SUD 101 Course 9: Motivational Interviewing for Clinical Practice-Course Content

Video Transcription

Video Summary

Carla Marienfeld, a psychiatrist specializing in addiction, presents an overview of motivational interviewing (MI) for clinical practice, particularly in substance use disorders and opioid use disorder. MI is described as a guiding, collaborative communication style that helps patients articulate their own reasons for change by listening for and reinforcing “change talk,” while reducing “sustain talk” (language favoring the status quo). It is not a standalone psychotherapy, not simply the stages-of-change model, and not just decisional balance; it requires practice to master.<br /><br />She reviews evidence supporting MI, noting it often shows stronger effects when compared to weak control conditions, and may work best as an ongoing communication approach rather than a one-time intervention.<br /><br />Marienfeld highlights the “spirit” of MI: partnership, acceptance, compassion, and empowerment (respecting autonomy). She introduces MI’s four tasks: engaging (building rapport and permission), focusing (agreeing on a shared agenda), evoking (drawing out values, motivations, and ambivalence), and planning (turning motivation into actionable next steps). Core skills are summarized with OARS: open-ended questions, affirmations, reflections, and summaries. Reflective listening—especially complex and double-sided reflections—is emphasized as central.<br /><br />She explains change talk using the DARN-CATS framework (Desire, Ability, Reasons, Need; Commitment, Activation, Taking steps) and shows how clinician MI-consistent behaviors increase change talk. Planning often uses a “change talk bouquet” summary followed by a key question and may be supported with SMART goals.<br /><br />The talk closes by stressing deliberate practice, feedback, and training resources, including the Motivational Interviewing Network of Trainers and PCSS MOUD mentoring and discussion forums.

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Keywords

motivational interviewing

MI spirit

substance use disorders

opioid use disorder

MOUD training

SAMHSA PCSS

change talk

sustain talk

OARS micro-skills

reflective listening

DARN-CATS

OARS skills

DARN-CATS framework

SMART goals

Motivational Interviewing Network of Trainers