Stop using motivational interviewing (MI) for clients in the action stage

IMG_0731.jpeg

Experienced MI practitioners know that MI has little application when theyare working with an individual who is activated, motivated, has a goal and plan to achieve what they set out to do.  Despite MI not being a panacea for use across different motivational states, and having little evidence for its effectiveness with motivated individuals.  I notice the conversation about change becomes a default communication process for quite a few people working with clients.  I asked myself, why do well trained individuals default to focusing on eliciting change talk when the individual has already stated and signaled they have a goal and a plan?

In my supervisory work over the last five years I listened to over 150 recorded intake interviews and follow up coaching sessions.  I listened for the interviewer’s readiness assessment, understanding and direction setting with the client.  As the sessions progressed and the interviewer recognized the person they were working with was ready to act because they had set a goal and created a plan the conversation stalled.  It would then turn into a circular conversation going nowhere as the interviewer explored for other problems.  

I listened as the person being interviewed got quieter and quieter until I heard only the voice of the interviewer.  The person being interviewed withdrew because they were frustrated at having to retread what felt like an old path.  They wanted to move on and get on with things to improve their situation.  When I talked with the interviewer after the interview to learn from their point of view, what they thought went well, what was difficult and how they might have improved things given the same opportunity with the same person.  They often replied they were stuck when they felt there was nothing to fix and the person did not need them.  They felt they had nothing to add because MI did not seem to help them when the moment to coach came about.  Exactly!  MI is not for coaching for action, instruction, teaching and the like.  That is a different communication process assuming roles have shifted. 

The “fixing” mindset of the interviewer seems to be a standard approach at the outset of the work for novice practitioners.  Not surprising as so much of their experience before I work with them is being told what to do.  It comes from a good place and is well intended but is often not always well received or acted on quite in the way the person telling might have liked.  It seems many interviewers focus on fixing a person instead of listening and modifying their approach to the client.  They tell the person they are interviewing what to know and how to act but do not show or coach the person how to implement their improvement.  Telling is cheap and coaching is costly. 

Interviewers are often confused about how to make the shift from a conversation about change to a conversation about capability and commitment in action. Action requires commitment, having a conversation about what it is and how to establish it is critical for the client to take responsibility for their own effort toward their goal.  A person engaging in a behavior must draw on commitmentwhen things get tough, in doing so it helps preventrelapse and keeps an individual on track.  They often feel more powerful over their own change because they are the one who is in charge of their effort and focus.  

When interviewers get stuck I encourage themto be mindful and consider these questions (see below) when they are working with a person and the conversation is shifting from planning and preparation to action in their life.  I invite interviewers to have these questions listed in front of them when the moment arises the shift in readiness and commitment happens in the conversation about change. 

What does the person need to know to make progress?

What skills do they need to be able to use to stay on track?

What do they need to learn today, right now?

What is my role here?

By asking these questions the interviewer can shift from guiding a conversation about change and eliciting the intrinsic resources and motivation for change from a person, to a conversation geared towards coaching for capability and commitment.  The role of the interviewer subtly shifts to becoming an educator and a teacher, which means the interviewer needs to know what their client needs to know and what skills they need to show to able to build confidence and work towards their goal. 

The interviewer need to assess and evaluate the desire and needs of the person and act on them educating and teaching the person properly to build on their commitment to achieve their goal.  The interviewing relationship is still collaborative but it shifted because the interviewer had further value to bring to the conversation by showing their client how their commitment and desire might be channeled for the client’s own progress.  These behaviors are coaching behaviors they are different from MI consistent behaviors. 

The key point to take away from this is that MI is for a conversation about change.  A conversation about how to concentrate effort and intensity into behaviors that achieve client goals is for capability and commitment.  This conversation is characterized by an exchange of knowledge, the teaching of skills and the implementation of self-monitoring tracking progress to goal.  By knowing the difference in the conversations an interviewer might experience a client becoming even more engaged and less frustrated.  The communication process being smoother, the interviewer feelingless stuck and progress to goal more likely to occur sooner rather than later. 

Stop talking about change.  Shift.  Start talking about how to make it happen. 

Register for your upcoming MI Training Workshop on May 18th, 2019 in Chicago.

