New Motivational Interviewing Article

I wanted to let everyone know about a new article that just came out which addresses an interesting aspect of Motivational Interviewing and an area where many of you may have been seeking more tools with which to work with your clients. It describes a new technique for making the transition to the action-planning stage, while at the same time maintaining the MI spirit. Here is the abstract and description and bio info. for you to use if you have access to an on-line library or choose to purchase it online. I hope you find it helpful. Enjoy!

Action reflections: a client-centered technique to bridge the WHY-HOW transition in Motivational Interviewing
Authors: Resnicow K, McMaster F, Rollnick S.

BACKGROUND:
When using Motivational Interviewing (MI), once resistance or ambivalence are resolved and motivation is solidified, many practitioners struggle with how best to transition the discussion toward action planning, while still retaining the spirit and style of client centeredness, i.e., moving from the WHY phase to the HOW phase of counseling in a style that is MI-consistent. For many, there is a perception that the counseling style, skills, and strategies used to build motivation are distinct from those used in the action planning phase. The WHY to HOW transition does not, however, necessitate abandoning a client-centered style for a more overtly educational or directive style. Goal setting, action planning, provision of advice, and relapse prevention can be implemented from an autonomy supportive, MI consistent framework.

METHOD:
To this end, this article will present a new class of reflection, which we have termed “action reflections”, that can be used to help bridge the WHY-HOW gap. Action reflections (AR) allow the clinician to maintain a tone and orientation that are consistent with MI, i.e. autonomy support; guiding versus directing, during the action phase of counseling. They differ from reflecting change talk as they focus not on the WHY of change, but the HOW, WHEN, or WHERE. Action Reflections (ARs) also differ from the more common type of reflections such as those that focus on client feelings, rolling with resistance, or acknowledging ambivalence as ARs usually contain a potential concrete step that the client has directly or obliquely mentioned. Like any type of reflection, ARs represent the clinician’s best guess for what the client has said or, more apropos here, where the conversation might be heading.

CONCLUSION:
This article describes the various types of ARs and provides examples of each to help clinicians incorporate them into their behavior change counseling.

To Find It:
Behav Cogn Psychother. 2012 Jul;40(4):474-80. doi: 10.1017/S1352465812000124. Epub 2012 Mar 14.

 

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Stepping on the Toes of Self-Determination

Guest Blog Post by Dr. Melinda Hohman, Ph.D.

Did you ever dance with someone who stepped on your toes? Ouch! What do you do when that happens? Some people back up, giving themselves some space from their partner. Others fumble a bit, losing their rhythm. Others might let out a loud yelp and get upset with their partner and maybe say something that isn’t so nice. Or they leave the dance floor altogether.

Using MI with our clients has been compared to dancing with them. There is a give and take and a nice, steady flow. And sometimes we inadvertently step on their toes whereby they respond as in the examples above, by distancing themselves, by losing their engagement or focus in the conversation, or by telling us in no uncertain terms that they aren’t too happy with us. The dance has lost its flow and rhythm.

What just happened? In MI when we get discord like this with clients, we need to stop and ask ourselves what we just did to cause this reaction. One way to think about this process is from concepts of self-determination theory (Miller & Rollnick, 2012; Ryan & Deci, 2002) which helps explain a bit why MI works the way it does. According to the authors of this theory, humans need three things to thrive: to be autonomous, to be seen as competent, and to be in relationships with others. Perhaps when we have “stepped on the toes” of clients, we have done so by not meeting these needs.

Stepping on the autonomy toes: Supporting clients’ autonomy is important in MI. Stepping on their toes in this area happens when we don’t ask clients what they think or how they view their problem or its solution. We make assumptions about their lives, their character, or their abilities and feel we have to help or direct them. Threatening or warning clients about what can happen if they don’t do certain things is certain to prompt them to leave the dance floor. People need to feel that they are in charge of their own lives and decisions.

Stepping on the competency toes: Offending clients can happen when we give them advice  without their permission. Or we launch into providing information on a specific topic without asking them what they already know.  Doing this gives the message to clients that we think they don’t know these things and they have to hear them from us. So what happens? Again, they check out. They argue. Or, they just say, “Whatever”. As we take an expert stance, we are not honoring their own expertise about their lives.

Stepping on relatedness toes: Most counseling methods will tell us that relationships with clients are key to the change process. Sometimes we damage our relationships by again assuming the expert stance, by not listening to what our clients have to say, or thinking we know best. We spend a lot of energy trying to get our point across. No collaboration here! When clients feel less than autonomous and not very competent due to our interactions, the relationship suffers.

We all want the dance to continue and feel badly when we make missteps. Even professional ballroom dancers misstep from time to time. When it happens and we see clients react, think about how well you are supporting their autonomy and competence and the relationship with you. Self-correct, come alongside, apologize if need be, and you will be off waltzing again.

