Motivational interviewing — structured clinical viva

Opening (definition and spirit)

MI is a collaborative, goal-oriented communication style that strengthens personal motivation and commitment to a specific change by exploring and resolving ambivalence.[1] Spirit PACE: Partnership, Acceptance (worth, accurate empathy, autonomy support, affirmation), Compassion, Evocation. Miller and Rollnick warn against common myths (MI is not a trick, not identical to stages of change, not technique without spirit).[2]

OARS demonstration (case lines)

• Open: "What would cutting down look like for you in a good week?"
• Affirm: "Coming after two falls takes courage."
• Reflect (complex): "You're not ready to stop completely, and you're already thinking a cut-down might protect you."
• Summary: "Falls scare you, lithium care matters, stopping feels too big right now, cutting down is on the table — what feels like a first step?"

Prefer reflection-to-question ratio greater than 1 in viva/CASC style.[1]

Change talk and righting reflex

Preparatory DARN (Desire, Ability, Reasons, Need) → mobilising CAT (Commitment, Activation, Taking steps). Commitment language strength predicts outcomes in process research.[6][7] Righting reflex ("you must stop") breeds sustain talk/discord; come alongside ambivalence instead.[1][2]

Stages vs MI

Transtheoretical stages describe readiness trajectories; MI is the method used across stages (e.g. build importance in contemplation; plan in preparation/action).[2][19] Use importance/confidence rulers to choose focus.

Evidence bundle

• MATCH: MET comparable to longer CBT/TSF for many alcohol outcomes; matching limited.[11]
• UKATT: MET and network therapy both effective.[13]
• COMBINE: supports combining pharmacotherapy with behavioural intervention packages including motivational elements.[14]
• Cochrane: short-term benefit vs no intervention; smaller/uncertain vs other active treatments — claim modestly.[16]

When MI is not enough alone

Medical alcohol work-up and withdrawal risk; lithium toxicity/adherence medical issues; falls safety; driving advice; indicated pharmacotherapy for AUD; compulsory care if risk/capacity thresholds met. MI aids engagement with these, not replacement.[14][16]

Examiner pushbacks