Find a trainer and MI resources at Motivational Interviewing Network of Trainers

 

 

Why the motivational interviewing training you had is not enough. 4 minute read.

by: Dr. John Coumbe-Lilley

John will be hosting a workshop at Center on May 18th.

Motivational Interviewing (MI) is now a widely shared research supported communication process focused on a particular conversation about change.  Sadly the workshops and training most individuals have taken does not sustain them for long, in fact there’s evidence to suggest most individuals lose competency following training.  The spirit of MI gets watered down, the emphasis on core skills, the ability to accurately assess the stage of readiness and the evocation of change talk lowers.  

MI training is not strong enough alone to override the years of professionals experience and training prior to MI learning.  It’s just not strong enough to win in the helping relationship and individuals slide into their previous approach and add MI to their approach.  This is not the MI way.  The MI way requires the person to tune themselves like a piano, practice like chess player with thought and care, and performance in the moment acting on the values and living the process MI is intended to create with the person seeking help. 

The competent MI practitioner is a facilitator starting in the middle of a continuum which has on one end directing and the other end following.  They focus on eliciting and affirming the client’s intrinsic resources for change. MI using professionals can be found in wide contexts of health, education, business and probation they are often initially we trained in college programs, well instructed and professionally delivered workshops by individual from the Motivational interviewing Network of Trainers (MINT).  

The rate of loss differs for different individuals it depends on the quality, type, frequency and accuracy of feedback about their MI work.  Individuals who are not refreshed by booster training lose direction from the true north of MI and have to course correct.  Using an MI coach in your agency or organization is good practice, and they should be effective at helping you identifying the gaps, help close the gaps and monitor MI practice to assess competency. Having ongoing MI learning in your job, at your workplace as a part of your ongoing professional development is essential to hold the gains made in initial MI training.  Up to 81% of MI trainees who reached proficiency in MI lost their competencies within 16 weeks!

Steven Covey in his classic 7 Habits of Highly Effective People talked about sharpening the saw, taking time to work on yourself, your skills and checking you are moving in your life the way you want to.  Taking further MI training is essential to retain the approach and your skills.  It is not different than other areas of life, you would not tell an athlete they will be okay with their performance and not work on their skills.  You want your dentist to work on their skills and you definitely want your teachers to know what they are doing because you trust to be competent. 

The best way to retain your MI skills is to ensure when you become initially proficient, you already have a plan to maintain your hard earned levels of performance.  Use your initial benchmarked proficiency as your baseline and measure yourself regularly.  Take stock of your performance every 12 weeks, get feedback from a trusted supervisor or peer, identify your gaps, set an MI practice goal and make a plan to achieve it. 

Get passed the fear of taped sessions of your MI practice.  Feedback is to performance improvement what oxygen is to the body.  Send your work to a coach for feedback.  These days where there is an absence of data it is hard to make decisions about where to focus your training dollar investment because you do not know what you should improve.  Submit your tapes for MI coding. 

Bill Millers is quoted as saying ‘real skill and comfort in the method can only be achieved through disciplined practice with feedback from a knowledgeable guide’.  Look in your organization for a guide, assess your organization’s cultural support for ongoing MI training and extended consultation about MI practice.  If these things are sketchy or hit and miss in your organization, determine how important your MI proficiency is to you and your clients and self-design an MI development program. 

If you were trained over a year ago and you have not been refreshed and  benchmarked your MI proficiency recently it might be time for you to take stock, understand your strengths and limits, set a goal and make a plan to regain the hard earned skills you once had. 

Find a trainer at Motivational Interviewing Network of Trainers. 

REGISTER FOR HIS UPCOMING WORKSHOP HERE!



Meet Richla Davis. LPC

Richla joined our team in April! She brings experience, creativity, and more specialization to our team. She is trauma informed and currently splits her time working at Center and for an intensive outpatient treatment center in the North suburbs of Chicago. 

Some things to know about her:

I have a passion for providing safe spaces for queer communities.

I am a yoga enthusiast and plan to become a certified yogi in the fall.

I help clients who suffer from addiction reclaim their identity through a therapeutic healing process and by rebuilding self-compassion.

My training is trauma informed and I incorporate mindful meditations into my sessions to treat anxiety and other distress.