References:

Miller, W. R., & Rollnick, S. (2012). Meeting in the middle: motivational interviewing and self-determination theory. Journal of Behavioral Nutrition and Physical Activity, 9 (25).

Ryan, R. M.,  & Deci, E. L. (2002). Overview of self-determination theory: An organismic-dialectical perspective. In  E. L. Deci & R. M. Ryan (Eds.), Handbook of self-determination research (pp. 3-33). Rochester, NY: University of Rochester Press

 

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Can You Use Motivational Interviewing on Yourself?

Guest Blog Post by Dr. Melinda Hohman

I recently heard a person say that he had used Motivational Interviewing (MI) on himself. I thought, “Is this possible? How does that work?” Being an experienced MI trainer and teacher, I thought maybe I would give it a try by writing this blog.

My issue in this case is that I just got hearing aids. I have what some might call “residual ambivalence” about wearing them. Do they work? Yes. Do I like them? Not really. But they aren’t so bad–I got the kind that go behind my ear with a small wire into my ear. No one can see them. My friends are shocked when I point them out to them.

I have been eligible for hearing aids for about the past 5-6 years. I kept thinking that I am too young to wear them and tried to compensate for my moderate hearing loss. No one can explain why I have hearing loss like this in middle age; it may have been from a virus.  I had noticed difficulty over time with my hearing, especially while teaching in the university classroom. I couldn’t hear students in the back of the room and would have to walk up to them to listen more closely. I figured they would just think this was part of my teaching technique, to walk around the classroom. I knew in the back of my mind that they were frustrated with having to repeat things but were always quite patient. A bit unfair to them. Sometimes I would even pretend like I had heard them and just nod. Think I fooled them? Community training events that were held in large rooms brought some concern and I would tell my audience ahead of time that I had some “mild” hearing loss and might need them to speak a bit louder. I guess that really instills confidence in your trainer! Again, I would do the walking around bit and tried to make it look like this was quite normal.

Sometimes in restaurants or while out shopping, I would not quite hear what the waiter/clerk said and would have to ask them to repeat it. I noticed at times my family and friends jumping in to tell me, knowing right away that I had missed something. They meant well, but again, this was unfair to them. And it didn’t make me feel so great.

So, where does the Motivational Interviewing come in? Even in just writing the above paragraphs, I see how I struggled and tried to compensate for my hearing loss. I never quite put it together this way; I would discuss some of these aspects with my family and friends, and say, “Oh, my poor students! They must think I am really an old lady!” and laugh it off a bit. Reading all these aspects of the “down side” of not wearing hearing aids is like listening to a long summary where all the pieces are pulled together. Bill Miller, the founder of MI, likens this to presenting a client with a bouquet of individual flowers. When clients hear summaries, especially ones with lots of details, they may be listening to their reality in a whole new way.

OK, so now I am a bit more motivated. I see the problems that not having hearing aids has caused me. I could now go on about why I don’t like wearing them, although I am in the transition stage and have been told it takes time for your brain to get used to them. So far, they are uncomfortable, making my ears itch and even hurt a bit. There is also a feeling of being a bit disabled; just about everyone I know wears glasses, but I only know two people who wear hearing aids. Do I see them as disabled? No. So I am being silly when I think of myself in this category.  And so what if I was. As an MI trainer/teacher, I discuss how a counselor should be cautious of eliciting too much “sustain talk” from clients—why they can’t, won’t, shouldn’t, aren’t able, etc. I have to watch doing that to myself as well. Complaining doesn’t change things and only feeds my residual ambivalence. So it’s better to move on. I can bring up the itchy/pain problem when I see my audiologist.

Time for me to focus on some change talk or discussion regarding the positive side of the change one is making or considering making. What are the benefits of wearing hearing aids? Well, I can actually stand in the front of the classroom and hear from the back row. I can hear what people are saying when I am out in public. I am not driving my poor husband crazy by asking him to repeat everything when he talks from the next room. When using Motivational Interviewing, we can link change to personal values. It is important for me to do a good job as a teacher and trainer. Being able to more clearly hear students will increase my effectiveness in my work. It also makes me feel more “able”.

What is interesting is the reaction from friends. They act like I am some sort of trailblazer, leading the way into older adult issues. They say things like, “I  know, I need them too,” “I should be getting them.” Their affirming my decision to actually do something about my hearing loss has been helpful. So maybe in doing self-MI, we listen for affirmations that come from those around us.  And maybe we could even affirm ourselves. For instance: I feel like it takes guts for me to just write this.

Let us know if and how you have used Motivational Interviewing personally!

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Success Secrets of Enterprising Women Interview

Check out my interview on the blogtalkradio show Success Secrets of Enterprising Women.
 

