Major focus area

Speech Therapy -> Pragmatics / Social Skills / Life Skills

Short description

Motivational Interviewing (MI) is a “collaborative conversation style for strengthening a person’s own motivation and commitment to change” (Miller & Rollnick, 2012) which is used by SLPs to support clients leveraging their own intrinsic motivation for change and collaborating to form meaningful goals (MacFarlane, 2012). 

Long description

Long description: Motivational Interviewing (MI) is a “collaborative conversation style for strengthening a person’s own motivation and commitment to change” (Miller & Rollnick, 2012) which is used by SLPs to support clients leveraging their own intrinsic motivation for change and collaborating to form meaningful goals (MacFarlane, 2012). 

Motivational Interviewing is evidenced-based, can be performed in a short time, and does not require specialized training (Miller & Rose, 2009). A review by Rubak et al. (2005) found that motivational interviewing outperformed the traditional medical model of advice-giving in approximately 80% of studies reviewed. Through MI, the SLP guides a patient through decision-making rather than directing the patient. This approach is in contrast to the traditional medical model where the clinician gives the patient a plan to follow without collaborating with the patient. Motivational Interviewing is appropriate for many areas of an SLP’s clinical practice, including social/pragmatic language, fluency, voice (Behrman, 2006), dysphagia (Smith & Robinson, 2013), aphasia (Hersh et al., 2018), and TBI (Medley & Powell, 2010).

Key Principles of Motivational Interviewing 
Express Empathy: By reflective listening, the SLP can help the patient feel “heard.” The principle is important through the whole process. 
Develop Discrepancy: The SLP guides the patient to see a discrepancy between goals and current behavior. This helps lead the patient on the path to deciding about why and how to change. 
Roll With Resistance: If the SLP hears resistance from the patient, avoid falling into a persuasive style of talking. Instead, understand that this is a necessary part of the process. Listen carefully and use empathetic statements to lead the patient to supportive problem-solving.
Support Self-Efficacy: This means that the SLP and the patient both believe the patient has the ability to change and follow-through with the plan.

Motivational Interviewing uses the following interaction styles (selectively) to focus the conversation upon change and help lead the patient down that road. I’ve created example statements using the techniques, for different parts of the clinical process. 
✧ Open Questions: By phrasing a question / statement in an open-ended manner, you allow the client to take the response in the direction that is important to them. 
✧ Affirmations: This technique allows you to recognize the client’s skills or appreciate them in a genuine way - you are highlighting strengths and facts in a way that differs from a compliment.
✧ Reflections: Studies have shown that we need to do more of these as speech-pathologists! These statements are important in letting a client know that you are really listening. These statements can be as simple as rephrasing what the client said, or more complex by adding meaning while rephrasing what the client said. As you start with this skill, use 1 reflection for each question you ask, and as you get better, use 2 reflections for each question you ask. 
✧ Summaries: This technique involves consolidating a discussion. The point of summarizing what you’ve discussed is to highlight change talk, promote strengths, consolidate info and move the discussion forward.