5-Minute Motivational Interviewing

Integrating MI into the 30-Minute Medication Management Visit

Executive Summary

Core Concept: Motivational Interviewing (MI) is a collaborative, goal-oriented style of communication that respects patient autonomy while eliciting intrinsic motivation for change.

Target: 30-minute medication management visits
Framework: Engaging → Focusing → Evoking → Planning
Core Skills: OARS (Open questions, Affirmations, Reflections, Summaries)
Key Recognition: DARN-CAT change talk signals readiness

The Spirit of MI: Partnership, Acceptance, Compassion, Evocation

Partnership
Work WITH, not ON

Acceptance
Honor autonomy

Compassion
Promote welfare

Evocation
Draw out wisdom

The "spirit" of MI matters more than perfect technique. In time-constrained environments, maintaining these four principles is more important than using every skill perfectly.

The Four Processes: Mapped to a 30-Minute Visit

Minutes 0-5: Engaging

Establish rapport and trust. Use open questions about patient's agenda:

"What's on your mind today?"
"What brings you in?"
"How have things been since we last met?"

Minutes 5-10: Focusing
Clarify the target behavior. Identify change goals:

"What would you like to work on today?"

"Of these issues, which is most important to you?"

"Where would you like to start?"

Minutes 10-20: Evoking

The heart of MI. Elicit patient's own motivation for change. Listen for change talk (DARN-CAT):

"What makes you want to take this medication?"
"What concerns you about your current situation?"
"What would be different if things changed?"

Minutes 20-30: Planning

When readiness is sufficient (CAT present), develop change plan:

"What steps could you take?"
"How will you remind yourself?"
"What might get in the way?"

OARS: Core Communication Skills

Skill	Description	Example
Open Questions	Cannot be answered yes/no; invites elaboration	"What concerns do you have about this medication?"
Affirmations	Recognize strengths and efforts	"It took a lot of courage to come in today."
Reflections	Simple or complex mirroring	"You're feeling frustrated because the side effects interfere with work."
Summaries	Collecting and linking	"Let me see if I have this right..."

📋 Clinician's Quick Reference

Open Question Stems: How...? What...? Tell me about...? Describe...?

Affirmation Patterns: "You showed [strength] when you..." "I appreciate your..." "Your effort to..."

Reflection Types: Simple (repeat), Complex (rephrase), Double-sided (acknowledge ambivalence)

DARN-CAT: Recognizing Change Talk

Preparatory Change Talk (DARN)

Type	Signal Words	Example
Desire	want, wish, like, hope	"I want to feel better."
Ability	can, could, able	"I could probably take it with breakfast."
Reason	would help, important because	"It would help me keep my job."
Need	have to, must, need	"I have to do something about this anxiety."

Mobilizing Change Talk (CAT) — Signals Readiness

Type	Signal Words	Example
Commitment	will, promise, intend	"I will pick up the prescription today."
Activation	ready, willing, prepared	"I'm ready to try."
Taking Steps	already doing, tried	"I called the pharmacy already."

💡 Clinical Pearl: When you hear CAT (Commitment, Activation, Taking Steps), the patient is ready for planning. Transition from evoking to planning.

Handling Resistance: Sustain Talk and Discord

Sustain Talk

Patient voices reasons against change. Do NOT confront. Use:

Reflection: "You're feeling overwhelmed by the idea of changing."
Rolling with Resistance: Avoid arguing; acknowledge perspective
Developing Discrepancy: "How does this fit with your goal to...?"

Discord (Relationship Problem)

Tension in the therapeutic relationship. Repair by:

Acknowledging the tension: "I sense some frustration."
Affirming autonomy: "You are the expert on your life."
Reaffirming partnership: "Let's figure this out together."

⚠️ MI Pitfalls to Avoid

The Expert Trap: Lecturing rather than evoking
Premature Focus: Setting agenda before engaging
Question-Asking Trap: Rapid-fire questions without reflection
Confronting: Arguing against sustain talk