MOTIVATIONAL INTERVIEWING

Motivational interviewing

Motivational interviewing

Objective

The authors propose that motivational interviewing (MI), a brief intervention designed to manage ambivalence regarding complex behavior change, is well suited for integration into psychiatric residency training programs.

Methods

The authors provide a brief description of MI. In addition, based on a review of the literature the authors explore which core competencies the empirically validated, client-centered, and directive method of MI would address.

Results

The authors argue that psychiatric residency programs can effectively address several core competencies through the addition of MI training in their curricula, including Brief Psychotherapy, Patient Care, and Interpersonal and Communication Skills.

Conclusion

The implementation of MI training offers psychiatric residency programs potential benefits in several key areas. However, the authors provide guidance for important research questions to more confidently ascertain whether MI training for psychiatric residents is worthwhile.

Background

Motivational interviewing (MI) is a technique with the potential to be quite useful for training psychiatric residents. MI originated as a treatment approach for alcohol addiction, but has since evolved into a brief, evidence-based intervention for a range of psychiatric and medical conditions. Due to the applicability of MI across medical disciplines, there has been growing interest in the literature regarding training in MI at both the medical student and resident levels. Recent articles describe the development and evaluation of MI curricula for first- and third-year medical students, with positive results shown in self-reported comfort and familiarity for medical students using MI techniques, and targeted areas for improvement in use of MI methods in patient-care.

Residency programs have also begun to report on the implementation of MI programs. Examples include a psychiatric residency curriculum focused on patients with dual diagnoses and a pediatrics program designed to prepare residents to address patient smoking. Furthermore, Greenberg and colleagues noted that by providing MI instruction in addiction training, they have found residents "becoming more hopeful and skillful in responsibly engaging challenging patients." The goal of our paper is twofold; express our opinion that MI meets several of the psychiatric residency core competencies and identify research goals needed to determine if training in MI for psychiatric residents is worthwhile.

Overview of Motivational Interviewing

MI is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence". Miller and Rollnick describe four general principles of MI: express empathy, develop discrepancy, roll with resistance, and support self-efficacy. The first principle of expressing empathy relies on reflective listening techniques, consistent with the client-centered approach associated with the work of Carl Rogers. Second, the goal of developing discrepancy is to help the patient elucidate a distinction between their current behavior or general condition and the patient's goals and values. (Poirier, 2004, 327)

The third principle of rolling with resistance is both a mindset and set of skills designed to manage resistance in a supportive and noncritical manner. Finally, the principle of supporting self-efficacy emphasizes that the patient is ultimately responsible for change. Fostering a belief that the patient is capable can in effect lead to the very change that the ...