How do social contexts support practitioners’ uptake of Motivational Interviewing? Social identification and appraisal among child and family social workers

Many health conditions are preventable or modifiable through behavioral changes. Motivational interviewing (MI) is an evidence-based communication technique that explores a patient's reasons for behavioral changes. This study assesses the current landscape of MI training in North American Family Medicine (FM) clerkships. We analyzed data gathered as part of the 2022 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of FM clerkship directors (CDs). The survey was distributed via email invitation to 159 US and Canadian FM CDs in June 2022. Of the 94 responses received, 61% indicated that MI training is provided in their FM clerkship. Medical school type, class size, and location were associated with MI training priority, offerings, and duration in the clerkship, respectively. CD experience correlated with MI training duration; student MI skill training level was associated with MI training duration and priority; the rigor of student MI skills evaluation was correlated with MI teaching methods and training duration; self-reported student MI competency was associated with the length of time students spent with FM community preceptors as well as MI training priority and teaching methods; and several items emerged as predictors of student, CD, and FM faculty MI training expansion. Opportunities exist to enhance the volume, content, and rigor of MI training in North American FM clerkships as well as to improve self-reported student MI competency within those clerkships.

A randomized controlled trial of training in Motivational Interviewing for child protection

Back to table of contents Previous article Next article Professional NewsFull AccessPsychiatrists Using Motivational Interviewing Say It’s Valuable Treatment AdditionJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:7 Sep 2012https://doi.org/10.1176/pn.47.17.psychnews_47_17_9-aAbstractA few months ago, a young man—“Greg”—visited Petros Levounis, M.D., director of the Addiction Institute of New York. He made it clear to Levounis that he had no desire to stop using cocaine and marijuana, but had made the appointment because his girlfriend had urged him to.Levounis told Greg that he respected his position, and they both agreed that the goal of his treatment should be to end it. Or as Levounis recalled recently with a chuckle, “We discussed what we had to do to get him not to come to see me!”Little by little, a rapport developed between Greg and Levounis. Greg started to admit that his drug use did have some down sides, especially regarding efforts to get established in the advertising industry. And, “well, it would be fair to say that we failed in our goal because I am still seeing him,” Levounis said. “He has become cocaine free. He continues to smoke marijuana every once in a while or perhaps more regularly than I would like. But he is certainly in a much better space than he was when he first came to see me.”The strategy that Levounis has been using with Greg is motivational interviewing (MI). How many psychiatrists are familiar with it is unclear, but the psychiatrists who talked to Psychiatric News about using the technique in their practices give it positive reviews (see Why Some Psychiatrists Started Using Motivational Interviewing below).Joji Suzuki, M.D.MI is essentially a method of communication for helping patients change problem behaviors such as alcohol use, drug use, smoking, overeating, or not adhering to medical treatment, Joji Suzuki, M.D., medical director of addictions at Brigham and Women’s Hospital and a psychiatry instructor at Harvard Medical School, explained during a recent interview. “You try to help patients move toward change by eliciting and exploring their own arguments for change.”The spirit of the strategy is crucial, another psychiatrist and MI user, stressed. She is Christina Delos Reyes, M.D., chief clinical officer of the Alcohol, Drug Addiction, and Mental Health Services Board of Cuyahoga County in Cleveland, Ohio. That spirit includes empathy and working together, she said.Bachaar Arnaout, M.D.Bachaar Arnaout, M.D., an assistant clinical professor of psychiatry at Yale University and an MI user, agreed: “The spirit is in many ways more important than the technique.”Suzuki concurred as well: “When many patients come to medical or psychiatric settings, and the conversation turns to alcohol or drugs or other unhealthy behaviors, they are ready to argue with you because clinicians have often adopted an educational or confrontational approach. But when you demonstrate that you are going to respect their autonomy and collaborate with them, it lowers their defenses and resistance, and you are able to have a more honest and empathic conversation. That is why the spirit of MI is so helpful if the goal is to increase people’s motivation for change.”Carla Marienfeld- Calderon, M.D.But MI does involve specific techniques, and one of the most important is trying to get patients to talk about how they want to change or are going to change, Carla Marienfeld-Calderon, M.D., an assistant professor of psychiatry at Yale and also an advocate of MI, pointed out (see Learning and Teaching Motivational Interviewing below). “We want to elicit change talk,” she explained, “because that has been shown to be the thing that is most effective in getting people to actually alter their behavior.”Another valuable technique is reflecting, Arnaout noted. During the conversation, the therapist often repeats or paraphrases what the patient is saying. It gives the patient a chance to hear what he or she has said, to elaborate further, and perhaps offer a correction. It is also an effective way to keep up the flow of the conversation, and it shows the patient that the therapist is listening.