

Provides information regarding MI and its applicability in working with families, particularly those in the child protection system. It addresses having difficult conversations in the context of authority while still maintaining the spirit and skills of MI.

Hohman, Melinda. 2021. Motivational interviewing in social work practice . 2d ed. New York: Guilford.

This updated version contains information on the four processes and applications of MI in various social work contexts, with accompanying learning competencies. It is a guide to learning MI with new example dialogues drawn from micro- , mezzo-, and macro-social work contexts. Includes a chapter on learning and implementing MI. Practicing social workers contributed their experiences with MI in textboxes. See also Social Work .

Miller, William R., and Stephen Rollnick. 2023. Motivational interviewing: Helping people change and grow . 4th ed. New York: Guilford.

Written by the founders of MI, this new edition adds updated concepts and practices in using the method, based on cumulative research studies and thinking of the authors, including the use of simple and complex affirmations. A learning MI chapter also covers artificial intelligence methods. Sample dialogues are provided to demonstrate skills. This book has been translated into at least twenty-eight languages.

Naar-King, Sylvie, and Mariann Suarez. 2021. Motivational interviewing with adolescents and young adults . 2d ed. New York: Guilford.

Provides an overview of the use of MI with adolescents and places it in the context of developmental needs. Clinical issues and needs are interwoven throughout with a new focus on the four processes. Use of MI in adolescent group work is included along with updated research and skill building exercises. See also Adolescents .

Rollnick, Stephen, Sebastian G. Kaplan, and Richard Rutschman. 2016. Motivational interviewing in schools: Conversations in improve behavior and learning . New York: Guilford.

Conversations about change in the context of school settings, learning MI skills, and applying MI to specific problems, such as bullying and dropout prevention. (Translated into Czech.)

Rollnick, Stephen, William R. Miller, and Christopher C. Butler. 2023. Motivational interviewing in health care: Helping patients change behavior . 2d ed. New York: Guilford.

Written as a user-friendly teaching guide to learning MI with a focus on MI skills that can be used in interprofessional settings. Sample vignettes and dialogues with new examples regarding advice giving and brief consultations, mostly in medical settings.

Schumacher, Julie A., and Michael B. Madson. 2015. Fundamentals of motivational interviewing: Tips and strategies for addressing common clinical challenges . Oxford: Oxford Univ. Press.

Written for those in the helping professions with various MI skills levels, this book provides information on the use of MI in setting with clinical challenges, such as missed appointments, mental health issues, and working with parents and groups.

Stinson, Jill D., and Michael D. Clark. 2017. Motivational interviewing with offenders: Engagement, rehabilitation, and reentry . New York: Guilford.

Provides application of MI to the setting for those working in the criminal justice system. How to do so within the four processes is covered along with how to implement and sustain MI in probation and parole settings. See Criminal Justice .

Wagner, Christopher C., and Karen S. Ingersoll. 2013. Motivational interviewing in groups . New York: Guilford.

Book describing MI, group work, and how the two fit together. Good details regarding implementing MI groups along with chapters on specific population applications. Useful for group work courses. See also Group Work .

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Motivational interviewing’s theory of practice for social work

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Motivational interviewing (MI) continues to evolve and be disseminated for use with different social work target populations. It places high importance on the relationship between the practitioner and the client, utilizing very specific communication skills to enhance relationships and promote clients’ advocating for their own change. This chapter focuses on the practice theory of MI. It describes the clinical components of MI to further illuminate its theoretical underpinnings. Quite to the contrary of critiques that MI is an atheoretical practice, MI represents a fundamental theoretical shift in thinking about client behaviour change. To fully understand MI’s underlying practice theory, one should understand the skills used in MI. The MI spirit consists of four aspects: partnership, acceptance, compassion, and evocation. In addition to demonstrating the MI spirit in clinical interactions, MI practitioners also attend to change talk.

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Motivational interviewing: what it is and how you can use it in social work

New podcast includes improvised scenarios showing an mi approach in action.

What is motivational interviewing?

Lydia Guthrie:  “Motivational interviewing is an approach to being with people in conversations to support them to make changes in their behaviour. And one of the things that is really special about motivational interviewing is that it works in a way which balances being directive with also being supportive and non-judgemental. So it’s not the same as a pure counselling approach, where you might take the position of, ‘It’s not for me as the worker to have an opinion. I’m here to support you to work out what’s best for you.’ So it’s not that end of the scale. Nor is it the other end of the scale of, ‘You need to listen to me and do what I say, ‘cause I’m going to tell you what to do.’ It’s a way of working that very explicitly aims to sit in the middle, between those poles, and offer support and guidance.

It’s underpinned by a really important set of beliefs about how to work alongside people, which are really compatible with some of the key social work values, such as recognising that people are the experts in their own lives, recognising that it’s really important to focus on strengths, what resources people have, the changes that they have been able to make and issues about their value base and their identity.”

David Wilkins:  “For me MI is both a set of techniques, a communication style, it’s a set of skills that you can learn and you can develop and you can practise, just like you can with other skill sets. So that’s things like using a particular language, using open questions, using reflections, affirmations […] So there’s a set of skills that people can learn, but it’s also exactly as Lydia said, a way of being with people. It’s a concept about actually how do people change and how do I help people to change, and there’s a kind of philosophy that underpins that, which is almost embodied in the skills but in some ways separate from them.

I think very high-level MI practitioners may end up using the techniques a little bit differently from how they’re set out in the textbooks, but actually it’s about embodying that philosophy that, ‘I’m here to help, I’m here to support. I am here to challenge but it’s about how I do that and why I do that.’ And it’s about not coercing or manipulating people. It’s about working alongside them – exactly as Lydia said – as human beings, and how would I like to be helped if I needed to change, and it’s bringing that philosophy alive, and that’s where the techniques come in as a way of doing that. But I think it’s not a set of techniques. It’s neither a philosophy. It’s the combination of the two.”

Four key parts of the motivational interviewing approach are known by the OARS acronym. Guthrie describes them:

Open-ended questions : Most social workers are really familiar with this idea of not asking closed questions, and instead asking questions which seek more information or ask someone to say something about how they view their world, to give information that isn’t previously known to the social worker.

