Why Is It So Difficult To Learn MI?
In some respects this is something of a “trick question”!
The fact is, in many respects MI skills are not so difficult to acquire. What tends to make a lot of learners express surprise at the seeming complexity of the skillful practice of MI has more to do with “unlearning things” than it does with learning! In the past 12 years, our little training group has conducted workshops for more than 7000 people. We’ve had lots of opportunity to hear from participants when they return after Foundations training for more advanced workshops. Here is a general overview of the kinds of things that are commonly expressed as people reflect on their own internal process as they experiment with MI practices:
Challenges that confront people when they’re trying to learn MI seem to fall into two general categories of:
1) Internal Challenges and 2) Organizational Challenges
1. Internal, or Personal Challenges
- My experience with other clients gets in the way! It’s harder than I thought to learn how to stay with the logic of my client in the early stages, when I know from previous client work or from my professional training what this new client needs to do to address their problem. (a potential “Expertise Trap”)
- I seem to always want to start assessing (even if somewhat secretly) before I’ve fully engaged with the client’s point of view (a possible “Assessment Trap”)
- It’s hard for me to listen deeply to my client because I seem to have a tendency to listen to my own thoughts about what my client is saying – more than I am listening to my client ( a possible “Expertise Trap”)
- I have a tendency to want to jump into “therapy” or some other form of “active helping” even before I’ve helped the client to want any help! (Helping people who aren’t ready for my help is not very productive, but I fall into that trap without even recognizing it. (A possible “Premature Fix-It Trap” – also sometimes known as “The Righting Reflex)
- I sometimes find myself thinking more about what “label” best describes my client’s problem, rather than attending to what the client is saying about the problem, or to the labels or descriptions the client uses to explain their understanding of the situation (a potential “Labeling Trap”)
- I am so used to asking questions that it is very difficult for me to feel natural about the reflective listening work that fuels so much of the change coming out of MI conversations (a possible “Question-Answer Trap” or the “Assessment Trap”)
- I haven’t had enough experience with MI to relax with it and trust that it will work even without me “causing” the client to change. My confidence is a bit low because I haven’t had a lot of experience with seeing it work – so I find myself trying to “make things happen” rather than facilitating a more collaborative approach.
- I know better than to do this, but I can’t help but practice MI as a “technique”. And, when I do that, I start to see it as something of a “trick” – as a way of secretly manipulating the client to take a particular action. I end up kind of “persuading” instead of cultivating motivation (the “Technique Trap”)
- I find it hard to learn MI because it involves much more than “technique”. It’s a way of structuring a conversation and developing a unique type of helping relationship that involves more than the usual “clinical savvy”. It’s like learning to move to the music when I’m more used to watching where I’m supposed to put my feet.
2. Organizational Challenges
- My organization doesn’t provide any means of getting any supervision or coaching on my MI practices after the workshop.
- Our organization is wanting to gradually shift toward a more MI- adherent paradigm within our overall approach to client care. But – we have no implementation or integration plan within the organization for how that is going to happen. It seems like there’s a sense that giving everyone an MI workshop or two will suffice. We need an “implemegration plan”!
- I understand that to actually acquire skill in MI I need to “practice, practice, practice” – but get no feedback on my practice – so I have no way of knowing where I’m doing it right – and not-so-right!
- Our management group doesn’t seem to understand what MI is. I think they see it as an “encouragement approach” or as a way of “pumping them up” or getting them enthused about change. When I explain that there are important systems issues that impact on whether MI will have any value, or not, they don’t seem to understand it at that level.
- Very few of my co-workers have had any training in MI. It makes it hard for me to do the post-workshop learning and practice that’s required when I can’t discuss MI work with others.
- My supervisor understands MI as a “technique” and doesn’t seem to be aware of MI training research which shows that more than workshop exposure training is required to master skill in this way of getting clients ready for change.