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January 2012 Workshops for Women V-log

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The Top 10 Reasons a Health Coach Should Learn Motivational Interviewing

Why Health Coaches should learn Motivational InterviewingIf you don’t know already, Motivational Interviewing (MI) is an evidence-based approach that was founded in the early 80’s by Dr. Bill Miller, a psychologist working with problem drinkers. Since that time, MI has grown in popularity as more and more helping professionals utilize the approach (as opposed to treatment as usual) and find that they feel much more prepared for working with their clients on behavior change issues.

In particular, health coaches have begun to rely on MI as a foundational skill. Katie Slack, the owner and Lead Trainer for MI Training Today, is a member of the Advisory Board for the National Society of Health Coaches, a wonderful organization that offers an excellent health coach certification program based on Motivational Interviewing’s main principles and techniques.

Still need a little more convincing? When Motivational Interviewing (MI) was compared to treatment as usual patients receiving MI were more likely to:

  1. Enter, stay in & complete treatment.
  2. Attend follow-up visits.
  3. Adhere to glucose monitoring.
  4. Increase fruit & vegetable intake.
  5. Reduce stress.
  6. Reduce sodium intake.
  7. Keep food diaries.
  8. Reduce unprotected sex & needle sharing.
  9. Improve medication adherence.

(Rollnick, Miller, & Butler, 2007)

If you would like to see any of these 9 outcomes for your patients, then learning MI is the next step for you. And if these 9 reasons are still not enough, there’s more!

  1. The 4 Guiding Principles of MI: RULE provide a clear cut & effective way to work with your clients:

                 R = Resist the Righting Reflex

                 U = Understand Patient’s Motivations

                 L = Listen to the Patient

                 E = Empower the Patient

Motivational Interviewing can seem both familiar, and at the same time difficult to integrate without sufficient training or support (Rollnick et al., 2007). Get the help you need to utilize this highly effective approach with your clients. Sign up for a training or purchase a webinar from the Health Coaches Webinar Series today.

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Co-Active Life Coaching & Motivational Interviewing

I had an interesting article passed along to me recently: “Assessing Motivational Interviewing through Co-Active Life Coaching Tools as a Smoking Cessation Intervention: A Demonstration Study.” The titles are never short are they? :> I had never heard of Co-Active Life Coaching (CALC) before, so I looked into it. It turns out the Coaches Training Institute out of San Rafael, CA offers training in the approach.

This is how they describe the Program:
Co-active® Coaching integrates three foundational principles that together serve to enhance the quality and results experienced in the coaching client’s life and work.
• Fulfillment – deriving deep meaning and satisfaction from life
• Balance – viewing the world from an empowered stance making powerful choices and taking effective action
• Process – fully experiencing the richness of any given moment of life or work

Coaching creates a powerful dynamic relationship between two Motivational Interviewing Coachingpeople. However, rather than instruct, advise or problem solve, the job of the coach is to ask questions, listen and empower. Co-active coaches believe their clients are already great and it’s their job to provide support to enhance the skills, resources and creativity the client already has to achieve extraordinary results.

For those of you practicing Motivational Interviewing, this may sound pretty familiar. As the articles describes CALC, it says “its’ strategies actually and effectively do put Motivational Interviewing principles into action.” Interesting… What I like about it is that there have been times over the past few years, as I have used and trained Motivational Interviewing that I wished there were even more Motivational Interviewing techniques that I could use and train other practitioners to use. So this may be exactly that, a Program based on Motivational Interviewing that offers a rich and comprehensive way of working with people. The study in the article had good things to report, saying that CALC proved “valuable for reducing smoking, and for providing smokers’ with insights about their behaviors, their triggers, and what they need to be and stay smoke-free.” It strikes me as a way to take things to the next level, so if you are drawn to Motivational Interviewing and are practicing at an intermediate or advanced level and want more, I thought this was a program you may find interesting as well. Let me know what you think.

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Motivational Interviewing and Self-Care

First of all, I figure practice what you preach, so I am writing this blog, on a Friday morning, from bed. It feels pretty nice. But there is another part of me struggling with questions like: “Is this ok? Should I be doing something differently? Is it ok to take it a little bit easy?” So, how does taking care of ourselves play into the therapeutic work we do with others?

Motivational Interviewing (MI) asks that we be empathic, collaborative and at the same time gently challenging as we work with our clients on making changes. Our presence and attentiveness are also key, as we try to understand the person’s worldview. It feels great, in my opinion, to use MI and be of service to someone in this way, but it’s not always easy. What’s the saying, “if your cup isn’t full…” hopefully you know the rest. Basically, I think the more we take care of ourselves, the more we are able to truly be of service to someone else. If we are frazzled and worn out, it is more difficult for us to be available and present for another. Not that we won’t try and not that our culture and jobs don’t lend themselves to this dynamic, to give and give until you have nothing left.