Affirmations : This is when you offer the person you’re speaking to an observation of something that you’ve noticed that is important to them, either something they’ve achieved or a value they hold dear.

Reflections : These are not questions. It’s reflective listening, repeating parts of what the other person says, but not as questions. It’s really crucial that your tone of voice doesn’t go up at the end. It’s like taking a verbal highlighter pen to something that you’ve just heard the person say. You can do that on the contents of what they say, which is the simplest form, where you just repeat back some words. You can also do that on the meaning of what they say, or offer a feeling reflection, reflecting back to the other person an impression you’re getting of a feeling that they might be experiencing or something that really matters to them.

Summaries : You can be very strategic in what you summarise. Summarising the change talk that you hear, summarising the things that the person has said which indicate that they’re already thinking about changing or have already taken some tiny steps towards changing.

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Related articles:, 5 responses to motivational interviewing: what it is and how you can use it in social work.

A SOUND AND TIMELY ARTICLE! C’ est le ton qui fait la musique !.

May be one point to be added: The reality of law, regulation, policy and, above all, risk cannot be

camouflaged in good supervision and advice.

I have done some nhs training in motivational interviewing and used it in working with families. I would like to read more on the research and scientific evidence behind it.

Most families will see right through that. Patronising.

Very effective way of working in substance misuse social work .

The important thing is that MI should be genuinely felt by the practitioner. You are absolutely right that people will see through this otherwise. MI is not a set of techniques to ‘trick’ the person into doing something they don’t want to do. This is why Miller and Rollnick (and MI practitioners) emphasise the importance of the spirit of MI. This is the atmosphere that the worker creates that makes it more likely that the service user will engage and feel open to explore their ambivalence about making change.

We know that it is hard to make change and we instinctively know that telling people what to do is unhelpful (and often counter-productive). MI gives us a way of responding to people that often fits with social workers’ own values of respecting a person’s autonomy and working collaboratively.

As a social worker and trainer in MI, I have found it to be an invaluable skill and think it is really well suited to social work settings.

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Motivational Interviewing in Social Work: Enhancing Client Engagement and Empowerment

Motivational interviewing (MI) is a client-centered, evidence-based approach used in social work practice to facilitate behavior change by enhancing clients’ motivation to address concerns and achieve goals. Originally developed in the field of addiction treatment, MI has since been applied across various domains of social work. Including mental health, healthcare, child welfare, and criminal justice. This article explores the principles, techniques, and applications of motivational interviewing in social work practice, emphasizing its role in promoting client engagement, empowerment, and positive outcomes.

Table of Contents

Understanding Motivational Interviewing

Motivational interviewing is founded on the principles of collaboration, evocation, autonomy, and compassion (Miller & Rollnick, 2012). It involves a guiding style of communication characterized by empathy, reflective listening, and a non-confrontational approach. MI aims to help clients explore and resolve ambivalence about change, thereby increasing their readiness and commitment to taking action. The spirit of MI fosters a partnership between the social worker and the client. With an emphasis on respecting the client’s autonomy and self-efficacy.

Key Principles of Motivational Interviewing

• Express Empathy: Social workers employing MI strive to understand the client’s perspective, validate their experiences, and convey empathy through active listening and reflective statements. Empathy builds trust and rapport, creating a safe space for clients to explore their thoughts, feelings, and concerns without judgment.
• Develop Discrepancy: MI encourages clients to examine the discrepancy between their current behavior and their goals or values, highlighting the discrepancy motivates clients to consider change. Social workers help clients explore the negative consequences of their behavior while reinforcing their intrinsic motivations and aspirations.
• Roll with Resistance: Rather than confronting resistance directly, MI emphasizes responding to resistance with empathy and curiosity. Social workers acknowledge and respect the client’s autonomy, reframing resistance as a natural part of the change process. By avoiding power struggles and coercion, social workers maintain a collaborative stance that encourages openness and exploration.
• Support Self-Efficacy: MI promotes clients’ belief in their ability to change and overcome challenges. Social workers affirm clients’ strengths, resources, and past successes, fostering optimism and confidence in their capacity to make positive changes. By highlighting clients’ self-efficacy, social workers empower clients to take ownership of their change process.

Techniques of Motivational Interviewing

• Open-Ended Questions: Social workers use open ended questions to elicit clients’ perspectives, values, and goals. Open ended questions invite clients to share their experiences and thoughts freely, facilitating exploration and deeper understanding.
• Reflective Listening: Reflective listening involves paraphrasing, summarizing, and affirming clients’ statements to demonstrate understanding and empathy. Reflective statements help validate clients’ experiences, build rapport, and encourage further exploration.
• Affirmations: Affirmations are statements that acknowledge and reinforce clients’ strengths, efforts, and positive attributes. Affirmations boost clients’ self-esteem and confidence, enhancing their motivation and commitment to change.
• Eliciting Change Talk: Change talk refers to statements made by clients that indicate their readiness, willingness, or ability to change. Social workers use techniques such as asking evocative questions, exploring goals and values. And highlighting discrepancies to elicit change talk and reinforce motivation for change.
• Summarizing: Summarizing involves synthesizing and reflecting back key points from the client’s narrative. Summaries help clarify and organize the conversation, reinforce client autonomy, and facilitate decision-making.

Applications of Motivational Interviewing in Social Work

• Substance Use and Addiction: MI is widely used in substance abuse treatment to help individuals explore their ambivalence about change, increase motivation for treatment, and enhance engagement in recovery efforts. Social workers collaborate with clients to set realistic goals, develop coping strategies, and navigate challenges in maintaining sobriety.
• Mental Health: In mental health settings, MI is employed to support clients in managing symptoms, adhering to treatment plans, and improving overall well-being. Social workers use MI techniques to explore clients’ concerns, enhance self-awareness, and promote self-efficacy in coping with mental health challenges.
• Healthcare: MI is integrated into healthcare settings to promote health behavior change, such as smoking cessation, weight management, and medication adherence. Social workers collaborate with clients to identify health goals, address barriers to change, and develop personalized action plans for improving health outcomes.
• Child Welfare: MI is utilized in child welfare settings to engage families in case planning, reunification efforts, and parenting interventions. Social workers employ MI techniques to empower parents, strengthen family relationships, and promote positive behavior change in the best interest of children.
• Criminal Justice: MI is applied in criminal justice settings to support individuals involved in the justice system, such as probationers, parolees, and offenders in diversion programs. Social workers use MI to address criminogenic needs, reduce recidivism, and facilitate reintegration into the community.

