Twelve Takeaways from a Recent MI Training

I recently spent three days assisting a motivational interviewing training in San Francisco with the one and only Steve Berg-Smith. If you ever have a chance to attend a training with this gem of a human being, I highly recommend it! I thought I’d share some of my top takeaways with you…

1. Motivational interviewing (MI) makes known what we already know—the things that have been taught out of us. When I introduce myself at the beginning of a training I often say “I was trained to get in the way of people’s change process.” This is true for many of us.

2. Our job isn’t to get other people to change. Our job is to invite a person to think and talk about a topic they’ve agreed on. We are opening the window and trying not to cause it to shut.

3. Motivational interviewing is grounded in established theoretical models, is evidence-based, and may be the most significant advance in counseling over the last 25 years.

4. MI helps people make well thought out, committed decisions about change and is often thought of as “The Prep Step before Action”. While many practitioners are very skilled at painting, few are skilled at the prep step of scraping. Most of MI is scraping. Long-term change is supported when you go about it incrementally, step by step.

5. Are you listening with your eyes, your eyes, your heart? Do you recognize that your body is in the room? Seventy percent of communication is non-verbal.

6. One word that captures what doesn’t work is fixing. Folks don’t get good at motivational interviewing until they get good at sitting on their hands. To develop proficiency, we have to sidestep a reflex that is very strong: the need to fix things. This strong instinct is sometimes called the “reflex of the heart” because it comes from a well-meaning place. Unfortunately, when the righting reflex is running the show, we are likely doing more harm than good. Behavior change does not respond to an authoritarian voice.

7. Most helping professionals ask closed questions. Open questions increase the odds of the person sharing more with you—they have a bigger yield.

8. MI is a radically different way of thinking and responding. You are not proficient in motivational interviewing until you’ve mastered the skill of reflective listening.

9. Style is everything! Playing the notes does not mean you are playing the music. You can ask open-ended questions and reflect often and it still doesn’t mean you are competent in motivational interviewing. Your presence—how you hold space with people who are thinking about change—is the most motivating and helpful thing about you. The metaphor of dancing vs. wrestling is often used to describe the spirit of MI.

10. There isn’t a correlation between what people know and what they do. Most health care providers are trained to believe that knowledge is what changes behavior. If this were true, we’d live in a pretty amazing world.

11. Give clients the good lines! People are influenced by what they hear themselves say, not by what others say to them. If you are the only one talking about the reasons change is needed, chances are your clients will only give voice to the reasons not to change. Miller and Rollnick (2013) say, “MI is a particular way of having a conversation about change so that it is the client rather than the clinician who voices the arguments for change.” Reflect the good stuff back to your clients.

12. People learn when they have significant time to reflect. At the end of your visits, ask clients to share what really stands out to them from your conversation. Write what they say down and circle back to it at your next visit.

So there you have it. I’m wondering what stands out to you from the list of “top takeaways” I just shared?

What might you want to focus on in the coming weeks?

Warm regards,
Dana