“MI has often been misunderstood as being a very passive therapy,” Levounis said. “Yet that couldn’t be further from the truth. While doing MI, we often explain what we think, and we are very up front about our own agenda as clinicians. But we just make sure that ultimately the decisions rest with the patient.”There is substantial research evidence that MI does work, particularly for addressing substance abuse, Suzuki reported.Yet there is no assurance that it will change a patient’s behavior, Delos Reyes emphasized.“It cannot really address the profound and devastating cravings for opioids that we see in some of our patients who are severely dependent on prescription pills or heroin,” Levounis stated. “That is where we absolutely need to use pharmacotherapy…. That being said, MI is a wonderful adjunct to the treatment of opioid dependence with medication.”And deploying MI can present other challenges—for example, making sure that it is being done correctly, Delos Reyes remarked, “because a lot of people hear a lecture on MI or see a videotape of it and say, ‘Oh yeah, I already knew that,’ when in fact they don’t.”But even if a clinician knows how to conduct MI correctly, “what is challenging and not really clear is, how do you apply these skills to somebody who is very depressed, or very anxious, or has significant personality issues, or somebody who is psychotic or manic?,” Suzuki observed. “This is an area where people are conducting research and where MI skills may need some adaptation.”Yet taking both the pluses and minuses of MI into consideration, those psychiatrists who use it tend to be very enthusiastic about it.“I use it with patients in consultation-liaison settings,” said Suzuki. “I can’t imagine practicing without it.”“I find it most helpful when patients using substances are ambivalent about coming in for treatment,” Marienfeld-Calderon indicated. One of the advantages of MI, said Arnaout, is that “we therapists no longer have to cling to the illusion that we can control other people. As a result, we can relax and carry on a dialogue with patients rather than try to convince them to do something.”“All psychiatrists should have at least some basic training in MI,” Delos Reyes suggested. “After all, many, if not all, of us, in psychiatry help ambivalent people change their behavior.”“Psychiatrists who have been trained in CBT will find that MI adds to the skill set that they already have and especially for patients in pre-contemplation and contemplation stages of change,” Levounis advised. More information about MI is posted at www.motivationalinterviewing.org and www.motivationalinterview.org and in the Handbook of Motivation and Change, edited by Levounis and Arnaout and published by American Psychiatric Publishing. APA members can order the book at a discount at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemID=62370.Why Some Psychiatrists Started Using Motivational InterviewingMotivational interviewing (MI) is based on humanistic psychology, particularly the work of Carl Rogers, Ph.D., and was partially developed by psychologists William Miller, Ph.D., and Stephen Rollnick, Ph.D., explained Bachaar Arnaout, M.D., in an interview with Psychiatric News. Arnaout, an assistant clinical professor of psychiatry at Yale University, became interested in MI during his psychiatry residency, he said—“first by reading Miller and Rollnick’s book Motivational Interviewing and then being a therapist in an MI study.”“I got introduced to MI in 2001 during my addiction psychiatry fellowship training,” Christina Delos Reyes, M.D., said. She is chief clinical officer of the Alcohol, Drug Addiction, and Mental Health Services Board of Cuyahoga County, Ohio. “So I’ve known about MI for years. But it has only been during the last five years that I have actually become part of the Motivational Interviewing Network of Trainers [thanks to training by]…the Center for Evidence-Based Practices at Case Western Reserve University.”Petros Levounis, M.D., director of the Addiction Institute of New York, was also first introduced to MI during an addiction psychiatry fellowship. “It was becoming more and more obvious to me that confronting patients about their substance problems was doing more harm than good,” he said. “MI was a breath of fresh air from this more traditional approach.”“When I was first exposed to MI during residency it didn’t resonate particularly with me because I was all excited about psychodynamic psychotherapy, cognitive-behavioral therapy, family therapy, and so on,” Joji Suzuki, M.D., a psychiatry instructor at Harvard Medical School, recalled. “It took me a while before I appreciated the effectiveness of MI, and it really wasn’t until I finished my addiction fellowship that I started practicing it.”Learning and Teaching Motivational InterviewingPsychiatrists who use motivational interviewing say that it is relatively easy to learn but takes time and practice to master.“If you were to ask some experts on MI, they might tell you that it is a very difficult therapy to teach,” Petros Levounis, M.D., director of the Addiction Institute of New York, said. “But I have found that the basic principles, maybe not all of the techniques, of MI are rather easily taught and assimilated.” By way of example, he reported that two years ago, he and his colleagues decided to train all of their 220 staff members—the nursing staff, administrative staff, secretaries, security guards, van drivers, and even the cooks—in MI techniques. At the end of the training, all had learned enough MI to use it informally in their dealings with patients who came to the institute, he said.True, “the concepts of MI are simple and easy to learn,” acknowledged Christina Delos Reyes, M.D., chief clinical officer of the Alcohol, Drug Addiction, and Mental Health Services Board of Cuyahoga County, Ohio. But, she stressed, “it takes a lifetime to hone the skills.”Joji Suzuki, M.D., a psychiatry instructor at Harvard Medical School, shares a similar view: “Learning about MI is relatively simple. However, becoming proficient at it is far more challenging.” When he works as an MI trainer, he said, “I am careful not to portray MI as something clinicians can learn in just a few sessions or even in a two-day workshop.” ISSUES NewArchived