Challenges and Considerations

While motivational interviewing offers numerous benefits in social work practice, it is not without challenges. Some common challenges include:

• Time Constraints: MI requires time for building rapport, exploring ambivalence, and eliciting change talk, which may be challenging in fast-paced or time-limited settings.
• Resistance and Ambivalence: Addressing resistance and ambivalence effectively requires skill and practice. Social workers may encounter clients who are initially resistant to change or reluctant to engage in the process.
• Training and Supervision: Social workers need training and ongoing supervision to develop proficiency in MI techniques and maintain fidelity to the approach. Continued professional development is essential for enhancing MI skills and addressing complex client issues.

Motivational interviewing is a valuable tool in the social worker’s toolkit, offering a client-centered approach to fostering behavior change, enhancing engagement, and promoting empowerment. By embodying the spirit of MI and utilizing its techniques effectively. Social workers can support clients in navigating challenges, achieving their goals, and creating positive change in their lives. As social work continues to evolve, the integration of motivational interviewing principles into practice holds promise for advancing client-centered care and improving outcomes across diverse populations and settings.

Read more: Is Social Work a Good Career?

Frequently Asked Questions:

What is motivational interviewing (mi) in social work.

Motivational interviewing is a client-center approach use in social work to facilitate behavior change by enhancing clients’ motivation to address concerns and achieve goals. It involves techniques such as empathetic listening, reflective questioning, and eliciting change talk to help clients explore and resolve ambivalence about change.

How does motivational interviewing differ from other therapeutic approaches?

Motivational interviewing differs from traditional therapeutic approaches in its focus on collaboration, evocation, and autonomy. Unlike directive approaches that emphasize advice-giving or confrontation. MI aims to evoke clients’ intrinsic motivations for change and empower them to explore their own solutions.

What are the key principles of motivational interviewing?

The key principles of motivational interviewing include expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. These principles guide social workers in fostering a collaborative and non-confrontational atmosphere that respects clients’ autonomy and intrinsic motivations.

What techniques are use in motivational interviewing?

Techniques used in motivational interviewing include open-ended questions, reflective listening, affirmations, eliciting change talk, and summarizing. These techniques help social workers engage clients in exploring their thoughts, feelings, and motivations for change in a non-judgmental and empathetic manner.

What are the applications of motivational interviewing in social work practice?

Motivational interviewing has diverse applications in social work practice, including substance use and addiction treatment, mental health interventions, healthcare settings, child welfare services, and criminal justice programs. It can be use to support behavior change, enhance engagement, and promote empowerment across various populations and settings.

How can social workers learn and develop skills in motivational interviewing?

Social workers can learn and develop skills in motivational interviewing through training workshops, online courses, supervision, and self-study resources. Ongoing practice, feedback, and reflection are essential for mastering MI techniques and applying them effectively in diverse practice settings.

What are some common challenges in using motivational interviewing?

Common challenges in using motivational interviewing include time constraints. Addressing resistance and ambivalence, and the need for ongoing training and supervision. Social workers may also encounter difficulties in maintaining fidelity to the MI approach and integrating it into their existing practice frameworks.

How does motivational interviewing contribute to positive outcomes for clients?

Motivational interviewing contributes to positive outcomes for clients by enhancing engagement, promoting self-efficacy, and fostering intrinsic motivation for change. By empowering clients to explore their goals and values, MI facilitates behavior change and supports long-term success in achieving desired outcomes.

Meet Manicka

I created The Social Work Success Path blog and podcast, during the pandemic of 2021 to provide online education and mentorship for Social Workers. I felt very isolated and disconnected being only in the second year of running my private practice. I strongly considered going back to work when everything shut down. The resources and tools that I share helped me to maintain my practice through the pandemic and plan a successful transition as a Social Work content creator, doing work that I love and connecting with Social Workers all around the world. I did this in the span of 1 year, but using the resources, trainings and tools that I have pulled together, and all my all lessons learned, you can make your career transition much sooner than I did!

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Motivational interviewing (pp. 451-454) from "The Blackwell Companion to Social Work (4th ed.)" Davies (Ed.). (2013)

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Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice

Gallus Bischof

1 Lübeck University, Department of Psychiatry and Psychotherapy, Lübeck

Anja Bischof

Hans-jürgen rumpf.

Motivational factors in health-relevant modes of behavior are an important matter in medical practice. Motivational interviewing (MI) is a technique that has been specifically developed to help motivate ambivalent patients to change their behavior.

This review is based on pertinent publications retrieved by a selective search in the PubMed, Cochrane, and Web of Science databases. Special attention was paid to systematic reviews and meta-analyses concerning the efficacy of MI in the medical care of various target groups. The present review focuses on the relevance of MI for patients with highly prevalent disorders.

Meta-analyses reveal statistically significant mean intervention effects of MI in medical care with respect to a variety of health-relevant modes of behavior, in comparison to standard treatment and no treatment in the control groups (odds ratio [OR]: 1.55; 95% confidence interval: [1.40; 1.71]). Statistically significant effect sizes were reported for substance consumption, physical activity, dental hygiene, body weight, treatment adherence, willingness to change behavior, and mortality; effects on health-promoting behavior were mixed. Studies of the factors that contribute to the efficacy of MI suggest that it exerts its effects largely through the selective reinforcement of statements made by the patients themselves about potential changes in their behavior.

MI has been found useful for strengthening the motivation for behavioral change in patients with various behaviorally influenced health problems and for promoting treatment adherence. It can be used to optimize medical interventions. Further research is needed with respect to its specific mechanisms of action, its efficacy in reinforcing health-promoting modes of behavior, differential indications for different patient groups, and the cost-efficiency of the technique across the spectrum of disorders in which it is used.

This article has been certified by the North Rhine Academy for Continuing Medical Education. Participation in the CME certification program is possible only over the internet: cme.aerzteblatt.de. The deadline for submissions is 18 February 2022.

