An advanced practice skill in MI involves learning to listen for how you can “hook” what the client is saying to the “north star” (intended direction) of your conversation. How can you connect what the client has said to the focus issue of the discussion? Learning to “hook” your reflections to the topic at hand not only helps you keep the conversation moving in the right direction but can also save a lot of time and prevent tangents.
Paul Burke Training Group offers a range of motivational interview training designed to enhance motivational interviewing skills for healthcare professionals, trainers, and other professionals interested in developing advanced practice skills in motivational interviewing (MI).
Thoughts on Improved Practice (TIP) #1515
This article is designed as an extension of motivational interviewing workshops, aiming to deepen your engagement and skills in this conversational approach.
Try this exercise derived from common scenarios in motivational interviewing courses. It showcases how to construct ‘hooks’ for more targeted conversations.
1
TARGET: Follow-through on conditions of probation order:
My Probation Officer says that if I don’t finish that stupid “Emotional Self-Regulation” workshop before the end of the month, I will have to repeat all three sessions all over again. That is just ridiculous. I did two of the three, didn’t I? Why should I have to retake those first two? I get so worked up over crap like that. I mean, what’s funny about it is that they were talking about that very thing in session two. They said sometimes, when people get so worked up, they start running on adrenaline, not brain power! It’s when your emotions get so loud they don’t leave any room for your thoughts that the trouble begins. It’s so boring, though! It’s way too much information all at once. I don’t know how my emotions get so powerful anyway. I’m not an emotional person, really. I just get all fired up at times.
In this scenario, often brought up in motivational interviewing for professionals, the client expresses frustration over completing a required “Emotional Self-Regulation” workshop, a common target in our motivational interviewing workshops. The client has attended two sessions but is resistant to completing the course, a typical challenge addressed in motivational interviewing skills development.
1A
Response Option 1
You really hate that Emotional Self-Regulation workshop, but you know you either follow the order or pay the price.
1B
Response Option 2
You don’t see any reason that you should have to take the first two sessions a second time. It’s almost like you need an Emotional Self-Regulation Workshop just to deal with your reaction to having to go to the workshop. This perspective is something we tackle in motivational interviewing courses, teaching practitioners how to navigate client resistance by linking their efforts directly to their probationary goals and emphasizing the value of completing such workshops not just as a legal requirement but as a step towards personal growth and emotional regulation—a key aspect in motivational interviewing for healthcare.
1C
Response Option 3
You think this is one of those situations they talked about at the workshop. Your emotions are getting so loud that your thoughts can’t be heard. The adrenaline has you fired up, and you know your thoughts need a darned good listen, too! What would they say about finishing the workshop if you were listening to your thoughts?
2
TARGET: Improved self-monitoring of blood pressure.
My Dad had a heart attack when he was only 53. I was 13. It scared us all pretty badly. Especially him. The doctor said it was only luck that saved him. We lived 3 minutes from the ambulance station at the time. You’d think that would be enough to make me want to take my blood pressure readings the way the doctor wants me to. And yet, I don’t. I mean, here I am at 49, and sometimes I think, “what am I doing?” My cholesterol is borderline, but my blood pressure just goes nuts sometimes. You’d think I’d learn. Even my daughter begs me to keep my blood pressure log. She says, “why don’t you just start taking it three times a day, with your meals. Then you’d remember to do it.” It’s like I’m playing the odds with my life, for Pete’s sake. But then there are times when I can play 18 holes of golf and not even blink. I feel healthy as an ox when I’m on the course. I love it. I guess you’d say I am a bit of a fanatic about it. I shot five under last week, and I almost always get a Birdie on the 5th and the 8th. I bought a new nine-iron last week. Titanium head. Best $500 I have ever spent.
This is a common scenario in motivational interviewing workshops, where clients recognize the importance of health but need help to take consistent action.
2A
Response Option 1
You’re saying that you know your Dad’s heart attack should be a reminder that life is short if you don’t take care of yourself.
2B
Response Option 2
You’re looking for a way to get the same focus on tracking your blood pressure scores as you do for your golf score. Golf is important to you, so you keep records to track your progress while experimenting with ways to improve. You’ve got some good evidence now, in black and white, about how that new nine iron has impacted your overall performance. If you could start to think about your blood pressure scores and your experiments with how to improve them in the same way that you do with your golf game and other things that are equally important to you, you think you might become more committed. In motivational interviewing courses, we emphasize finding personal motivators to encourage healthier behaviours. So, what do you do to remind yourself to record your golf score after each hole?
2C
Response Option 3
You’re playing the odds with your life. It worries you because you know that regulating blood pressure is no game—at least not in the same way that golf is. You invest a lot of time in improving your golf game, yet you can’t find the self-discipline to find ways to improve your hypertension. I bet you would find that keeping a blood pressure journal would be a great “9 Iron” for your health.
3
TARGET: School Reinstatement.
