How Do Your MI Skills Measure Up?

In the next several blog instalments, I’ll focus on various measurement criteria that can be used to determine “How MI am I”.

Motivational Interviewing is NOT a technique. Rather, it is a set of guidelines and “conversational criteria” that can be used to help you to increase influence the way that clients speak about and plan for various changes. In the early stages of learning MI, it can be quite overwhelming to put all of your MI skills to the test simultaneously. When learning the approach, I recommend practising, getting good at, and examining one skillset at a time.

A wonderful instrument for “coding” the degree of fidelity that a particular interview has to Motivational Interviewing practices and processes is a standardized and reliable tool called the “Motivational Interviewing Treatment Integrity (MITI) Coding Manual (Current version = 4.2). One of the indicators of good M.I.  practice as measured by the MITI tool is the degree to which a motivational interviewer is able to “cultivate change talk”. In a nutshell, a high score on this dimension of MI work, means that the focus of the change discussion was clear to both the interviewer and client, and the interviewer “worked like a trooper” to guide the client to thinking about his/her Desire, Ability, Reason and Need (and eventually Commitment) to plans that support achievement of the change target. Here are the “broad strokes” criteria for each of the rankings (on a scale of 1-5) for measuring “Cultivating Change Talk” in an MI session.

Cultivating Change Talk for more detailed scoring information, see https://casaa.unm.edu/download/MITI4_2.pdf

             LOW FIDELITY                                                                                                                              HIGH FIDELITY

1

2

3

4

5

Clinician shows no explicit attention to, or preference for, the client’s language in favour of changing Clinician sporadically attends to client language in favour of change – frequently misses opportunities to encourage change talk Clinician often attends to the client’s language in favour of change, but misses some opportunities to encourage change talk Clinician consistently attends to the client’s language about change and makes efforts to encourage it Clinician shows a marked and consistent effort to increase the depth, strength, or momentum of the client’s language in favour of change

“This scale is intended to measure the extent to which the clinician actively encourages the client’s own language in favour of the change goal, and confidence for making that change. To achieve higher ratings on the Cultivating Change Talk scale, the change goal must be obvious in the session and the conversation must be largely focused on change, with the clinician actively cultivating change talk when possible. Low scores on this scale occur when the clinician is inattentive to the client’s language about change, either by failing to recognize and follow up on it, or by prioritizing other aspects of the interaction (such as history-taking, assessment or non- directive listening). Interactions low in Cultivating Change Talk may still be highly empathic and clinically appropriate” (from
Moyers, T.B., Manuel, J.K., & Ernst, D. (2014). Motivational Interviewing Treatment Integrity Coding Manual 4.1. Unpublished manual.) You can download the MITI 4.2 manual at no charge at https://casaa.unm.edu/download/MITI4_2.pdf