In highly developed industrialized countries, behavioral risk factors such as substance use (tobacco, alcohol), unhealthy diet, and insufficient physical activity are a key determinant of the burden of disease in the population as measured by disability-adjusted life years (DALYs) ( 1 ). These factors also have a crucial impact on the course of a variety of chronic diseases.

For example, according to the Global Burden of Disease study, the 23.9 million DALYs lost in the German population in 2010 can be attributed in percentage terms to the following causes ( 2 ):

• Unhealthy diet (men: 16.2%, women: 11.2%)
• Smoking (men: 14.2%, women: 6.7%)
• High blood pressure (men: 11.5%, women: 10.2%)
• Overweight (men: 11.5%, women: 10.3%).

Therefore, motivational aspects are a significant factor in patient treatment. Other important motivational factors for medical practice stem from the often insufficient adherence to medication, which, according to a number of studies, lies between 31.2% and 59.1% and also represents a significant factor in the chronification of health impairments ( 3 – 5 ).

Furthermore, societal changes in recent decades that challenge our understanding of the clinician’s role are reflected in the concept of “shared decision-making,” according to which treatment steps should be developed in consultation with the patient ( 6 ).

Motivational interviewing (MI) ( 7 ), which originated in the field of addiction treatment, is a promising concept for encouraging motivation to change in patients that are currently either unwilling or ambivalent to change, and can be deployed even with limited time resources. Since the first publications on the approach in the early 1980s, it has also been increasingly used, and successfully so, in other disciplines. This article presents the basic principles of the approach from the perspective of their applicability in medical practice. To assess the effectiveness of the method, systematic reviews and meta-analyses published in the PubMed, Cochrane, and Web of Science databases since 2005 on the effectiveness of MI across disorders in medical treatment settings, as well as on the effectiveness of MI on medication adherence, were selectively searched and summarized using the search terms (“Motivational Interviewing” AND (“primary care” OR “medical care”).

Basic tenets of motivational interviewing

Although MI is not a theory-guided approach, it nevertheless combines a variety of evidence-based approaches from cognitive psychology and social psychology. MI assumes that people with problematic behaviors (for example, smoking, high-risk alcohol consumption, unhealthy diet, lack of medication adherence, insufficient exercise) have different levels of readiness for behavior change.

According to Janis and Mann’s conflict-theory model of decision-making ( 8 ), the advantages of healthy behaviors (such as better health prognosis and improved fitness, among others) are always countered by disadvantages of behavior change (for example, loss of hedonistic reinforcers, significant effort, possible side effects of medication). The assumption in MI is that people with problematic behaviors are not fundamentally unmotivated to change their behavior, but are instead ambivalent, that is to say, their problem behavior conflicts at least to some extent with their self-concepts, values, or life goals, with those affected potentially having subjectively good reasons against a behavior change. If this ambivalence is not recognized, well-intentioned medical advice is perceived by patients as an assault on their freedom of choice, which, according to socio-psychological reactance theory ( 9 ), increases their motivation to restore their own subjective power to make decisions. This, in turn, often results in non-compliance either in the form of open disagreement or non-adherence to recommendations. A prerequisite of sustained encouragement of motivation to change is that patients become more aware of their behavioral discrepancies and actively confront their behavior. Therefore, MI is defined as “a person-centered, goal-oriented style of communication with particular focus on expressions of change. The goal is to increase personal motivation for and commitment to behavior change by eliciting and intensifying a person’s own reasons for change in an atmosphere of acceptance and empathy” ( 7 ). In line with self-determination theory (SDT; [10]), the approach recognizes the needs for autonomy, competence, and relatedness. As such, the atmosphere of acceptance and empathy represents a necessary condition for patients’ self-disclosure in interviews relating to difficult or stigmatized subjects such as substance use, overeating, or health problems. The authors of MI have repeatedly emphasized that MI is not a technique, but a fundamental therapeutic style that does not seek to make people change their behavior against their will. Roger’s person-centered therapy ( 11 ) forms an important basis of the approach, whereby MI is characterized by a goal-oriented approach and can essentially be combined with other therapeutic methods. The hallmark of MI is a differentiation into inner attitude (“human image”), methods and principles of implementation, as well as different processes of implementation ( box 1 ).

The spirit of motivational interviewing (MI)

The fundamental spirit of MI is to encourage and strengthen a trusting relationship, which is key to treatment success and can be characterized by the following components ( 7 ):

• A partnership-like, unpatronizing collaboration with the patient (“communication on equal terms”), in which the clinician does not assume the role of the expert (superior to the patient).
• A fundamental attitude of acceptance and empathy towards the patient’s needs, experiences, and points of view. In addition to unconditional regard for the patient, this includes ensuring their autonomy of choice and decision-making in relation to behavior change as well as the desired goals and methods of change (patient autonomy).
• Compassion for the patient’s life and experience, as characterized by the clinician not pursuing their own interests and giving highest priority to the patient’s needs.
• Evoking motivation to change by exploring and reinforcing the patient’s reasons for change. This also includes developing discrepancy between current problem behavior and the patient’s goals and values (for example, “You said that it’s important to you to do more exercise again. How does that tie in with your smoking?”).

Techniques of motivational interviewing

In addition to the basic principles of MI, the method includes altogether five intervention techniques, the importance of each of which may vary depending on the patient and the status of their treatment ( 7 ). The first four intervention techniques are methods that are also used in other schools of therapy, such as client-centered interviewing.

First intervention element

Open-ended questions are helpful for encouraging patients to confront their problem behavior, for example, “What worries you about your drinking?” MI is deemed to be good when at least 70% of the questions asked are open-ended ( 12 ).

Second intervention element

Active listening makes it possible to discover and focus on the patient’s concerns regarding their problem behavior. As part of this process, the clinician reflects back to the patient the essential content of their statements. Furthermore, active listening not only has the effect that the individual experiences understanding, it also enables the problem to be considered more deeply through increased self-exploration. At least 50% of reflections should be complex and go beyond simple repetition ( 12 ). Complex reflections refer either to non-explicit content that is inferred or to emotional elements (for example, patient: “I do think my cough comes from smoking.”; physician: “And that worries you.”). In good MI, at least two reflections should be used per question asked.

