Motivational Interviewing

Explicit content warning

02/24/25 • 96 min

In this episode Preston and Margaret are joined by Dr. David Roberts to explore the fascinating world of motivational interviewing (MI)—a counseling technique designed to help patients navigate ambivalence and commit to meaningful change. Dr. Roberts shares insights from his years of experience training psychiatrists and therapists, breaking down MI into practical techniques that anyone can use to foster deeper, more effective conversations. We even do a fake therapy session with our producer Aron Korney!

Takeaways:

Motivational Interviewing Bridges Ambivalence: MI helps people resolve mixed feelings about change by guiding them to articulate their own reasons for making a shift.

Change Talk Sparks Action: Encouraging patients to express their desire, ability, reasons, and need for change strengthens their motivation to take action.

Reflections Deepen Understanding: Simple and complex reflections help mirror a patient’s thoughts and feelings, making them feel heard while subtly guiding them toward insight.

Pacing Matters: Being too directive can lead to resistance, while being too passive may feel ineffective—MI teaches a balanced approach that fosters real conversations.

Practice Makes Progress: MI is a learnable skill that improves with intentional practice, making difficult conversations about change smoother and more effective over time.

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Want more Dr. David Roberts:

https://providers.uthscsa.edu/providers/david-l-roberts-1255650917/

Want more Aron Korney:

Human Values Podcast: https://podcasts.apple.com/us/podcast/human-values/id1622760459

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

Learn more about your ad choices. Visit megaphone.fm/adchoices

Takeaways:

Motivational Interviewing Bridges Ambivalence: MI helps people resolve mixed feelings about change by guiding them to articulate their own reasons for making a shift.

Change Talk Sparks Action: Encouraging patients to express their desire, ability, reasons, and need for change strengthens their motivation to take action.

Reflections Deepen Understanding: Simple and complex reflections help mirror a patient’s thoughts and feelings, making them feel heard while subtly guiding them toward insight.

Pacing Matters: Being too directive can lead to resistance, while being too passive may feel ineffective—MI teaches a balanced approach that fosters real conversations.

Practice Makes Progress: MI is a learnable skill that improves with intentional practice, making difficult conversations about change smoother and more effective over time.

—

Want more Dr. David Roberts:

https://providers.uthscsa.edu/providers/david-l-roberts-1255650917/

Want more Aron Korney:

Human Values Podcast: https://podcasts.apple.com/us/podcast/human-values/id1622760459

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

Learn more about your ad choices. Visit megaphone.fm/adchoices

Previous Episode

Treating Back Pain and Trending on Tik Tok

In this episode Preston and Margaret welcome their first guest, neurosurgeon and content creator Dr. Betsy Grunch (aka Lady Spine Doc), for a deep dive into pain—how we treat it, how we misunderstand it, and how the system often fails those who experience it.

Takeaways:

Pain Is Not Just Physical: Chronic pain isn’t just about physical damage—it involves neurological, psychological, and emotional factors that make treatment complex.

Back Surgery Isn’t Always the Answer: Failed back surgery syndrome is common, often because patients receive the wrong procedure or aren’t properly prepared for surgery.

Empathy Improves Patient Outcomes: Research shows that patients who feel heard and understood by their doctors have better surgical and pain management outcomes.

Social Media Shapes Medical Conversations: Platforms like TikTok have transformed how patients and doctors discuss pain, sometimes for better—but also with risks of misinformation.

Medical Training Can Be Dehumanizing: The culture of surgery often discourages emotional connection, but rediscovering empathy is key to being a great physician.

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Want more Dr. Betsy Grunch:

TikTok: https://www.tiktok.com/@ladyspinedoc?_t=8rhZfY7LgLe&_r=1

Twitter: http://www.twitter.com/ladyspinedoc

Instagram: http://www.instagram.com/ladyspinedoc

Facebook: https://www.facebook.com/ladyspinedoc

YouTube: https://youtube.com/@ladyspinedoc

LinkedIn: https://www.linkedin.com/in/drgrunch

Amazon: https://www.amazon.com/shop/ladyspinedoc

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

Citations:

Chapters 1.16 and 27.15. Sadock, Benjamin J, et al. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 11th ed. Philadelphia, Wolters Kluwer, 2025.

Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, van Tulder M, Koes BW. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3. PMID: 29971708.

Stanford Center for Chronic Pain and American Chronic Pain Association Guide.

https://www.acpanow.com/acpa-stanford-guide.html#/

George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, Gilliam JR, Hendren S, Norman KS. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021 Nov;51(11):CPG1-CPG60. doi: 10.2519/jospt.2021.0304. PMID: 34719942; PMCID: PMC10508241.

https://pubmed.ncbi.nlm.nih.gov/30265840/

https://www.ncbi.nlm.nih.gov/books/NBK219252/#:~:text=Pain%20is%20a%20subjective%20experience,relieving%20or%20terminating%20the%20experience.

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Next Episode

Cannabis and Coping: A Mixed Relationship

In this episode Preston and Margaret explore the endocannabinoid system, cannabis, and its impact on mental health. They break down the science behind CB1 and CB2 receptors, explain why marijuana affects people so differently, and discuss the complex relationship between THC, CBD, and dopamine. Along the way, they tackle myths about cannabis use, addiction, and medical marijuana, shedding light on what we actually know—and what remains a mystery due to historical barriers to research.

Takeaways:

The Endocannabinoid System is Vast and Mysterious: CB1 and CB2 receptors exist throughout the body, influencing pain, pleasure, nausea, and more—but the full scope of their role remains unclear.

Marijuana’s Effects Depend on the User: Some people experience relaxation and appetite stimulation, while others develop anxiety, paranoia, or even worsening nausea with chronic use.

The THC-to-CBD Ratio Matters: Over time, cannabis strains have been bred to increase THC potency, which may contribute to heightened psychiatric risks, including psychosis.

Cannabis Can Have Severe Side Effects: Long-term use can lead to cannabinoid hyperemesis syndrome (CHS)—a condition causing severe nausea and vomiting—and may increase the risk of cannabis-induced psychosis in predisposed individuals.

Medical Cannabis Outpaced the Research: While cannabis is now widely used for medical purposes, much of its effectiveness is anecdotal, and research on its long-term mental health impacts is still catching up.

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Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

Learn more about your ad choices. Visit megaphone.fm/adchoices