stephenrollnick

Dear Colin,

I doubt you could dominate this forum, so relevant are your needs and concerns to so many others.

Do you do any direct client-contact work yourself?

My every instinct is for you to be discerning.  There are good learning opportunities out there, and some very poorly-conceived training efforts.  You can imagine how a less discerning MI trainer might see on-line training as an easy commercial operation. Yet some of them might be quite good.

And there might be local MI trainers in your area who are very good.  If you tell me where you live I dont mind writing back-channel to you with some information about people I respect.  I cant do this in a public forum.

Think about a rank order of learning possibilities for you.  What would your top 2-3 achievable aims be, given your location and budget?

get back to us here anytime.

Steve

Wow, I hate to dominate this discussion forum by asking two questions in a row, however:

I've read that Auburn University (in Alabama, US) has a Motivational Interviewing Training Institute and was wondering if anyone reading this has been through their program.  If so, would you mind sharing your thoughts?

Also, it appears that there is now on-line training in MI is now available.  Is MI something that can be learned over the phone (I'm open to that idea - I'm genuinely interested in what folks think about this notion).

These questions are prompted by my desire to undergo high-quality training in MI, but having to do so on a very limited budget (i.e., wishing to keep travel expenses to a minium).  I believe I've gotten everything I'm going to get out of reading books and journal articles --- I'm ready to engage in real training at this point.

Best to all,

Collin

Dr. Rollnick

Yes, that certainly does help.   I was certain the diagram was from one of your articles or books but I simply could not locate it.  It helps to have the proper reference.

As I mentioned in my initial post, I find your diagram to be a very elegant way to visually conveying these crucial points.

Thank you so much!

colin

Dear Colin,

Yes, the diagram comes from Health Behaviour Change: A Guide for Practitioners (1999) by Rollnick, Mason & Butler.  As far as I can remember, I designed it to show the links between these concepts, as a rough approximation and guide to understanding motivation. The logic was that high importance and confidence would approach readiness and that together, if positive, these three amounted to high motivation.

I must confess that this simple model was an attempt to help clinicians to understand and work with motivation in a more constructive way. For serious academics in the behaviour change field it probably lacks a few concepts, like intention. Although i wouldnt take it too seriously as a guide to behaviour change research, it does cross my mind that were importance and confidence to be measured reliably, I'd put money on high scores being correlated with a measure of readiness and indeed, subsequent behaviour change.

The context for this work was to avoid a reliance on readiness to change (or stages of change) as the a guideline for clinical work. Why? Because when a colleague and I interviewed some smokers we found that people who told us that they were midway along a readiness to change continuum (about smoking cessation) were very very different to one another. Some were high on confidence, and low on importance, while others revealed the opposite pattern. Their needs were quite different.

The concepts of importance and confidence were distilled from Bandura's twin concepts of outcome expectation (importance) and efficacy expectation (confidence). My friend and colleague Vaughn Keller came up with a very similar distinction, between "conviction" and  "confidence" at about the same time.  At one point we each thought that the other had "stolen" out good ideas!  Then we realised it was a coincidence.

One thing that pleases me is that simple questions derived from these two concepts have roved useful in clinical practice, or so people tell me. They are simply aids to good practice....

Hope this helps?

Steve

P.S.  Dr. Rollnick - it this is NOT your depiction of the relationship between importance and confidence for change, I would LOVE to hear your thoughts on it.

One question I've heard from students, for example, is:  In that model, which line best depicts what the TYPICAL layperson would describe as "motivation"?  

(I'm certain it's not the horizontal axis, but arguements could be made for either of the other two)

Dr. Rollnick and all other readers

I am trying to locate the original article that graphically depicts Readiness for change as in relation to an individual's percieved Importance and Confidence for change.

In case the graphic below does not come through:  confidence is depicted on the horizontal axis and importance on the vertical. 

I believe I first came across this concept in an article or pehaps a book by Dr. Rollnick, but I simply can't locate the original source.

I fell it is an elegant model and that someone deserves proper credit.

Any suggestions on who deserves credit for this and/or which article one should properly cite??

Colin

Brad, i forgot to mention, there is an exchange on accreditation in the list of postings in this forum...... see below, Steve

Dear Oscar,

I produced quite a long list of people who responded to the email i sent to the MINT trainers' discussion group and I will send this to you now.  Good luck, and let us know in this forum how you are getting on.

Kind regards

Steve

Dear Brad,

Apologies for the delay in getting back to you.

Practitioner certification in MI has grown exponentially in just the last few years.  There is no public or private record of who certifies people. The organization that unites MI trainers, MINT (see www.motivationalinterview.org) does not hold a record, let alone endorse any particular system of certification.  This state of affairs is unfortunate, we saw it coming years ago, but the MINT organisation is run by volunteers and has not been able to get on top of this issue before people started setting up systems of certification.

If you imagine a continuum from quick access certification to a much more thorough examination, one could place the systems out there on this line. The most thorough system is the only one I have been connected to, as an unpaid advisor, and this is MI-Campus (see www.mi-campus.com). It has just been launched. Check it out and see what suits you. I dont want to advise you which one to go for, only to inform you of what's out there.

if anyone knows the details of other systems, feel free to post them up here, not as an advertising device, but as a genuine description of exactly what the certification entails.

Get back to us here Brad if you have any further queries.  In due course, for better or worse (and its probably both!), being certified will have value - exactly to whom, why and with what effect is for another discussion, not an easy one to be clear about.

kind regards,

Steve

I did some digging about this, and a kind colleague explained what had happened.  It was as I suspected. Some parents, not all, got angry at the letter and called to complain.  Among their concerns were what to say to their obese children?  There was an obvious concern about the child being labelled, and so on.