Third intervention element

Affirmation includes praise (“That’s great that you want to do something about your smoking!”), recognition (“You are going through a difficult time right now.”), and understanding (“I can well understand that you are concerned about the side effects your medication could have.”).

Fourth intervention element

Summarizing is an effective technique whereby the contents mentioned by the patient that are significant for motivation to change are reflected back to the patient (for example, “On the one hand, you don’t want to forbid yourself anything, but on the other, the amount of money you spend on smoking bothers you and your cough worries you”).

Fifth intervention element

MI is characterized in a narrower sense by the encouraging of self-motivational statements. This involves making a distinction between patient utterances that oppose change and suggest a stabilization of the status quo (“sustain talk”; for example, “I don‘t think those 10 cigarettes a day are so bad”) and utterances that make a behavior change more likely in that the patient names reasons and intentions for change (“change talk”; for example, “If I got sick again, I would probably lose my job—maybe I should try the medication after all”). “Change talk” is encouraged by asking specific questions (“How could the medication help you against your depression?”), by affirming (“It‘s impressive that you see a link between the medication and opportunities for your further career”), or by selective reflection (“The medication can help you to stay healthy”) and can be differentiated according to two objectives:

• Building motivation through concrete expressions characterized by the patient stating their desires, abilities, reasons for change, and perceived needs for change, as summarized by the acronym DARN (desire, ability, reasons, and need)
• Stating commitment, activation, and first steps (acronym [CAT] for “commitment,” “activation,” and “taking steps”).

For successful behavior change, it is important that the patient’s need for change translates in the next step into a commitment to change behavior.

Information, as well as the clinician’s own ideas, can be incorporated in MI, whereby it is important to ensure that the patient is prepared to be confronted with the information and that the clinician’s viewpoint is expressed merely as an option and not as the only truth. From a methodological perspective, this is achieved in a three-step process (elicit–provide–elicit) by first asking for consent (“Would you like to know more about…”), secondly, offering the information in a neutral way (for example, “Scientific studies have shown…”), and finally asking the patient for their view (for example, “What do you think about…”). Information that the patient does not want or that they perceive as threatening usually causes reactance.

Conflicts during an interviewing session typically occur when interventions are not suited to the patient’s current motivation to change, for example, when a patient with high-risk alcohol consumption is given recommendations for action, whereas the patient is not yet clear about whether their alcohol consumption constitutes problematic behavior. This can manifest interpersonal dissonance (discord; for example, “Are you trying to imply that I’m an alcoholic?”) or in a reversion to “sustain talk” (“In my case, exercise wouldn’t do any good anyway”). In situations such as these, in addition to treating the patient with empathy, it is particularly important to emphasize their autonomy (“Only you can decide whether you want to change something about that”) ( Box 2 , 3 ) .

Processes of motivational interviewing (MI)

The format of MI treatment can be divided into four distinct processes ( 7 ); however, these do not follow on from one another in a static manner, since processes that have already been gone through may become more important again at a later point in time:

• In this phase, which is indispensable for the development of a therapeutic working relationship, non-judgmental understanding of the patient’s views, values, and goals is of central importance. This can also be significant, for example, if the patient is not attending the interview voluntarily but due to external pressure.
• In most cases, patients have a number of problem areas, the subjective significance of which can vary greatly. Focusing is about identifying the areas that take priority for the patient.
• This process involves the transition to MI in the narrower sense; at this point, the interview becomes goal-oriented. Here, the motivation to change is encouraged relative to the patient’s priority areas of life, such that reasons for change and strategies for behavior change are incited by the patient themselves, that is to say, the patient “talks themselves into change,” so to speak. These change-related statements are reinforced and intensified.
• Whereas the first three phases are fundamental constituents of MI, achieving this fourth phase depends on whether the patient decides for behavior change. If this is the case, the focus is put on making the intention to change more concrete in terms of the goals of a change, the envisaged strategies for achieving these goals, and formulating a concrete (that is to say, near-term and implementable) change plan.

Effectiveness of MI in medical care

Since the approach was first developed, the number of MI-specific publications has increased exponentially, to the extent that there are now more than 1300 randomized trials and around 150 reviews on the effectiveness of MI in a variety of behaviors and target populations. The majority of studies address problematic substance use. By means of a systematic literature search limited to systematic reviews and meta-analyses in the PubMed, Cochrane, and Web of Science databases on the effectiveness of MI in medical care settings using the search terms (“Motivational Interviewing” AND [“primary care” OR “medical care”]), it was possible to identify a total of nine systematic reviews published since 2005, of which two were meta-analyses. Both meta-analyses found small to moderate effect sizes with regard to various health-related behaviors such as blood pressure, substance use, and medication adherence of d =0.18 (95% confidence interval [0.03; 0.33]; p =0.02) ( 13 ) and (odds ratio: [OR] = 1.55 [1.40; 1.71]; p <0.001) ( 14 ), for the effectiveness of the technique. The included MI interventions varied from single contacts lasting 15 min to long-term treatments lasting up to a total of 480 min, with the majority of studies including brief interventions of no more than three sessions ( 14 ). Selected results on individual outcome parameters from the more comprehensive meta-analysis by Lundahl et al. (2013), which covered 48 studies with a total of 9618 included subjects, are shown in the Table ( 14 ). Effect sizes represent the improvement in the outcome criterion relative to controls; odds ratios > 1 indicate superiority of the MI group. The practical effect of the intervention is expressed by the binomial effect size display (BESD), in which the probability of success in the treatment group is subtracted from the probability of success in the control group. Values of >50% indicate a greater effect for the condition in question. Particularly marked treatment effects were found for a reduction in substance use, physical inactivity, body weight, and mortality, as well as for improved dental hygiene, acceptance of further treatment, and self-monitoring of health behavior (for example, with regard to blood glucose monitoring and nutrition). No significant effects were seen for eating disorders, self-care behaviors, or individual medical parameters such as heart rate. Effect sizes were greater when the intervention was delivered by the treating clinicians (versus medical/technical assistants). The average treatment effects were significant across all outcome measures, but were most pronounced for patient self-reports (OR = 1.69; [1.55; 1.84]), followed by third-party assessments (OR = 1.48; [1.24; 1.78]), and lowest for biological outcome parameters (OR = 1.18; [1.09; 1.28]) ( 14 ). According to Lundahl et al. (2013), effect sizes decrease over time, but five studies with follow-up surveys after more than 13 months nevertheless demonstrate significant effects compared with controls (OR = 1.14; 95% CI [1.03; 1.28]). Treatment effects were significant in waiting lists, as well as in unspecified routine treatments and psychoeducational control conditions.

