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. SUPPORT OUR PARTNERS: SimplePractice.com/bootcamp (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:Sales@Human-Content.Com Connect with HumanContent on Socials: @humancontentpods Produced by: Human Content 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 Learn more about your ad choices. Visit megaphone.fm/adchoices
