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Using Motivational Interviewing to Discuss Substan ...
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Video Summary
Dr. Brian Barsari, a psychologist and researcher at the San Francisco VA and UCSF, presented a webinar on Motivational Interviewing (MI), part of the American Academy of Addiction Psychiatry’s Advanced Addiction Psychotherapy series. MI is a collaborative, empathic, goal-oriented communication style focused on eliciting patients’ intrinsic motivation to change health-related behaviors, particularly substance use. Originating as a compassionate alternative to confrontational substance use treatments, MI emphasizes partnership, acceptance, empathy, and respect for patient autonomy.<br /><br />The session focused on MI’s “spirit,” foundational skills called OARS—Open-ended questions, Affirmations, Reflections, and Summaries—and the first two key MI tasks: engaging and focusing. Open questions encourage patients to share their experiences, reflections convey therapist understanding (with downturned voice to avoid questions), affirmations recognize patient strengths, and summaries tie dialogue themes together. Effective use of OARS facilitates collaboration and evokes “change talk”—patient language favoring behavior change—while managing “sustain talk,” which supports maintaining the status quo.<br /><br />Engagement establishes a trusting therapeutic relationship through active, undistracted listening and genuine curiosity, while focusing involves collaboratively identifying specific target behaviors to discuss, crucial for aligning therapist and patient goals and reducing discord. Dr. Barsari illustrated MI in practice via a video demonstration with a challenging patient, showing strategic use of OARS to build rapport and guide conversation protectively.<br /><br />He emphasized that MI is appropriate when patients have control over the target behavior and highlighted the importance of clarifying scope and consent upfront. MI is directive yet non-coercive, allowing patients to own their decisions. Dr. Barsari encouraged clinicians to trust the MI process, practice OARS consistently, and prepare for the challenging but rewarding path of evoking motivation toward healthier behavior change.
Keywords
Motivational Interviewing
MI
OARS
Open-ended questions
Affirmations
Reflections
Summaries
Engagement
Focusing
Change talk
Sustain talk
Addiction psychotherapy
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