Reviews of the effects of MI on medication adherence across disorders not limited to medical care found positive, albeit small, effects with a pooled relative risk of 1.17 ([1.05; 1.31]; p < 0.001) ( 15 ) and a Cohen’s d of 0.23 ([0.08; 0.37], p > 0.001), with the included studies being of heterogeneous quality ( 16 ).

A systematic review of the overall effectiveness of MI across settings and based on 104 published reviews (of which 39 were meta-analyses) found good evidence for cessation or prevention of unhealthy behaviors, particularly with regard to problematic substance use (primarily alcohol, cannabis, and tobacco), whereas the evidence for health-promoting behaviors (except the promotion of physical activity) was more heterogeneous and, in terms of the methodological quality of the studies included, weaker ( 17 ). With regard to potential moderator variables, effects were found compared to control groups that had received either no treatment or unspecified routine treatment, but not compared to control conditions with other evidence-based interventions such as cognitive behavioral therapy ( 17 ). Although studies on the effectiveness of MI in substance-related disorders point to greater cost-effectiveness for MI compared to other evidence-based interventions ( 18 ), corresponding reviews on the cost-effectiveness of MI across disorders are lacking to date ( 17 ).

On the basis of the studies conducted to date, MI has proved to be an evidence-based, effective, and comparatively economical method of promoting behavior change in ambivalent patients, particularly in the case of problematic substance use. There are not yet enough studies of high methodological quality available for a variety of other medical fields of application, such as motivation to adopt health-promoting behavior, to be able to make detailed statements on the indication for and differential efficacy of MI.

Mechanisms of MI

With regard to the specific mechanisms of MI, three alternative hypotheses are purported. The technical hypothesis, according to which the effectiveness of MI is achieved through basic skills such as open-ended questions, active listening, affirming, and summarizing in the form of selective reinforcement of patients’ self-motivational utterances, is the hypothesis that has been the most extensively studied to date and, comparatively, has received the most empirical support ( 19 – 21 ). The relational hypothesis, in contrast, assumes that relationship quality and therapeutic empathy are the most significant factors for the effectiveness of MI. This hypothesis has been investigated to a lesser extent and is deemed to be insufficiently substantiated, with one critical review pointing out that, in the majority of studies considered, the MI clinicians studied differed insufficiently in these characteristics to be able to demonstrate effects on effectiveness ( 19 ). The conflict resolution hypothesis states that the effect of MI can be attributed to a large extent to exploration and resolution of conflict, although here again, the empirical evidence is heterogeneous. In their review, Magill and Hallgren ( 19 ) conclude that the various factors should be regarded more as necessary than as sufficient conditions for the effect of MI, whereby further research needed.

Conclusions for clinical practice

The MI approach has proved its value for the promotion of intentional readiness for behavior change in a number of behavioral health problems, as well as for the promotion of treatment adherence, and can be used in medical practice even with limited time resources. Continuing education courses on the basic principles of MI, which usually last 2 days, are regularly offered by German Medical Councils and various private sponsors, and specialist literature on different fields of application is available in German ( 7 ). A number of German-speaking trainers are members of the international Motivational Interviewing Network of Trainers ( www.motivationalinterviewing.org/trainer-listing ).

BESD, binomial effect size display: 2 × 2 table [group (MI, controls) × improvement (yes, no)]; * 1 p < 0.05; * 2 p < 0.01 MI, motivational interviewing

Example interview of motivational interviewing

Clinician: “We took a blood sample at your last appointment and I would like to discuss the findings with you. On the whole, your values are normal—only one liver enzyme value is elevated. You can see here, your gamma-GT is 220, a normal value would be 66 at the most. The gamma-GT level generally rises when, over a long period of time, one drinks more alcohol than the liver can break down. How does that sound to you?”

Patient: “I really can’t imagine that, I don’t actually drink that much. Well, okay, sometimes when I’m under a lot of stress at work, I’ll have a few more beers in the evening than usual, but otherwise I just have my after-work beer, and never any hard stuff.”

Clinician: “So this surprises you…”

Patient: “Yes, of course, I really don’t think I drink that much. I mean, I hardly ever get drunk.”

Clinician: “On the whole, you’ve got your drinking well under control; you only really drink a bit more when you’re under a lot of stress.”

Patient: “Of course, I’ll admit that now and again I need something in the evening to switch off. But I can’t imagine that my liver can’t cope with it; after all, I used to drink a lot more while I was training and never had any problems.”

Clinician: “You don’t see any problems with your alcohol consumption, and now the findings bother you, of course. Would you be interested in having a bit of information about the link between alcohol consumption and liver values?”

Patient: “Oh well, why not? Of course, I once read that too much alcohol is not good for the liver, but not in the case of one or two after-work beers….”

Clinician: “Recent studies have shown that alcohol consumption even in comparatively small amounts can cause a number of physical effects. Low-risk alcohol consumption is considered to be a daily amount of no more than two small alcoholic drinks in healthy men, which corresponds to about half a liter of beer. Higher alcohol consumption increases the risk of health consequences such as liver and cardiovascular diseases. Also, the recommendation is to not drink alcohol two days a week. What does hearing that make you think?”

Patient: “Well, to be honest, I’m already above that. I sometimes have four or five beers in the evening. But it never never seemed that much to me—it doesn’t make me drunk. But what you’ve told me about my liver values does of course sound quite worrying…”

Clinician: “On the one hand, you found your alcohol consumption quite normal, buth on the other, you’re worried now….”

Patient: “ Of course, and I don’t want it to get worse. But does that mean I can’t ever drink beer again?”

