Paul Burke Training Group
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Beyond training: Looking at learning MI in a whole new light!
Developing Competence in MI: Part 1
One of the more wonderful gifts that the Universe has provided me of late was the opportunity to see Bette Midler, aka “The Divine Miss M” in concert in Vancouver. Seeing and hearing her perform 50 years’ worth of her amazing music was a thrill, a privilege, and an awe-inspiring spectacle – the likes of which I have experienced only a few times in my life.
For me, witnessing the polish and the perfection that radiate from people like Bette Midler, Elton John, Tina Turner, Mick Jagger and other masters of their craft, evokes a very deep sense of respect for the “thing” that they bring to their work.
When I got back to my hotel room after the show, I reflected a little on what that “thing” is all about. I realized how impactful it is to watch someone who is able to “dance in her competence” the way Bette Midler does.
Excellent MI practitioners are like that too. I guess it’s no coincidence that “MI” exists at the very beginning of “MI-dler!”
I marvel at people who take the time, to work so hard, to make it all look so effortless! Seeing Ms. Midler in concert got me to thinking about times when I’ve been lucky enough to take MI training from one of the most talented, skillful, knowledgeable, and practiced MI trainers on the planet. Like the Divine Miss Midler, Dr. Teresa (Terri) Moyers (MI instructor and Assistant. Prof of Psychology at University of New Mexico) inspires awe when she practices, demonstrates and teaches MI.
She too is a woman who is able to dance with her competence – with all the skills and concepts and the foundational spirit factors that are the basis of MI. Seeing her at work always inspires me to keep practicing, and to keep learning. Her work is proof that mastery comes from practice, and sticking with it until it all becomes part of our second nature. Developing strong motivational interviewing skills is a process that requires ongoing effort and refinement. (Dr. Moyers is the woman who interviews the “rounder” (pink shirted cowboy trucker guy who has a problem with his drinking) on the DVD sample that I often show in the intro workshop – one of the best MI examples I have ever seen. If you ever get a chance to participate in a motivational interviewing course with Dr. Moyers – do it! She’s Rolls Royce.)
So – this week, I invite you to so some thinking about how you can get the Moyers and Midler phenomenon going in your own practice. Skill at the level of those who have mastered their craft does not happen by natural talent alone. It comes from conscientious, dedicated, hard work. It comes from practice-til-perfect, and then more practice, and feedback on practice, and then more practice again!
I’ll be writing several T.I.P.s this year on how to move to competence in your practice of MI. For this initial installment, I’ll begin with the need to develop skill in “Cultivating Change Talk” (CCT). From the new MITI 4.2 coding manual (Moyers, T., Manuel, J., Ernst, D., 2015, available online at casaa.unm.edu/download/miti4_2.pdf) I’ve copied and reproduced here the criteria that are used to determine overall competence in evoking, encouraging and embellishing change talk. Your “CCT Score” is a fundamental marker of your capacity to “dance in your competence” with MI skills. I encourage you to review it here, and give a little attention this week to working on this aspect of MI skill. If you can get to the point where you have reason to believe that you are a Moyers or a Midler with this component of the work, – then it will be time to move on to add strength to your “SST” score (Softening Sustain Talk).
Cultivating Change Talk
Low
High
1
2
3
4
5
Clinician shows no explicit attention to, or preference for, the client’s language in favor of changing
Clinician sporadically attends to client language in favor of change – frequently misses opportunities to encourage change talk
Clinician often attends to the client’s language in favor 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 favor of change
This scale is intended to measure the extent to which the clinician actively encourages the client’s own language in favor 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.
Verbal Anchors
- Clinician shows no explicit attention to, or preference for, the client’s language in favor of changing.
Examples:
- Asks only for a history of the problem
- Structures the conversation to focus only on the problems the client is experiencing
- Shows no interest or concern for client values, strengths, hopes or past successes
- Provides education as only interaction with the client
- Supplies reasons for change rather than encouraging them from the client
- Ignores change talk when it is offered
2. Clinician sporadically attends to client language in favor of change – frequently misses opportunities to encourage change talk.
Examples:
- Superficial attention to client language about the change goal
- Fails to ask about potential benefits of change
- Lack of curiosity or minimal interest in client’s values, strengths and past successes
3. Clinician often attends to the client’s language in favor of change, but misses some opportunities to encourage change talk.
Examples:
- Misses opportunities to encourage client language in favor of change
- May give equal time and attention to sustain talk and change talk, for example using decisional balance after momentum for change is emerging
4. Clinician consistently attends to the client’s language about change and makes efforts to encourage it.
Examples:
- More often than not, acknowledges client reasons for change and explores when they are offered
- Often responds to change talk with reflections that do not encourage deeper exploration from the client
- Expresses curiosity when clients offer change talk
- May explore client’s values, strengths, hopes and past successes related to target goal
5. Clinician shows a marked and consistent effort to increase the depth, strength, or momentum of the client’s language in favor of change.
Developing strong motivational interviewing tips and techniques is a journey. Over time, with persistence and dedication, we can all learn to refine our approach and improve our ability to guide meaningful change conversations. See you next week!
Examples:
- Over a series of exchanges, the clinician shapes the client’s language in favor of change
- Uses structured therapeutic tasks as a way of eliciting and reinforcing change talk
- Does not usually miss opportunities to explore more deeply when client offers change talk
- Strategically elicits change talk and consistently responds to it when offered
- Rarely misses opportunities to build momentum of change talk See you next week!
Paul Burke Training & Consulting Group (www.paulburketraining.com)