Experiencing a New Approach to Service Delivery Lesson Eighteen: Learning Motivational Interviewing

Topics Covered

Review: Motivational Interviewing

Motivational Interviewing is a complex set of integrated strategies and skills. We review the style, strategy, and processes of Motivational Interviewing, and explain the relationship among them. The OARS skills are used in every strategy and process to maintain the spirit or style of MI, and to keep the conversation focused. 

Importance of Feedback

MI is not a cure all or a magic bullet, it will increase our outcomes but is not a 100% successful practice. MI Proficiency does not come from one instructional method alone, we also need to have people review our work and listen to our use of MI to ensure that we are gaining skills that increase the quality of our work. 

Coding

Coding is much like grading your practice, and focuses only on the interviewers responses to clients. It occurs to determine the staff’s fidelity to MI, by tallying the consistency and quality of MI responses. Coding can be done through having an interview observed or recorded. Some coding methods include MITI, MIA-STEP, and MISC. A coder can listen to our recording and count our number of reflections, count our questions, and note the ratio of reflections to questions. We provide an opportunity for you to practice coding by listening to a dialogue between a client and a staff person and marking a tick whenever you hear  open questions, closed questions, reflections, and affirmations.

Learning Groups

Listening to each other’s sessions, in a learning group, can be a very helpful way to get feedback for your MI practice. It is important to remember to stay in the Spirit of MI in our interactions with others. We explore some questions that can be asked in a learning group to aid in receiving beneficial feedback.

Coaching

Coaching is required to develop full proficiency in MI, it is not something that can be accomplished solely by taking web courses and attending workshops. Coaching is working with an MI trainer or with a staff member who has strong MI skills and helps a small group to focus on the kinds of skill development that are relevant to the particular group or setting in which MI is being practiced. MI coaches work in an MI style to help practitioners identify strengths and target skill development they would find helpful.  

Motivational Interviewing Skills

Motivational Interviewing is not a single skill, but an integrated set of interviewing skills. When these skills are used together, they allow us to practice MI with increasing proficiency. We review the skills that makeup MI proficiency.

Barriers to Learning Motivational Interviewing

A fundamental barrier to learning to be fully proficient in MI is not recognizing the difference between learning about MI and developing proficiency in MI. A second barrier to learning MI would be a fundamental disagreement with the basic style or spirit of MI. Skillful MI coaching always is done in the spirit of MI, so it is unlikely you will experience embarrassment or judgement. We explore these barriers in greater detail and ways they can be avoided.