Clinician: “The idea that your liver values will continue to get worse scares you. From a medical perspective, it would be a good idea to abstain from alcohol completely for the time being so that your liver can regenerate, but only you can make that decision. So what do you think about what we’ve discussed so far?”

Patient: “Well, I suppose I should definitely cut down. To start with, no more alcohol until my liver is okay again. How long will that take?”

Clinician: “Not drinking anything for a while might actually be a good option. It generally takes 2–3 months for liver values to return to normal. How does that sound to you?”

Patient: “Well, 2–3 months sounds like an awfully long time—I mean, I can definitely manage it if I have to, but it’s probably okay to drink a beer once in a while when I’m with friends, isn’t it? The main thing is that I don’t drink as much as I have been drinking.”

Clinician: “You’re not sure whether you want to see this through for so long. On a scale of 0–10, how important is it to you at the moment not to drink alcohol for 2–3 months, if 0 means “not at all important” and 10 means “very important”?

Patient: “ Well, definitely a 6 or 7.”

Clinician: “Being able to sustain temporary abstinence is quite important to you. Why did you choose a 6 or 7 and not a 3 or 4?”

Patient: “If I’m honest, the thing with the liver values does make me think, and you did say that it takes that long for the values to normalize. And perhaps I could prove to myself at the same time that I’m still able to do that.”

Clinician: “In addition to the physical health aspect, you could also prove to yourself that you don’t need the alcohol. What would have to happen for your importance rating to increase from a 6 or 7 to an 8 or 9?”

Patient: “I’d need to have some sort of plan for what to do when I’m with my buddies. It would be weird to just have a water.”

Clinician: “It is actually normal to drink alcohol in your group of friends. How could you nevertheless abstain from drinking alcohol in those situations?”

Patient: “A good friend of mine once went on a diet and cut out beer, and actually everyone accepted it. Maybe I could try that too.”

Clinician: “That’s a really good idea! If you tell them that you’re not drinking at the moment for health reasons, that might help you feel less weird about the situation. So to recap: At the moment, you’re worried about your liver values, and you can imagine, in principle, giving up alcohol completely for a while. That way, you would also prove to yourself that you don’t need that after-work beer. It would feel strange at first when you meet up with friends, but if you tell them in advance, it shouldn’t be a problem. So what could you next step be?”

Patient: “ I think, to start with, I’ll try not to drink any alcohol for the next two months. Maybe that will already make a difference to my liver values, like you said.”

Clinician: “That’s a great idea! I suggest we make an appointment in six weeks and see how it went, and do another blood test at the same time.”

Questions on the article in issue 7/2021:

The submission deadline is 18 February 2022. Only one answer is possible per question. Please select the answer that is most appropriate.

What are the four processes of motivational interviewing?

• Engaging, evoking, planning, clinician discontinues contact
• Engaging, focusing, evoking, planning
• Focusing, evoking, evaluating success, praising/criticizing the patient
• Education, provocation, evaluation, distancing oneself from the patient
• Focusing, distancing oneself from the patient, evaluation, praising/criticizing the patient

What does the abbreviation DALYs, which is used as a measure of the disease burden in the population, stand for?

• Disease-adjusted life years
• Duration-adjusted life years
• Disease-affected life years
• Drug-affected life years
• Disability-adjusted life years

What is the patient’s basic attitude assumed to be in motivational interviewing (MI)?

• The patient is essentially unmotivated.
• The patient recognizes no abnormal behavior whatsoever in themselves.
• The patient is ambivalent about behavior change.
• The patient is highly motivated to change their behavior.
• The patient has no understanding of the fact that their behavior could harm their health.

In terms of the therapeutic style of motivational interviewing, what should be avoided?

• Evoking motivation to change
• Compassion for the the patient’s life and experience
• Being on eye level with the patient
• Achieving behavior change against to the patient’s will
• Developing discrepancy between problem behavior and the patient’s values

One of the techniques of motivational interviewing is to ask open-ended questions in order to address the problem behavior. How high should the minimum percentage of open-ended questions out of all the questions asked be in this type of interview?

• At least 70%
• At least 30%
• At least 10%
• At least 50%
• At least 90%

Patients’ statements about their problem can be roughly divided into two categories. What are these called?

• “Denial talk” and “progress talk”
• “Negative talk” and “positive talk”
• “Bad talk” and “good talk”
• “Sustain talk” and “change talk”
• “Ill talk” and “health talk”

No significant positive effects have been achieved as yet for which disease pattern according to Lundahl’s meta-analysis?

• Eating disorders
• Level of alcohol consumption
• Level of cannabis use
• Tobacco consumption

The chronification of health impairments is often promoted by inadequate medication adherence. How high is the percentage of patients with poor medication adherence according to a number of studies?

• Approximately 30–60%
• Approximately 20–40%
• Approximately 15–30%
• Approximately 5–10%
• Approximately 1–2%

Which mechanism of MI is able to best explain the effectiveness of the procedure?

• Exploration and conflict resolution
• Psychoeducation
• Reinforcement of self-motivational statements
• Positive relationship building
• Confrontation

Question 10

Motivation is built through the patient naming their desires, abilities, reasons for change, and needs for change. Which acronym summarizes these aspects?

Acknowledgments

Translated from the original German by Christine Rye.

Conflict of interest statement The authors are members of the international Motivational Interviewing Network of Trainers.

Motivational Interviewing in Social Work: An Evidence-Based Communication Approach

Kognito brand to sunset beginning august 2023.

Kognito, as a brand, will be sunset, which includes winding down our library of resources and simulation products at the completion of our current customer agreements. As of August 2, 2023, we have stopped all selling and marketing activities of Kognito’s product portfolio.

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March is Social Work Month , a time to celebrate the social work profession and the immeasurable contributions social workers make to our society. Social workers are one of the largest groups of mental health care providers in the country, helping individuals and families overcome challenges so they can live to their fullest potential. Especially at a time of pandemic, racial unrest, economic uncertainty, and political divisiveness, social workers help the nation heal through the power of communication. And one of the most powerful communication methods they draw from is motivational interviewing.

Here’s a brief overview of what motivational interviewing is, the importance of motivational interviewing in social work, and how current and future social workers can gain valuable practice using motivational interviewing skills.

