Motivational interviewing
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Motivational interviewing (MI) is a client-centered, directive approach that strengthens a patient’s own motivation for change by exploring values, goals, and mixed feelings – rather than relying on advice, pressure, or fear-based messaging. MI is especially effective when discussing substance use during pregnancy, where many patients have experienced trauma, stigma, or fear of judgment.
Even brief MI-informed conversations can positively impact care.
Why use motivational interviewing with pregnant patients?
Motivational interviewing helps providers:
Build trust and reduce stigma
Encourage honest disclosure
Support patient autonomy
Increase readiness for behavior change
How providers communicate can significantly influence patient engagement and outcomes.
Core principles of motivational interviewing
Motivational interviewing is guided by five key principles:
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Express empathy using non-judgmental, reflective listening
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Develop discrepancy between current behavior and personal goals
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Avoid argumentation or scare tactics
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Support self-efficacy by reinforcing the patient’s ability to change
Key elements of motivation
Motivational interviewing focuses on three components of motivation:
Importance – Does change matter to the patient?
Confidence – Does the patient believe they can change?
Readiness – Is this the right time?
Providers can tailor conversations based on where a patient is in this process.
Eliciting “change talk”
Motivational interviewing encourages patients to express their own reasons for change. Providers can do this by:
Asking open-ended questions
Reflecting patient statements
Exploring ambivalence without judgment
Change is more likely when motivation comes from the patient rather than the provider.
Using motivational interviewing in practice
Motivational interviewing is less about following a script and more about provider values and skills. Self-awareness, empathy, and a non-judgmental approach are essential, especially when discussing substance use during pregnancy.
MI works best when integrated with:
Universal screening
Brief interventions
Referral to treatment and support services
Even brief MI-informed conversations can positively impact care.
Trauma-Informed Motivational Interviewing Examples
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“I ask everyone these questions, and you’re in control of what you choose to share.”
“This is a judgment-free space, and my role is to support you.”
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“It sounds like this has been helping you cope, and you also have concerns about your pregnancy.”
“I hear how much you’re juggling right now.”
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“Many people feel unsure about changing – what feels hardest for you right now?”
“It’s common to have mixed feelings about this.”
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“How does this fit with what you want for yourself and your baby?”
“What feels most important to you when you think about your pregnancy?”
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“It sounds like stopping completely doesn’t feel possible right now.”
“We don’t have to rush this – let’s talk about what feels manageable.”
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“Would it be okay if we explored some options together?”
“You get to decide what, if anything, you want to change.”
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“What changes, if any, feel doable to you right now?”
“What makes you think about wanting something different?”
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“What strengths have helped you make changes in the past?”
“You’ve handled hard things before – what helped you then?”
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“Thank you for being open with me – I appreciate your honesty.”
“I’m glad you felt comfortable sharing that.”
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“We can revisit this whenever you’re ready.”
“Support is available whenever you want it.”