I have completed 4 half marathons, a 10k, and quite a few 5ks!

dog from richla.jpg
IMG_0951.JPG
dog best friends.jpg

Richla also enjoys meeting new dogs! She has a secret hobby of taking pictures of other dogs.  Maybe one day she'll have her very own. ;)

Richla is a graduate of DePaul University with a Master's in Community Counseling. Much of her experience is with trauma survivors, specifically in the LGBTQ community. She also has experience with addiction recovery. She currently works for an organization providing Intensive Outpatient Therapy for eating disorders as well as mood/anxiety disorders.

Richla believes in building a therapeutic relationship with her clients that is genuine and authentic. Her goal is to normalize the human experience which includes pain, suffering and the desire for connection. She help individuals find that connection through self exploration, while also observing their interpersonal relationships and their connection with the world around them. She believes a fulfilling relationship with the self and others can help people maintain emotional well-being and this model benefits those seeking relief from long term emotional distress.

 

 

What is Room To Breathe?

Hi All! We are excited to start working on expanding our services. We would really appreciate a vote for our first go round!

Here is the link, and below is our video. Beautifully curated by Serena!

https://smallbusinessgrant.fedex.com/home/detail/01bac1fe-d2c1-46df-9915-aba264469d11#/gallery/detail/01bac1fe-d2c1-46df-9915-aba264469d11

Introducing Cami, come work with her!

Hello! My name is Cami Beauregard. 

Cami

I am currently pursuing a Masters in Counseling Psychology at Northwestern University. That sounds pretty intimidating when reading it in writing. But, when I step back and take a look inside, I remember -- I did not find my way to Northwestern overnight.  Like many things, it was a custom-made path that had a lot of bump and turns. There were many paths that led me to where I have chosen to be today.  My passions have only begun to be revealed.  I realize now that it was okay to feel a bit helpless along the way. It’s in the wondering that you begin to see a strength, a match, and some growth into an expectation for yourself.  It can become a mission.     

When I was young, I had epilepsy. And for a while, I let the diagnosis become me. Through the practice of meditation, yoga, sleep patterns and support from others, I overcame the affliction. Despite being seizure free for years, the scars still remained. I wanted to “forget” this period in my life; I was plagued by the curiosity of how things may have been different if I never had those seizures. 

At a time when I needed to learn to understand my own mind, the power of these practices allowed me to breakthrough my fears and begin the healing of my personal relationship with myself.

I allowed myself to live in this space of “what ifs” or “if only” until I found yoga and psychotherapy. At a time when I needed to learn to understand my own mind, the power of these practices allowed me to breakthrough my fears and begin the healing of my personal relationship with myself.  I found a little miracle in the reflection of a mirror and on this path I now find myself walking. Becoming a clinical mental health counselor was important to me to help others be inspired and find deeper meaning and enjoyment of their authentic being. In my vocation, I want to help cultivate gratitude, build community, strengthen from the inside and enliven a commitment to personal growth for others just as I was once helped.  

So, why work with me?  Why is my personal experience relevant to you?  Will I be able to help you  and understand the path you are on and the choices you have made to put you there?  Am I  as capable as a licensed counselor to help you? These are all real and valid questions. 

We are all unique and perfect in our OWN way, but we are wired neurologically to question ourselves, to question what we choose to do, and to question others. Decisions are difficult to make, and we become a collection of those choices. In working with me, I want to help you see that you are worthy and capable of love and belonging. You have all the "right" decisions within you, and it takes deep work to discover and trust.

We are wired neurologically to question ourselves, to question what we choose to do, to question others.

Together, we can learn to examine the struggles in decision-making and blossom to positive outcomes. I have a unique personal experience base, and when matched with my professional training, I have the empathy and understanding to help guide you in seeing your truth.  I am excited to build on a valuable foundation to help you on your path to empowerment and achieve the change you are seeking in your life.

I am excited to build on a valuable foundation to help you on your path to empowerment and achieve the change you are seeking in your life.

When you give a girl a pair of cleats....