What is motivational interviewing?

Motivational interviewing (MI) is a communication technique originally developed by psychologists and educators Miller and Rollnick with the goal of helping people make behavior changes. Below is their most recent definition of motivational interviewing found in their book, Motivational Interviewing: Helping people to change (3rd edition):

“MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.” – Miller and Rollnick (2013)

The four processes Miller and Rollnick outline in motivational interviewing include engaging, focusing, evoking, and planning. The approach uses skills and techniques to foster a partnership with clients, with elements including:

• Collaboration
• Promotion of autonomy
• Affirmation

Motivational interviewing skills are especially useful when working with people who are resistant to change, uncertain or doubtful about an issue, or struggle with low confidence. By helping these individuals discover their own intrinsic motivation to change, therapists, social workers, and other health professionals can help make a lasting impact in their clients’ lives.

The value of using motivational interviewing in social work

Motivational interviewing in social work is powerful because of the profession’s practice in behavioral health .

Social workers provide a wide spectrum of services to diverse populations and are focused on the overall wellbeing and health of their clients, with behavioral health being key. For every 10 people who visit a doctor, seven are there for reasons related to behavioral health . These prevalent issues can include:

• Diabetes management
• Weight loss
• Alcohol and other drug use problems

The social work practice in behavioral health involves the assessment, diagnosis, treatment, and prevention of mental illness, substance use, and other addictions.

Social workers are unique in that they not only help clients identify how they feel about situations, they also help create action plans for responding to them. Social work is complex and multi-faceted. Motivational interviewing is a powerful skill for social workers to master because it fits into the various roles they take on, particularly related to addiction.

Motivational Interviewing and SBIRT

An approach known as SBIRT — Screening, Brief Intervention, and Referral to Treatment — has gained popularity in recent years as an effective, evidence-based public health approach to the delivery of early intervention and treatment to these individuals, and uses motivational interviewing skills to increase awareness and motivate behavioral change.

SBIRT been bolstered by initiatives and formal recommendations from the National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA) , Health Resources and Services Administration (HRSA) , Agency for Healthcare Research and Quality (AHRQ) , and several national and international public health agencies.

NORC at the University of Chicago, in collaboration with the Council on Social Work Education (CSWE), created a curricular resource on SBIRT. In this valuable resource for social work educators, motivational interviewing in social work is the sixth competency outlined.

“Through SBIRT, and consistent with the spirit of MI, social workers foster conversations that are centered on the strengths, priorities, and self-identified concerns of the individuals with whom they work. Social workers are mindful of the heavily contextualized nature of SBIRT practice and understand how individuals are affected by and affect families, other influential groups, organizations, and communities.” – NORC at the University of Chicago, Curricular Resource on Screening, Brief Intervention, and Referral to Treatment (SBIRT) , P. 16

Because social workers understand the importance and influence of external factors and contexts, they are uniquely positioned to effectively use motivational interviewing and SBIRT to effectively engage with their clients.

Learn and practice motivational interviewing techniques

Schools of social work are embracing technology to train their students . Using simulation technology to give students practice using motivational interviewing in social work can help give them valuable practice before they work with clients in-person or during telehealth sessions.

“It can be really scary for our students to walk out there and greet clients for the first time and remember all the things that we taught them about – confidentiality, how to engage, how to establish rapport, all of that,” says Dr. Noell Rowan, a professor and associate director at the University of North Carolina Wilmington (UNCW) School of Social Work. “The Kognito simulations can help students to feel more confident when they reach an actual client or client system or family or organization.”

Kognito’s behavioral health simulations use evidence-based role-play simulations to help equip social work professionals and students of social work with skills and knowledge to address clients’ behavioral health.

Two simulations are particularly impactful in social work:

SBI With Adolescents helps health professionals build and assess their skills in conducting substance use Screening & Brief Intervention (SBI) with adolescent patients and providing referrals to treatment when appropriate.

SBI Skills Assessment helps health professionals assess their skills in conducting substance use Screening & Brief Intervention (SBI) using evidence-based intervention and motivational interviewing techniques.

Motivational interviewing in social work is powerful, but takes practice to master. Through virtual simulation, learners can gain meaningful practice in a safe environment.

Learn more about Kognito’s behavioral health simulations and request a demo at kognito.com .

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Motivational interviewing

Author: Karen Evans

Updated Date: 31 May 2024

Publication Date: 11 October 2013

Introduction

Learning points How the underlying principles and spirit of motivational interviewing integrate well with the social work role. The four tasks of motivational interviewing (engaging, focusing, evoking and planning) and traps to avoid when applying the approach in practice. Examples of using the core skills of motivational interviewing. Contents Introduction The principles and spirit of […]

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Title * Motivational interviewing

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A theory and evidence-based artificial intelligence-driven motivational digital assistant to decrease vaccine hesitancy: intervention development and validation.

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Li, Y.; Lee, K.-C.; Bressington, D.; Liao, Q.; He, M.; Law, K.-K.; Leung, A.Y.M.; Molassiotis, A.; Li, M. A Theory and Evidence-Based Artificial Intelligence-Driven Motivational Digital Assistant to Decrease Vaccine Hesitancy: Intervention Development and Validation. Vaccines 2024 , 12 , 708. https://doi.org/10.3390/vaccines12070708

Li Y, Lee K-C, Bressington D, Liao Q, He M, Law K-K, Leung AYM, Molassiotis A, Li M. A Theory and Evidence-Based Artificial Intelligence-Driven Motivational Digital Assistant to Decrease Vaccine Hesitancy: Intervention Development and Validation. Vaccines . 2024; 12(7):708. https://doi.org/10.3390/vaccines12070708

Li, Yan, Kit-Ching Lee, Daniel Bressington, Qiuyan Liao, Mengting He, Ka-Kit Law, Angela Y. M. Leung, Alex Molassiotis, and Mengqi Li. 2024. "A Theory and Evidence-Based Artificial Intelligence-Driven Motivational Digital Assistant to Decrease Vaccine Hesitancy: Intervention Development and Validation" Vaccines 12, no. 7: 708. https://doi.org/10.3390/vaccines12070708

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