Motivational Interviewing- Part 2 - FREE NO CME-Motivational Interviewing- Part 2

Video Transcription

Video Summary

Part two of the series focuses on handling “discord” and “sustained talk” in motivational interviewing—patient resistance or ambivalence that often appears when clinicians push too hard. The speakers emphasize that sustained talk is normal, reflects how difficult change is, and should be met with reflection, validation, and patience rather than confrontation. Techniques include “penduluming” (temporarily leaning into and affirming the patient’s reluctance to show understanding) and apologizing/resetting when the clinician oversteps.<br /><br />A role-play case demonstrates working with a patient with recurrent vomiting who uses high-potency cannabis. The clinician avoids arguing, explores benefits and harms, uses a motivation ruler, and focuses on planting “seeds” for future change rather than forcing immediate action.<br /><br />They then connect MI to chronic opioid prescribing. For stable patients, MI helps build readiness for gradual, long-term improvements (e.g., tapering, risk education, small “experiments,” considering buprenorphine). A second case shows empathic listening paired with firm safety boundaries when a depressed nurse takes extra Percocet. The plan includes no early refills, closer follow-up, mental health treatment, and discussion of transitioning to buprenorphine—highlighting that autonomy is respected, but safety is non-negotiable.

Keywords

motivational interviewing

discord and sustained talk

patient resistance and ambivalence

reflective listening and validation

penduluming technique

cannabis hyperemesis syndrome

chronic opioid prescribing

buprenorphine transition