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Beyond training: Looking at learning MI in a whole new light!
Thoughts on Improved Practice (TIP) #1702
Dr. Miller explains how Stephen Rollnick (codeveloper of MI) was watching him conduct an MI interview. Rollnick was very impressed with the strategy that he could see in Miller’s approach, and at the end of the interview, he exclaimed “Wow, Miller – you’re a duck!” Miller was surprised by the description and asked Steve what he meant. Dr. Rollnick explained by saying “yes – you’re a duck. On the surface it looks like you are moving along slowly, smoothly, effortlessly, and yet below the surface,
underneath the water, you’re actually paddling away like mad!” (see page 319 of MI-3 for the complete story)
1701: Are You A Duck?”
Dr. Miller tells this story to illustrate an important truth about the practice of MI. He uses the anecdote to point out that when you are actively involved in the process of interviewing in the style of MI – you will probably experience yourself being pretty darned busy! When guiding an MI conversation, most people can relate to the experience of working like the busy little webbed feet of a duck! When all is going well, you are paddling like crazy, even though, on the surface, it looks like an effortless and graceful thing to just “mosey along” in your casual and relaxed way. Generally, what it looks like on the surface betrays how busy the brain is, working, and processing, and making choices and decisions while you listen to what is being said and thinking about where you are heading.
Personally, I think Dr. Rollnick’s comment is a perfect descriptor for what it’s like to be the interviewer in an MI conversation. If you’re doing it properly, everything should look quite calm and effortless on the surface, and that sense of “ease” should be a sharp contrast to what is really going on inside your head when you’re at work in an MI interview. When MI is done well, the good ol’ cog-wheels should be spinning away at a pretty good clip – just like the duck’s little legs are just paddling like crazy while it glides across the pond.
In explaining what goes on inside his head when guiding an MI discussion, Miller says:
I am very conscious about what is happening and where I’m heading – where the sunrise horizon is. As a prime directive, I mean to stay with the person in the present, paying attention and not letting my awareness drift off into plans or distractions. At the same time, I am remembering what has already transpired, logging away what the person has said (p. 319)
Dr. Miller’s report of his inner process while guiding an MI session is useful for those of us who are actively trying to learn, and improve upon our practice. He is suggesting that avoiding premature movement into the planning process requires self-discipline; it means staying with the client, and staying attuned to the direction in which the conversation needs to move – without pushing, or pulling, before the client has articulated his/her argument for change.
Miller also suggests that he stays with the focusing process until the light on the horizon becomes clear enough to act as a beacon toward which the conversation will be guided or “steered”. In an MI conversation, once it becomes clear as to where you and the client ought to be headed (the target), then your head needs to get even busier! Then (and only then) is it time to begin making important decisions about how, as the interviewer, to behave in the discussion. There are many decisions to be made, in real time, quite quickly
MI interviews are not just about listening and helping your client hear what she has said. Interviewers need much practice with thinking on their feet, so to speak, so that they can work to influence, guide, and shape the pathway the conversation takes. While listening to their clients, MI interviewers ask themselves questions such as:
- Is there any Change Talk in what I just heard? (If so, what should I do with the Change Talk that I heard? Reflect it back? Ask for elaboration? Affirm it? Collect it up, for the time being, so that I can include it in a bouquet summary a little later on?
- Should I reply to what the client has said right now? Should I wait a bit, and bring it up later? (Note: Miller suggests that the timing of your responses is important too. He recommends that we not “pounce” on what seems important in a conversation, and instead, to consider coming back to it later. To do this however, an interviewer must work to remember key statements that the client has made so that they can be attended to later on in the discussion).
- Am I hearing any Sustain Talk? Is there any Discord showing up in the way my client and I are
communicating? If so, how should I modify what I am doing so that we don’t get into a tug-ofwar?
At first glance, MI work can be deceptive. Sometimes, people who have become quite good at it can make it look almost too easy. Effortless. Casual. It can seem like little other than “friendly chat”. But – don’t be fooled!
The truth is, MI work is … well, just that! It is work! Once you get good at the skills and learn to trust the process, it can become entirely enjoyable – even fascinating! For me, it is almost a “fun” experience, to see if I can help my client to find her inner desire, and her inner reasons, and ultimately, her inner commitment to pursuing health-enhancing change. That said, it has taken me a long time to get to the point of being able to “relax into” the conversation. MI is certainly not something that you can do when
your brain is tired, or when you are not ready and able to be present.
your brain is tired, or when you are not ready and able to be present.
holding the past, present, and future simultaneously. I am clearly hearing
and attending to whatever the client is saying in this moment and adjusting
my own course accordingly. I hear it in the context of what has already
transpired, putting together pieces like flowers in a bouquet. And I am
conscious also of direction, of that compass that tells me where I’m headed
and how to get there. No wonder it’s such a rich experience! (p.319)
and attending to whatever the client is saying in this moment and adjusting
my own course accordingly. I hear it in the context of what has already
transpired, putting together pieces like flowers in a bouquet. And I am
conscious also of direction, of that compass that tells me where I’m headed
and how to get there. No wonder it’s such a rich experience! (p.319)
I can relate to what Dr. Miller is saying, although, as a Canadian, I prefer to think of myself not so much as a paddling duck – but more like our busy beaver! I’m a busy little beaver when I’m doing it well. I’m thinking hard. I’m listening hard. I’m concentrating hard. I’m making hard choices. I’m asking myself what to reflect? How to reflect? Simple? Or complex? What question would stimulate a good answer for my client to hear herself saying? Am I hearing change talk? What would be most useful as a next step?
This week, when working with your clients, you’re invited to try “paddling hard” beneath the surface while practicing to keep the waters calm, and smooth, and graceful, and effortless, as you and your client glide across the pond! Over time, as you practice with and hone your key MI skills, your interviews will start to feel smoother in their flow – and you’ll become more able to ‘relax into’.
