Motivational interviewing
Formal Definition
A patient-centered, directive counseling style designed to elicit and strengthen the patient's own motivation for behavior change by exploring ambivalence, rolling with resistance, and amplifying the patient's intrinsic motivation; used for smoking cessation, alcohol reduction, medication adherence, weight management, and other health behavior changes.
How It's Used on the Ward
"MI" or "using MI techniques" — meeting patients where they are and drawing out their own reasons to change rather than lecturing them.
Example
""Patient says 'I know I should quit smoking but I enjoy it.' Using MI: 'Sounds like it's important to you and also something you enjoy — what makes you bring it up today?' [Exploring ambivalence.] 'On a scale of 1-10, how important is quitting to you right now?' [Ruler technique.] 'What would it take to get from a 4 to a 6?'""
Clinical Context
OARS techniques: Open-ended questions, Affirmations, Reflective listening, Summaries. Spirit of MI: partnership (not expert-to-patient), acceptance, compassion, evocation. The righting reflex — the natural clinician impulse to fix, advise, and correct — is the enemy of MI; it creates reactance and resistance. Change talk: statements from the patient about desire, ability, reasons, or need to change (DARN) — reinforce these. Sustain talk: reasons to stay the same — acknowledge without amplifying. Stages of change (Prochaska): precontemplation → contemplation → preparation → action → maintenance — MI is most useful in contemplation and preparation stages.