Doing online homework assignments suck. Ever since I got kicked out of school, I have to do all my assignments online. It’s boring. It’s a lot of keyboarding. My keyboarding skills kind of suck. I always hit that tab key thing, and then my spacing gets all wonky. I was thinking maybe I should just pack it in for now, and then maybe next year, when I am back in school, I can do the assignments the normal way. You know – by just doing the book report presentations instead. I am way better at presentations anyway. The only problem is then I have to repeat all of the English Concepts section all over again. That would suck. It would be nice to have it over with once and for all. That class sucks. It is just stupid to study all these old poet guys and try to figure out what they mean. If I never read any more crap by an old poet, it will suit me fine. Why can’t they just make you read poetry from a guy like DJ Funky Fred? Now, there’s a real poet. He said he’ll never get married because rap is his only true love. Wild! He said the only thing that he can’t make a rhyme for is the word “orange”. None of them old poet guys could make a rhyme for “orange”, either, I bet. It’s just a hard word to rhyme, that’s all.
The challenge of school reinstatement presents a unique opportunity for motivational interviewing, particularly those involved in motivational interviewing workshops aimed at youth. The client’s reluctance to complete online homework assignments due to perceived boredom and difficulty with keyboarding skills reflects a common barrier to educational achievement discussed in motivational interviewing courses.
3A
Response Option 1
You’re trying to decide whether to pack in the English Concepts class for this year or not. There are some advantages to getting it over with online, but you must deal with all the keyboarding hassles. On the other hand, having English Concepts out of the way by the time you return to school next fall would be nice. Which way are you leaning? This scenario is typical of what we explore in motivational interviewing for trainers, which focuses on encouraging clients to weigh their options and consider the long-term benefits of completing their assignments now rather than delaying and facing repeat courses.
3B
Response Option 2
There be poets that are old … and poets who are dead.
There be poets that are boring … but not good ol’ Funky Fred!
He’s a modern-day master – and he’s a major funky scribe.
He tells it like it is – and he doesn’t have a bride.
He can rhyme…all the time… which is no crime… ‘cause he’s so fine…All his
poems really shine!
Fred be phat.
Fred be kewl.
But Funky Fred can’t get you back in school!
Fred be nimble – and Fred be quick,
but Fred don’t make your Tab Key stick!
You need your school … and you need that class …
so open up your browser baby – …or you’ll just be an ass!
3C
Response Option 3
On the “suck-o-meter” of life, your keyboarding skills get about a 5. English Concepts class rates suck way beyond that, though. Suck-o-meter-wise, English Concepts gets a solid 8, or maybe even a 10. You really don’t want to repeat that course all over again, partly because you’ve already had to endure a lot of the reading you have to do. If you could just figure out a way to make that Tab Key a little less of a pain, you’d be able to “rap” this thing up pretty quickly, if you’ll pardon the pun! If you did decide to try to get your keyboarding skills a bit lower on the old “suck-o-meter”, what kinds of things could you try to get this course out of the way so you can start fresh next fall without having to go through this crap all over again? This humorous approach can be effective in motivational interviewing for healthcare, where engaging clients on their terms can lead to breakthroughs in commitment. By acknowledging the client’s frustration lightheartedly, the interviewer can foster a more open dialogue about overcoming obstacles to school reinstatement.
4
Target: Adherence with medication prescription
Yah. I hate those pills. Every time I take them, they remind me that I am not a “normie”. It’s like every day when I wake up, I have to pop a pill, and all it does is say to me “yep – you’re a mental case alright”. And it just starts me off thinking that way for the whole day. Why can’t I just be normal? Normal people are lucky. They have a life. They don’t have to remind themselves every single morning that “there is something wrong with me”. They just get up in the morning and brush their teeth, and then they start their day by focusing on what they want to do. They just have a regular routine. Normies are lucky because they don’t have mental illness stuff on their mind all day long. Like – “did I take my pills this morning?” Like – “I wonder if I’m going to have an episode today just because I forgot?” A lot of people just take being able to live in a routine for granted. They don’t have constant reminders that they have problems.
This highlights the challenges faced by professionals employing motivational interviewing for healthcare, where the goal is to foster a more positive association with necessary health actions.
4A
Response Option 1
You’re aware that there is a difference between you and people who don’t have mental illness. Other people don’t have as much hassle in their daily routine because they don’t have to take pills every day and be reminded of their illness. You worry about the consequences of not taking your pills each time you forget to take them, but at the same time, you hate them. So what do you think you’ll do here?
4B
Response Option 2
Your saying that If you could have a routine every morning, just like most people do with brushing their teeth, where taking your pills was just a simple part of your routine, like putting the toothpaste on the brush, you’d be free to just focus on the rest of your day because the pills would just be a small part of your routine. If taking your pills became a habit for you, like brushing their teeth is for others, you wouldn’t have to worry about whether you were going to have an episode or not. So, I wonder what kinds of things you might be willing to experiment with a little to try to establish a routine around the pills?
4C
Response Option 3
The number one reason that people end up back in hospital after their diagnosis is not taking their pills in a routine way. “Normies”, as you call them, don’t have to worry about taking their pills. That’s true. But that’s life. They don’t have to worry about it because they don’t need pills. You do. I’m hearing you say that. This fact is often discussed in motivational interviewing for trainers, highlighting the importance of establishing a reliable routine for medication adherence.