There isn’t much simple about Motivational Interviewing. Yes, there are ‘simple’ reflections, but, as Bill Miller points out, learning to form them isn’t simple. Throw in using summary and double-sided reflections, mastering reflective listening, using open-ended questions, being continually aware of engagement with the client, listening for change talk, understanding ambivalence… well it’s complicated.
If it’s complicated for individuals to learn these skills how much more challenging is it for an agency to take on the task of training their staff in MI? And to make it even tougher here’s what Miller and Rollnick have to say about learning MI in the third edition of their great book:
“One thing that is relatively clear at this point is that self-study or attending a single workshop is unlikely to improve competence… Reading or a single workshop can increase knowledge of MI, but there is little reason to believe that it will instill skill.
Worse, we know from firsthand experience that if we imply that participants will become skillful in MI through attending our workshop, they are likely to believe mistakenly that they have learned it.
In a first evaluation of our own 2-day training workshop, participants showed very little improvement in skills, certainly not enough to make any difference in how their clients responded, but we did manage to significantly decrease their interest in learning more about MI. Why? It was not because they didn’t like MI or thought it was ineffective. It was because they believed they had already learned it.”
So what’s an agency to do? M&R write “Our recommendation, then, is not more workshops but ongoing coaching with feedback based on observed practice…”
ACT teams provide a perfect forum for ongoing MI skill development; a group of clinicians who are together daily, working with common clients. Then there’s the secret ingredient for success – a team leader who recognizes and embraces the importance of making MI skill development not as something special, but rather as a normal expectation of all staff, like charting and being at morning meeting.
There is a second ingredient that I believe can make this task even more successful – that the team’s psychiatrist be involved. The psychiatrist practising (and teaching) MI can really help teams take it to another level.
If you’re unconvinced as to the value of training ACT staff in MI read Manthey, Blajeski & Monroe-DeVita’s 2012 paper Motivational Interviewing and Assertive Community Treatment: A Case for Training ACT Teams.
BTW Professors Miller and Moyer are doing a workshop in Odense, Denmark in early June. So do attend a workshop, just remember, afterwards repeat to yourself – “I learned so little, must learn more, must get feedback and practice, practice, practice”…(and repeat again and again and again)
You can find a wealth of info at www.motivationalinterviewing.org. Check it out.