Motivational Interviewing- Part 2 - CME Paid Option-Motivational Interviewing- Part 2

Video Transcription

Video Summary

Part two of this Motivational Interviewing (MI) series focuses on managing “discord” and “sustained talk,” which often appear when clinicians push too hard or when patients aren’t ready to change. The presenters emphasize that sustained talk reflects normal ambivalence; clinicians should validate it, reflect it, and “roll with” resistance rather than argue. Techniques include emphasizing rapport, “planting seeds,” and even highlighting a patient’s reasons for not changing (“penduluming”) so the patient feels heard. If the clinician overpushes and creates defensiveness, a simple apology and a reset can restore collaboration.<br /><br />A role-play with a patient who uses high-potency cannabis and has recurrent vomiting demonstrates reflective listening, affirmations, exploring pros/cons, using a readiness ruler, and backing off when resistance rises—aiming for gradual movement rather than immediate behavior change.<br /><br />The session then applies MI to chronic opioid therapy. For unstable, high-risk situations, safety requires decisive action. For stable “legacy” patients, MI helps introduce long-term changes (tapering, risk education, buprenorphine rotation) through small experiments and ongoing conversations. A final case shows empathic listening paired with firm boundaries: no unsanctioned dose escalation, close follow-up, treating depression safely, and offering alternatives while preserving the therapeutic relationship.

Keywords

motivational interviewing

discord management

sustained talk

reflective listening

rolling with resistance

readiness ruler

cannabis hyperemesis syndrome

chronic opioid therapy tapering