 

Love this piece, give it a read! : https://www.theodysseyonline.com/when-you-give-girl-pair-of-cleats

I, too, was once this girl. In the beginning, my cleats felt awkward, too small, too big, I didn't move like the "other girls" in their cleats around me. I wasn't "athletic", I didn't feel fast or agile. But I had coaches and I had people who let me figure it out and encouraged me to keep going. There were others who were not so encouraging, but they didn't matter, because the one who believed in me kept buying me cleats and giving me high fives. They came to all my games and gave me a hug after, no matter what the result was. Whether it's cleats, a paintbrush, a pencil, a keyboard, an instrument, or leotard (the list goes on),  it truly is the foundation of character, courage, and relationships that will last forever. 

When you give a girl a pair of cleats, you are giving her a challenge. She is going to grow and learn, and she’s going to want to quit at times, but she is going to look down at her feet and remember why she’s doing this. She’s going to remember her teammates and her coaches and the amount of time she’s poured into this sport, and she’s going to realize that it’s worth it. She’s going to be covered in bruises and her socks are going to stink, and she’s always going to be looking for a sock or needing a hair elastic. She’s going to be tired, and she’s going to get hurt. But those cleats are going to establish lessons that she’s going to remember for the rest of her life, friends that she is going to learn to love, and discipline that she is going to be thankful for. If you’re the girl with the cleats, soak it in. Love the long practices and the exhaustion and the sound of the whistle that starts the game. If you’re the girl without the cleats, go get some. Try something new. Take the risk. Sign up for the team, the musical, the club. You will regret it if you don’t. Even if you fail, few things can teach you the lessons that those cleats will.

Our Book List

Self Help books can be difficult to navigate. Sometimes they repeat themselves, or after we read them we don't really feel like we have gained any super helpful tools. And then sometimes, it just seems like a daunting task to have to face our vulnerabilities in a book... 

SO! Here is our list of favorite books. The books that actually make you feel GOOD, and NORMAL, and like there is a way to apply change, mental shifts, increase happiness, and feel like you can be "your best self". There certainly isn't a "one size fits all" to being happy, rich, less anxious, BUT these are great sources to start making the shift!

The Gifts of Imperfection by Brene Brown (ALL of her books are great!)

The Four Agreements by Don Miguel Ruiz

The Happiness Trap by Russ Harris

Mindfulness for beginners by Jon Kabat-Zinn

How to Wake Up by Toni Bernhard

How to Live Well with Chronic Pain and Illness by Toni Bernhard

Love Warrior by Glennon Doyle Melton

We will continue to update this list!

 

Beginners Philosophy!

This weekend, Serena will be offering a workshop for all at Room to Breathe. She will be teaching how Yoga can be used for all - shapes, sizes, backgrounds, beliefs, goals- and how you to wrap your head around, what is, the most ancient and effective practice for healing and development. 

Beginner’s Philosophy:
Working With the Body To Clarify the Mind


with Serena Brommel
Saturday, January 14, 1pm to 4pm
$35

How do the physical practices of yoga postures and breathing techniques relate to the deeper work of resolving emotions and inducing mental clarity? This workshop aims to demonstrate the clear linkages between the primary tools of breath-centric yoga and the foundations of meditation.

Join Serena for an exploration of techniques and a discussion of the theories that drive them. Develop a deeper understanding of what you’re doing on the mat that will help enrich your personal practice and build momentum for deeper, more effective yoga.

Through our practice and conversation we will:
+ Learn how breath-centric yoga develops concentration
+ Explore energy from a yogic perspective
+ Look for stillness through opposing movement
+ Conceive the mind as a field of movement that we can actively influence
+ Discuss common misconceptions that may impede our growth

This is not an advanced practice; all techniques we explore will be accessible to newer students. A little prior yoga experience will be helpful, but it is not required. Wear comfortable clothing for gentle movement, and a pad and pen in case you want to take notes.

From Serena:

One of the cornerstone ideas I'll present is yoga as a systematic process for growth and transformation. This, to me, is the essence of yogic philosophy. Yogic philosophy, including what's presented in the Yoga Sutras, provides us with the roadmap for HOW to make this work, practically speaking.

Here's a great quote from Gary that we'll use as a jumping off point:

“Life is inherently stressful, and the effects of that stress cause suffering. The ancient yogis understood this very well. Although it’s hard to imagine what daily life was like for them thousands of years ago, what is clear is that they created and handed down a systematic approach for overcoming the effects of stress on the mind and body: [this is] yoga.”
– Gary Kraftsow, founder of the American Viniyoga Institute