Dr. Mark Mullen welcomes Dr. Allison Hadley, a psychiatrist and medical director of the psychiatric emergency service at Oregon Health & Science University, for a discussion on motivational interviewing in high-acuity psychiatric settings. Dr. Hadley introduces a novel teaching framework that draws on Tina Fey's rules of improv from her memoir Bossy Pants, mapping core improv principles, including "yes, and," making statements rather than only asking questions, and treating perceived mistakes as opportunities, onto the foundational techniques of motivational interviewing. The conversation covers the OARS mnemonic (open-ended questions, affirmations, reflections, and summaries), the relationship between motivational interviewing and trauma-informed care, and practical strategies for identifying and reinforcing patient change talk.
The discussion also addresses the stages of change model and the ask-tell-ask method for delivering psychoeducation in a patient-centered way, along with harm reduction interventions used in the psychiatric emergency department, including methamphetamine safety kits. The episode concludes with an extended clinical role-play demonstrating how to apply these techniques with a patient presenting with anxiety and co-occurring cannabis use, illustrating how motivational interviewing can be used to build therapeutic alliance without alienating patients who are ambivalent about behavioral change.
Takeaways:
Motivational interviewing is considered a cornerstone, evidence-based treatment approach for substance use disorders in psychiatric practice.
The improv principle of "yes, and" can be applied clinically by affirming an emotionally salient part of a patient's statement before introducing a new therapeutic direction.
The OARS framework, open-ended questions, affirmations, reflections, and summaries, provides a structured method for conducting motivational interviewing conversations.
The ask-tell-ask method allows clinicians to deliver psychoeducation only when a patient has explicitly consented to receive it, preserving patient autonomy.
Harm reduction tools, such as methamphetamine safety kits distributed in emergency settings, reflect an evidence-based, non-judgmental approach to meeting patients where they are in their stage of change.
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Chapters:
00:00 Why Motivational Interviewing
01:09 Meet Dr Allison Hadley
02:33 Who MI Is For
04:37 How MI Works
07:27 Tina Fey Improv Lens
09:06 Improv Rules In Practice
19:19 OARS Core Skills
23:13 Reflections That Land
24:25 Summaries And Change Talk
25:01 Sponsor Break
27:38 Spotting Change Talk Cues
32:08 Stages Of Change Basics
34:23 Ask Tell Ask In Practice
39:30 Roleplay And Final Takeaways
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