Implementing motivational interviewing techniques in schizophrenia

What is motivational interviewing?  

Motivational interviewing has been defined as "a collaborative conversation style for strengthening a person’s own motivation and commitment to change."¹ It has been implemented effectively in psychiatry, as well as in medical specialties, such as cardiology, as demonstrated by improved patient outcomes.^2,3 For example, a lower frequency of relapse has been observed among people with psychosis receiving motivational interviewing in combination with psychoeducation, compared with a control group receiving no such intervention.²

Key elements of motivational interviewing

Motivational interviewing is a collaboration with patients, family, caregivers, and the care team that should continue and evolve throughout the patient journey. The four key interactive elements of motivational interviewing are engagement, goal-setting, motivating, and planning.¹ 

1. How to engage your patient

It is key to establish rapport by demonstrating your personal interest in the patient.^4,5 This may include asking open-ended, rather than yes/no, questions,⁵ giving your patient the opportunity and time to tell their story without rushing,⁵ while clearly expressing your interest,⁴ and referring to previous conversations to demonstrate effective listening.⁵

2. How to set goals with your patient

Collaborate with your patient to identify attainable goals that are meaningful to them, as well as any discrepancies between these goals and their current behavior.⁵ This can involve: identifying how your patient makes sense of their own symptoms and treatment;⁴ empowering your patient to participate in decision-making around their own treatment;⁶ encouraging them to reflect on their own goals, values, and willingness to change;⁵ and helping them to relate their goals and values to the target behavior, such as long-term medication adherence.⁵

3. How to motivate your patient

It is crucial to elicit the patient’s motives for change. By understanding their motive, you can continue the conversation in a way that strengthens their motivation to achieve a goal or target behavior.⁵ You may approach this, for example, by exploring the challenges or barriers articulated by your patient5 or by discussing the advantages and disadvantages of a treatment approach in the context of a patient's goals.¹

4. How to make plans with your patient

Finally, to ensure behavior change, it is key to develop short- and longer-term plans that initiate and maintain change.1 You may find it useful to break down longer-term goals into shorter-term subgoals,1 as small, specific steps help your patient commit to the behavior. The most fundamental aspect is working with the patient to create a concrete plan that aligns with the patient’s own actions and strategies for reaching their goals.4

Engagement remains important throughout the patient journey

Engaging with patients is a clinical skill that remains important throughout goal-setting, motivating, and planning. As circumstances evolve and obstacles are met along the way, it will be necessary to re-engage and potentially revisit and adapt other steps of the process.¹