Motiverande samtal (MI): vad det är

MI som ett samarbetande samtalssätt som stärker personens egen motivation till förändring, efter Miller och Rollnick. Första lektionen, fri att läsa.

Motivational Interviewing

What is Motivational Interviewing?

Motivational Interviewing (MI) is a collaborative, person-centred conversation style that helps people explore their own reasons for change (Miller & Rollnick, 2013). Its central insight is counter-intuitive for clinicians trained to inform and advise: people are more persuaded by what they hear themselves say than by what we tell them. The work is not to install motivation from the outside, but to evoke what is already there.

What you will learn

You will practise exploring patients’ ambivalence, listening for what matters to them and inviting their own reasons for change. You will learn to respond to hesitation without arguing or lecturing, while respecting each patient’s choice about what happens next.

Course map

The Spirit of MI (PACE)
Understanding how Partnership, Acceptance, Compassion, Evocation shape an MI conversation.
The Four Processes
Using engaging, focusing, evoking and planning to guide an MI conversation.
Reflective Listening
Using reflections to show understanding and encourage further exploration.
Evocation
Drawing out the patient's own reasons and motivation for change.
Partnership & Autonomy
Working collaboratively while respecting the patient's right to choose.
Affirmation & Compassion
Recognising strengths and keeping the patient's wellbeing at the centre of the conversation.
Responding to Change Talk
Recognising and responding to the patient's change talk.
Rolling with Sustain Talk & Discord
Responding to sustain talk and discord without falling into the righting reflex.
Strategic MI Techniques
Using summaries, agenda mapping and importance/confidence rulers to guide exploration of change.

How to practise

Each module introduces a skill you can take into the lab. Practise with one focus, use your feedback to refine what you try next, then repeat. This is a deliberate practice loop (Rousmaniere, 2016).

What the evidence says

What the trials support, where MI has no proven advantage, and why the smoking evidence in particular stays uncertain.

The trial literature on MI is large, and its overall picture has been consistent across meta-analyses covering substance use, health behaviours and treatment engagement. Against no treatment, waiting lists or treatment as usual, MI produces small improvements, and pooled analyses found those gains held up over follow-up. Against other specific, active treatments it has not been shown to be superior: meta-analytic comparisons found no significant advantage, and a Cochrane review of substance use reached the same conclusion (Lundahl et al., 2010; Smedslund et al., 2011).

In Project MATCH, a large multisite trial of alcohol treatments, four sessions of motivational enhancement therapy, an MI adaptation with structured feedback, produced drinking outcomes at one year that differed little from twelve sessions of cognitive behavioural therapy or twelve-step facilitation (Project MATCH Research Group, 1997).

The weakest ground sits closest to this course. For smoking cessation, the 2019 Cochrane review judged the evidence insufficient to say whether MI helps people stop smoking, on its own, added to other support, or compared with other counselling, and rated every estimate as low certainty (Lindson et al., 2019). Andrea, the patient you practise with here, has smoked for nearly forty years. Keep the state of this evidence in mind as you practise: the lab lets you practise conversation skills, and for smoking it is genuinely uncertain whether even a well-conducted MI conversation changes the outcome.

There is separate evidence about how MI works when it works, and it offers context for the skills practised in the lab. A meta-analysis of process studies supported the technical pathway: when a larger share of the therapist's behaviour is MI-consistent, a larger share of the patient's speech is change talk, and a higher proportion of change talk is associated with less risk behaviour at follow-up. Sustain talk predicted worse outcomes. The purely relational pathway, empathy and MI spirit without the technical work, was not supported in that analysis (Magill et al., 2018).

When MI can be useful

Practical reasons to use MI, with limits on what the evidence supports.

MI can be particularly useful when a conversation about change has become stuck or when advice alone has not helped a person move forward.

It is built for the stalled conversation. Every clinician knows the consultation where advice has already failed: the patient agrees, and nothing changes. MI is a method for exactly that situation. It names the trap, the righting reflex, and replaces arguing for change with deliberate work on the patient's own reasons.
It can fit a brief clinical conversation. MI skills can be used in brief formats and alongside other treatment. Brief delivery does not by itself prove an efficiency advantage. For smoking, the cited evidence does not establish that adding MI to other support improves cessation outcomes.
Its skills can be observed in conversation. The lab uses broad MI conversation skills and some observable actions as prompts for practice feedback. Its AI output has not been validated as a measure of clinician competence.

Lab feedback helps you notice which MI skills appeared in this conversation and what to practise next. It cannot tell you whether Andrea will stop smoking or whether a particular response will work for a real patient.

Understanding your lab feedback

How to interpret your practice feedback and its limitations.

The lab looks for four broad skills: understanding the patient’s perspective, sharing control, drawing out the patient’s own reasons for change, and responding to reasons against change without argument. It also shows practice counts for observable moves such as questions, reflections and affirmations. Summaries, agenda mapping and rulers matter because of how you use them; each is discussed in context rather than given a separate global rating.

Use the feedback to choose one skill to try next. The counts and ratings are AI-generated practice estimates, not validated measures of clinician competence. A rating describes this conversation; it cannot say whether a patient should change or whether MI will help that person.

Sources

The references for the course and its evidence discussion.

Sources

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.
Miller, W. R., & Rollnick, S. (2023). Motivational Interviewing: Helping People Change and Grow (4th ed.). Guilford Press.
Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change (2nd ed.). Guilford Press.
Rousmaniere, T. (2016). Deliberate Practice for Psychotherapists. Routledge.
Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137–160.
Smedslund, G., Berg, R. C., Hammerstrøm, K. T., Steiro, A., Leiknes, K. A., Dahl, H. M., & Karlsen, K. (2011). Motivational interviewing for substance abuse. Cochrane Database of Systematic Reviews, (5), CD008063.
Lindson, N., Thompson, T. P., Ferrey, A., Lambert, J. D., & Aveyard, P. (2019). Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews, (7), CD006936.
Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58(1), 7–29.
Magill, M., Apodaca, T. R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R. E. F., Tonigan, J. S., & Moyers, T. (2018). A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. Journal of Consulting and Clinical Psychology, 86(2), 140–157.

Nästa lektion: The Spirit of MI (PACE)

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Fortbildning för kliniker. PsychBase utfärdar inga intyg eller CPD-poäng, och ingenting här är råd om en enskild patient. Kursöversikten och första lektionen är öppna för alla; de andra fria lektionerna kräver ett kostnadsfritt konto, och hela kursen ingår i Pro eller kan köpas separat.