Thankfully, as it turns out, MI may in fact lend itself to a healthier dynamic, making this process of give and take a little bit easier. Therapists have discussed it for years, although it has yet to be conclusively studied, the idea that utilizing MI in one’s practice may decrease burnout. How about this for the title of an article: “The Unbearable Fatigue of Compassion: Notes from a Substance Abuse Counselor Who Dreams of Working at a Starbucks.” Annie Fahy (2007) writes “In the 90’s we called it ‘burnout’ and we wore it like a badge because it meant we were working hard and we really cared… At night we came home bone tired and zombified watching television or drinking while our families clamored around us.”

She then goes on to mention MI as a therapeutic approach that “holds great potential” for impacting not only the client in a helpful way, but also the practitioner. She quotes a Substance Abuse professional:

“I had to change in my work so I wouldn’t go crazy. I thought… I couldn’t work in treatment anymore…Then I learned Motivational Interviewing… I really felt born again in my work. I didn’t have to control for the outcome anymore. I had to change some other things too… like get a life and live it. There was no guide for this.”

So maybe, those of us that practice MI are more poised to seek and actually achieve a healthier stance in our work and in our lives. MI reminds us that no matter what we give, the client is accountable for the change; we couldn’t do it for them- even if we wanted to. The challenge is to continually remind ourselves of the MI principles and try to operate from them, and then, as the quote mentions- to get a life and live it.

Below, please feel free to share ways that you have sought balance in your own work and life.

My Best,
Katie Slack

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On Change and Compassion

They always say time changes things, but you actually have to change them yourself.
-Andy Warhol

That’s the toughest thing about change isn’t it? That in fact it does not show up on our door step one morning all wrapped up with a pretty bow. We actually have to work, and work, and work, until maybe one day we catch ourselves going, oh yeah, I have made strides in this area of my life, or I did accomplish that goal. Our clients/patients are no different. We all struggle and we all suffer.

The amazing thing is that you are actually in the position to ease another’s suffering. I think we forget this sometimes. We think we should be pushing them, or doing more, or that they should be making more progress. When that happens, if I may make a suggestion, take five minutes and consider your own track record in regards to major life changes. Change is often a non-linear, illogical process. Sometimes we don’t know what the magic bullet will be that will actually catapult us to that next step, or towards long-term change. But I will say this; never underestimate the power of standing with someone in their suffering.

It comes down to the question, will we choose to be judgmental and take a harsh stance with our clients about their lack of progress towards change, as we have all done at one time or another. Or will we stand with them- where they are in the moment- and have compassion for their struggles, while still gently challenging them with the question “What do you want to do now?”

Compassion is the fourth element that Miller and Rollnick will add to the “Spirit” of Motivational Interviewing (MI) in the third edition of the main MI text, coming out soon. Compassion, means to suffer together with and it is more vigorous than empathy; an active desire to alleviate another’s suffering (Wikipedia). Maybe take a day or a week and experiment with this concept, move through your day with as much compassion for yourself and others as you can, and then just see what happens, see how you feel, see how your clients respond, see where you get snagged and are tempted to move away from compassion. As Bill Miller said recently; “The clients we get are the clients we create” (MINT Forum, San Diego 2010). See what kind of client you can create with a hefty dose of compassion. Not a bad challenge for any of us as we move into the new year…

My Best,
Katie Slack

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Use It or Lose It! How to Get the Most Out of Your Motivational Interviewing Training

A recently published systematic review on training in Motivational Interviewing (MI) over the past ten years (Madson, Loignon, & Lane, 2008) concludes with the old adage “use it or lose it”. Would you agree?

One of the studies reviewed demonstrates that although communication skills were enhanced after training, the effect on actual clinical practice was minor. It seems that without some support and coaching after initial training, the benefits slowly disappear, and the skills become limited. Does this sound familiar to you?

Well, old sayings don’t stick around unless for some reason they still ring true. But, I digress, this blog is not about old sayings; it is just another way for us to keep you, our readers, informed about the latest Motivational Interviewing news.

This sounds like bad news, you might say; you go to a two-day training, invest your time and money, and then, two months later – you are back to your old repertoire of skills? Not necessarily! The fact is that MI Training Today is committed to providing the highest-quality Motivational Interviewing trainings, and making sure that there is continued support available to you after you complete your introductory level training.

At MI Training Today we take your investment and scientific research very seriously. We offer you a continuum of learning tools: 2-Day Intensives, Advanced Training Courses in 2011, Individual Coaching Services, In-House Agency Trainings, and a soon to be announced Refresher Webinar Series.

We hope this information on what is needed to learn Motivational Interviewing will empower you. And we are here to assist you; please do not hesitate to contact us regarding any training needs you may have.

My Best,
Katie Slack

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