Step Away from the Questions ...

and you actually might be able to do something for your client

Last week (yes I have gotten a bit behind with the posts) the staff at Health Care for the Homeless and Primary Health Care attended a three day Motivational Interview (MI) training.  At the beginning the lecturer stressed that the concept was easy to learn, but in order to get any good at MI we would have to practice A LOT.  As a result, the next three days were filled with real play and was probably the best free therapy we could have gotten.  Real play, not role playing, was used because many times people strive for the Academy Award performance and things can get out of control quickly.  Instead, we were asked to take from our own experiences which makes things a bit more realistic and applicable to the concept. 

In the broadest sense, MI is "a collaborative, person centered, evidence based, guiding method of communication for enhancing and strengthening intrinsic motivation for change."  When used, even among the more unskilled staff, it has been shown to double client/patient outcomes. 

One important note is that this is NOT a theory, but a series of techniques whose delivery will help facilitate communication.  Many of the techniques (empathy, sympathy, reflection, open ended questions) are skills that we all have.  MI merely allows us to use its spirit to create a dance of give and take through a series of simple and complex reflections, not through a series of directed questions.  The spirit of MI also emphasizes that we get away from person first language which I mentioned a few days ago. 

The MI spirit focuses on three main components:

1. Collaboration
2. Evocation i.e. listening and eliciting
3. Autonomy i.e. the ability of the client

As I mentioned before, this technique moves away from drilling (notice the language) the client with questions to dig (again, language) for information.  During an intake clients are asked an average of 148 questions.  With this technique there is a shift towards using both simple and complex reflections, with a few open questions sprinkled in along the way.  One of the other key components is that you are not supposed to express your opinion/a time when you were in a similar situation and are not supposed to give any unsolicited advice. 

Many of you who have been following my journey have somehow been involved in the field of human services through jobs/internships, volunteering, listening to me stand on my soapbox, ect.  As a result you all know that this field is all about empowering clients to make their own decisions and choose what is best for them.  Unfortunately when we ask clients questions their empowerment is taken away.  MI, however, allows people to reflect on what they want to work on which increases their empowerment. 

Workers in the human services field have an innate need to fix ... to fix the problem, to fix the person, to fix the environment.  Probably the best thing that I got out of this was that we are responsible for the intervention, NOT the outcome. 

Over all the three day training was extremely helpful and eye opening.  Much of what we covered pushed against and challenged me to rethink everything I have learned over the last few weeks. 

My major take aways:

1.      The client already has the answers

2.      We need to create a heightened ambivalence

3.      People are willing to do the wrong thing to maintain power in a relationship

4.      MI is a dancing relationship, not a linear one

While the real playing helped me to begin to understand the spirit of MI and ways I can incorporate it, I am still holding out until I can see its application in my clinics.  Many people who worked primarily in a clinical setting were unsure if they would be able to incorporate it into their programs.  The jury is still out for me, but I will keep you updated with what I find out in the field.