A systematic review of motivational interviewing training for general health care practitioners

BackgroundMotivational interviewing (MI) is a collaborative, client-centred counselling style aimed at eliciting and strengthening clients' intrinsic motivation to change. There is strong research evidence supporting the efficacy of MI, notably in its application among alcohol and drug abuse populations. MI interventions in smoking cessation may yield modest but significant increases in quitting. The present study sought to assess the acquisition and retention of MI skills in counsellors at the Swedish National Tobacco Quitline.MethodsThree audio-recorded sessions from each of three counsellors were assessed using the Motivational Interviewing Treatment Integrity (MITI) Code Version 3.0 over 11 assessment periods at fixed intervals in a two-and-a-half year period during which counsellors received ongoing supervision.ResultsThe mean skill for all counsellors improved throughout the study period in most MITI variables. However, great variations in MI skill between counsellors were observed, as well as fluctuations in performance in counsellors over time.ConclusionThe present exploratory study covers a longer time period than most evaluations of MI training, and has several advantages with regard to study design. It may provide a basis for (larger sample) replication to test MI skill (as measured by the MITI) in relation to behaviour change in clients, to evaluate MI training, and to assess the acquisition and retention of MI skill over time. Difficulties in acquiring and retaining MI skill may raise the issue of a selection policy for MI training. Moreover, fluctuations in MI skill over time emphasise the greater importance of continuous feedback and supervision over initial MI training, and the need for the use of validated treatment integrity assessment instruments in ordinary clinical implementations of MI.

The purpose of this study was to develop a motivational interviewing (MI) training program to improve competency in communication and to effect the evaluated changes that would occur in dental students’ counseling techniques as result of the training in the program. The study proceeded through the program via role-play practice, which was explained effectively during the MI program training process. A convenience sample of 43 fourth-year dental hygiene students was recruited. Twenty-two students were randomly assigned to the intervention group and 21 to the control group in the order of recruitment. The theoretical lecture was delivered over 3 hours and the practice was done in parallel by applying cases occurring in clinic settings. The practice was technical training, partner practice, and small group practice. The intervention group received three hour MI lecture while the control group received no lecture. Evaluation through role-play practice was separated according to “researcher’s viewpoint,” “counselor’s role viewpoint,” and “patient’s role viewpoint.” The results of the analysis showed that the intervention group had higher MI skills and ability than the control group. Furthermore, program participants showed positive impressions to the MI training program. The use of coaching sessions improved the MI techniques and counseling skills of dental hygiene students learning MI. The effect of the application of the MI training program was that the MI training improved counseling skills and interviewing abilities. Moreover, continuous training and feedback enhanced MI techniques and core skills. Training using lectures in parallel with practice rather than education through theory alone improved students’ techniques. Application of role play through the combined method of the MI program was confirmed by an effective training method.

Objective: Healthcare training has increasingly focused on interprofessional education (IPE) to provide students opportunities to gain competencies and learn accountability. IPE was incorporated into the curriculum by creating a course for all health science. Motivational interviewing (MI) training was added to enhance the IPE process. The purpose of this study was to determine the effectiveness of MI training in patient counselling simulations. Methods: A cohort of students enrolled in an IPE course were evaluated on MI skills before and after receiving training. MI performance was coded using the Motivational Interviewing Treatment Integrity (MITI) 4.2.1 scoring system. A student perception survey was also administered. Results: A total of 210 students were included in the study. Results from the MITI indicate an improvement in the four global ratings after MI training in individual and group cohorts. For example, for the Cultivating global score, 0% reached at least a fair benchmark in the pre-training groups while 90% (individual) and 50% (group) reached the benchmark post-training. Student perceptions of IPE improved following MI training with more students strongly agreeing that working together was better for patients post-training (66.2% vs 75.5%). Conclusion: The use of MI training in the setting of IPE setting appears to be beneficial. MI gives students a common language and approach to working with patients in an interprofessional setting.

Effectiveness of asynchronous motivational interviewing training for pediatric nurse practitioner students: A mixed-methods evaluation.

