Motivational Interviewing (MI) Enhancements

Motivational Interviewing (MI) Enhancements

• ✅ Simplify Questions
  • Ask direct, open-ended questions to encourage reflection.
  • Example: “What happens when you drink or use?” vs. “How does substance use affect your symptoms?”
  • Dual Diagnosis Consideration: Avoid compound or abstract questions—structure them clearly to accommodate cognitive impairments.

  💡 Simplifying questions helps clients focus on their experiences and reduces cognitive overload, making it easier for them to respond authentically.

• ✅ Refine Reflections
  • Use metaphors to help clients connect with their experiences.
  • Example: “It sounds like substances are a crutch—helpful but holding you back.”
  • Dual Diagnosis Consideration: Reflect often, but avoid reinforcing distressing content that could heighten psychotic symptoms.

  💡 Refining reflections deepens client insight and fosters a more empathetic understanding of their situation.

• ✅ Emphasize Strengths
  • Acknowledge resilience and progress to build motivation.
  • Example: “I can see you’re working hard to make changes, even though it’s tough.”
  • Dual Diagnosis Consideration: Dually diagnosed clients often face stigma—affirmation is crucial in reducing disengagement.

  💡 Emphasizing strengths boosts confidence and encourages continued effort in the recovery process.

• ✅ Use Decisional Balance
  • Explore the pros and cons of change to increase awareness of ambivalence.
  • Example: “What are the pros and cons of staying sober vs. continuing to use?”
  • Dual Diagnosis Consideration: In addition to substance use, explore treatment engagement (e.g., “What are the pros and cons of taking your medication?”).

  💡 Using decisional balance helps clients weigh their options and gain clarity on the benefits and drawbacks of change.

• ✅ Accommodate Cognitive Impairments
  • Use simple, structured feedback and avoid information overload.
  • Example: Instead of complex charts, use colour-coded visuals or metaphors like a “three-legged stool” for stability in dual diagnosis recovery (substance use, medication, and treatment).

  💡 Accommodating cognitive impairments ensures that clients can understand and engage with the intervention without becoming overwhelmed.

• ✅ Roll with Resistance
  • Avoid argumentation and instead explore concerns collaboratively.
  • Example: “It sounds like you’re unsure about quitting. What worries you about stopping?”
  • Dual Diagnosis Consideration: Resistance may be heightened due to paranoia or disordered thinking—validate experiences without reinforcing delusions.

  💡 Rolling with resistance fosters a non-confrontational atmosphere that encourages clients to express their ambivalence safely.

• ✅ Adapt MI for Psychiatric Symptoms
  • When cognitive distortions are present, gently reframe without challenging the client’s reality.
  • Example: If a client believes they “don’t need help because their voices keep them safe,” explore their experience of safety rather than directly disputing the delusion.

  💡 Adapting MI for psychiatric symptoms ensures that interventions are sensitive to the client’s mental state, promoting engagement without invalidating their experiences.

🚀 Key Takeaway: Keep MI structured, collaborative, and strengths-based, while adapting for cognitive, emotional, and psychiatric complexities.