Featuring Sylvie Smith, Lead Therapist, Community Addiction Services (CADS), Homewood Health Centre
Motivational Interviewing (MI) is an evidence-based approach to help ambivalent patients modify their behaviour, leading to improved treatment outcomes. This person-centred approach ensures conversations with health care providers focus on what is meaningful to the patient, empowering them to implement change.
Sylvie Smith, therapist at Homewood Health Centre's Community Addiction Services (CADS), offers her expert insights on incorporating MI in clinical and medical practice. With over 25 years of experience as a psychotherapist and educator, Sylvie works with clients experiencing challenges and is the lead therapist helping those with gambling, gaming, over-shopping, and overuse of technology. She helps clients who want to modify their behaviours and supports family members. At the Mental Health Symposium hosted by Homewood Health Centre, Sylvie delivered a presentation focused on Motivational Interviewing (MI).
Sylvie Smith discusses MI at the Mental Health Symposium hosted by Homewood Health Centre.
Defining MI
“Trying to get others to change is hard, as is making changes ourselves. Change is especially hard if it was not our idea to start with" says Sylvie. She cites a definition of MI by Miller & Rollnick (2023) - “MI is a particular way of talking with people about change and growth to strengthen their own motivation and commitment."
In adopting a person-first approach, Sylvie shares - “we should see the person in front of us as a person with strengths and struggles like ourselves, rather than simply seeing the problem." This shift in mindset is the underpinning of MI.
The benefits of MI
MI helps health care providers to reconnect with their purpose. Sylvie acknowledges that the health system continues to experience disconnect, and patients and healthcare professionals are frustrated, which can hinder MI. “Stress causes us to dehumanize, stigmatize, and disconnect, which are a roadblock to achieving change." Sylvie encourages providers to reconnect with the reason for choosing their professions in the first instance – “Reminding myself of wanting to help others challenges me to go back to basics. That is what MI is. “
Motivational Interviewing also helps to build therapeutic alliances. Sylvie says, “a good working alliance and evoking a patient's desire for change is a significant influencer."
Sylvie also advocates for the use of MI to help health care professionals switch from autopilot mode to connection and engagement – “Routine, whether it is from our daily commute or responsibilities, can make us disconnected from our patients. To change from auto pilot and re-connect, it may require us to change what we are asking and how we interact with our patients."
Myths about MI
Sylvie addressed some common myths about MI, including the assumption that a health care professional cannot see improvements if a patient is not motivated to change. Sylvie noted, “As health care professionals, we can help access and improve a person's motivation to change well before consequences occur. Although change is the person's responsibility, we can enhance our patient's motivation for beneficial change ."
Confrontation as a requirement to motivate change is another myth.
Sylvie asserts that confrontation may promote resistance rather than motivation to change. “Research suggests that the more frequently clinicians use adversarial, argumentative techniques, the less likely patients will change. Instead, connection and compassion can encourage motivation."
Strategies for implementing MI
Among the many insights shared on incorporating MI into clinical practice, Sylvie shares a few helpful tactics.
Asking open-ended questions: Open-ended questions can help a health care provider to understand the patient's perspective and invite them to reflect and elaborate on their experiences.
Affirmations or statements that acknowledge the existence of something. These help the patient to acknowledge even the most minute forms of change.
Reflection and the use of summarizing statements: This is a special form of reflection. It is directional and focused on change talk, and planting seeds. It reassures the patient that they are heard and moves the conversation along. Examples include: “Let me see if I understand…so far" or “Here is what I have heard. Tell me if I have missed anything."
Sylvie concludes that MI is a deliberate way of interacting and moving towards goals. “It is not a technique, not just being nice; instead, it is a way of being with a patient and using skills to help cultivate motivation."