This study examines the outcomes of a 22-hr motivational interviewing (MI) course and compares online and in-person offerings of the course. It also evaluates clinicians' ability to accurately self-assess their MI skills. 34 clinicians participated in this study and completed MI workshops either in-person or online. Use of MI in an acting patient encounter was recorded early in the training and again following the training. Recordings of these encounters were coded using the Motivational Interviewing Treatment Integrity (MITI) 3.1 coding system. After each acting patient encounter clinicians also self-evaluated their use of MI. Participants showed statistically significant improvement in MI skills measured by the MITI. There were no meaningful differences between the MI skills acquired by the participants in the online group compared with those who completed training in-person. There was little correlation between participants' self-assessment of MI skills and objective assessment. It is feasible to complete MI training through synchronous online workshops. Participant self-assessment of MI skill does not appear to be a useful approach for assessing MI skill. The acquisition of MI skills by health professionals is possible via the Internet. Learning should be assessed using objective measures rather than relying on self-report. (PsycINFO Database Record

The effectiveness of motivational interviewing (MI) for reducing vaccine hesitancy (VH) has been demonstrated in Quebec. We conducted a study to evaluate the acquisition of MI skills after MI training via videoconferencing for interns training as general practitioners (GPs) in southeastern France. A vaccination-specific MI training workshop was offered to interns in 2021, consisting of two separate Zoom videoconference sessions. Participants completed the Motivational Interviewing Skills in Immunization questionnaire before and after the training to measure skills acquisition. We used pairwise exact Wilcoxon-Pratt signed rank tests for the analysis. Among 45 GP interns enrolled in the first MI session, 34 (75.6%) attended both sessions and completed the questionnaire at 3 different time points. After the first session, MI knowledge scores improved significantly (+21.1 ± 21.6; P < .0001), as did application of MI skills (+36.8 ± 36.7; P < .0001), and MI practice confidence (+21.2 ± 11.1; P < .0001). The second MI session maintained the skills developed after the first session without further improvement. Participant satisfaction was high. This is the first study in France assessing the impact of a vaccination-specific MI training for GP interns. It shows a substantial improvement in knowledge, application of MI skills, and self-confidence in the practice of MI. GP interns were highly satisfied with the training despite the videoconference format. These promising results will allow the integration of MI training in GP medical curricula in order to prepare future GPs for communication in the field of vaccination.

Objective: Vaccine hesitancy is a complex problem. We previously demonstrated that motivational interviewing (MI) could be helpful to enhance parents’ motivation to vaccinate their child. The aim of this study is to develop a new, simple and robust evaluation tool that is suitable for evaluating MI learning of vaccination health professionals. Methods: We designed the Motivational Interviewing Skills in Immunization (MISI), a short written questionnaire to evaluate the MI knowledge and skills of participants in an immunization context. It covers three key areas: knowledge of MI, ability to apply MI-related skills, participant self-confidence in using MI. Questionnaire content and face validity were assessed by MI experts and internal consistency, reliability and effect size were analyzed using a multiple pretest-posttest design. Results: Psychometric measures showed good to excellent internal consistency of the questionnaire for all three areas (Cronbach’s and KR coefficient: 0.70 to 0.88). Test-retest reliability showed good measurement stability (ICC: 0.53). Good sensitivity to change was also obtained (Cohen’s d: 0.80 to 1.66). Conclusion: The MISI questionnaire is the first paper/pencil evaluation method to assess MI training specific to immunization. Psychometric measures showed high reliability. Practice implications: This questionnaire could provide a convenient and inexpensive method to evaluate knowledge and competencies following immunization-specific MI training.

What is this thing called motivational interviewing?

A survey of motivational interviewing training experiences among internal medicine residents

Training medical students to conduct motivational interviewing: A randomized controlled trial

Motivational interviewing (MI) has proven a well-established psychotherapeutic intervention designed to enhance motivation for behavior change. While the benefits of MI have been established, little research has systematically evaluated dissemination of MI efforts to healthcare providers, especially among pediatric providers. The present pilot study evaluated whether healthcare providers gained valuable knowledge, confidence and desire to utilize MI, and skills in MI techniques and if these outcomes varied based on provider characteristics or duration and intensity of MI training. Twenty pediatric healthcare professionals in a large academic pediatric hospital completed an advanced 20-h MI training and 103 pediatric healthcare professionals completed a basic 4-h MI workshop. The study demonstrated no significant differences in post-workshop MI knowledge, confidence, or desire based on trainee demographics. We also found no significant change from post-basic workshop to post-advanced workshop for advanced MI trainees. However, the advanced training workshop participants evidenced significant growth in utilizing MI skills (via MITI coding) and self-reported confidence in using MI skills. We therefore conclude that while the basic workshop allows participants to gain valuable MI knowledge and confidence and desire to utilize MI, it is through the advanced training that providers have the opportunity to practice these skills, receive feedback, and ultimately gain the expertise necessary to be effective MI providers. Overall, results from this pilot study suggest MI training in pediatric hospitals represents an important area of opportunity for multidisciplinary training, dissemination, and practice.