I still dont think that these people who receive the calls should receive training.  The problem must be with an approach to health promotion that completely bypasses the need for engagement of parents and their kids (see posting on new framework for MI), one that also assumes that all people need is fearful information and they will change the behaviour of their children.  I appreciate that there are challenges in dealing with obesity, and that focusing on individuals has some value.  However, I just dont think that an impersonal technological fix (a letter) does health promotion any good.

Steve

I've come across a few crazy misunderstandings about MI.

Just this week I came across a potential winner. It went like this, and I quote:

"Can you do half day training for pct's (Primary Care Trusts) on how to handle angry calls from parents who get a letter from the dh (Department of Health) informing them that their child is obese? Rolling with resistance skills, over the phone?"

This is absurd.  Its origins, I imagine, are fascinating.  An organisation decides that "something must be done via a letter about a "public health problem" - childhood obesity.  I cant quite believe it, but it seems like this is the UK Department of Health? So they locate obese children, and then decide that the parents should be sent a letter?  Anyone with any common sense, or anyone who works in primary care, knows this is a sensitive subject for parents, but no, its assumed that a letter could be part of "health promotion"?   Then when the staff at the local primary care office get angry calls, someone decides that these staff need skill training in handling angry parents?

I am tempted to go in and offer to do the training just to experience quite how any organisation can get health promotion so badly wrong.

Steve

Hi all!

Wondering if there are updates re: being certified in MI.  Last year I attended a web-cast in which Dr. Rollnick referred to this.  I am very interested!  FAQ states "Not yet, but very soon! I am not in a position to reveal details, but a small team of dedicated MI trainers are putting a certification process together, in which the submission of audiotapes will be rated using a reliable and valid assessment procedure. Details will be posted on this and other sites as soon as this process begins. It should be up and running by Summer 2010."  Any updates?
Thanks,
Brad

Dear Steve: my email address is oscarmolteni@ciudad.com.ar. I have already contacted Dr. Janhe, Dr Cantillanos de Chile - near here! - and Dr Balan who comes to Argentina frequently. If more coaches on your list I will contact them and no doubt we will organize something, tango included! Thank you very much for everything
Cordially
Oscar

Dear Oscar,

When I wrote to the email discussion forum for trainers in MI I got some some good replies, even one from a very well-known psychiatrist who is a tango dancer, speaks Spanish and who loves your country!  Carolina Yahne also replied.

I have a list of names and their replies.  There will be good contacts here if you follow these up.

I dont have your email address. if you send this to me I'll send you the document with contact details on it.

Kind regards and good luck,

Steve

Stephen: Thanks for your response. I'll be expecting some more information. William Miller has recommended me to Dr. Yanhe. For now still working in the Hospital to extend the practice. Start a line of research with patient groups. I hope to formalize my training and join colleagues from Argentina. Also very interesting to Becci for primary health care. Thanks and see you soon

Oscar

Dear Oscar,

Good to hear from you!  I have been trying hard to think of contacts in your country with an interest in motivational interviewing, with no success.  So I wrote to an email discussion group of trainers in motivational interviewing, and asked them if they knew of anyone in your country who you could get in contact with. I'll let you know here in this forum when I receive a reply.

I am sorry to hear that the workshop in San Diego is full.  It will be conducted in English, yet I believe that there are many Spanish-speaking trainers in motivational interviewing who live in the US, Mexico and a few other places.  Most of our books have been translated in Spanish.   I'll see what my colleagues on the email discussion group come up with.

Meanwhile do not hesitate to put any questions to us here in this forum.

Best wishes

Steve

Yes that helps a great deal!!! Thank you very much for your response and help! I really respect the work you have done.  Thanks. Take care!

Dear Colleagues,

I gace a plenary talk with Bill Miller in Stockholm recently at the 2nd ICMI conference (International Coniference on Motivational Interviewing). We gave an overview of a "new" framework for MI that we are going to build the 3rd edition of the basic Mi text around, to be published in 2011 (its not written yet)>

ThenI got lots of emails and queries about this framework.  So here is a very brioef account that can be amplified if you so wish, just ask!

ENGAGE: process no 1.  Use core skills like listening to engage the person. The system around you can undermine or enhance engagement too. No point in proceeding with any useful helping without engagement.

GUIDE: process no 2. Help the person work out what direction they would like to take, what change they would like to address.  Agenda-setting is a core task and skill. identify a change topic.

EVOKE: process no 3.  This is where MI skills are used to evoke the persons own sense of how and why tey might change. You elicit and reinforce change talk.

PLAN: process no 4.  here you use the same core skills to help someone formulate a change plan that is specific and achieveable.

They are not stages, but you couldnt get going with 3 & 4 without 1 & 2 intact.

OK. More if you want this.

Steve

Dear Elizabeth,

Oh dear, I cant recall exactly what we wrote in the Health Behaviour Change book!  Its not near me, so I'll deposit in this post a brief summary of what's in my head right now, if that's OK?

Then come back to us with further comments or questions.

You ask about the difference between buidling rapport and setting the agenda.  They are linked, the first is a description of the state of the relationship, the second a quite specific task.  Do the latter well, and rapport will be enhanced hugely. However, just buidling rapport does not help a lot to set the agenda!

I'll try putting this another way!  Agenda-setting was a term I borrowed in the early 1990s to describe a task - when a practitioner is facing a patient, often with a long-term condition like diabetes, and there are many change topics they could talk about. But which one do they start with? Who decides?  As you probably know, its all too often the practitioner, with a resulting negative imact on the patient (and their rapport).  Agenda-setting is a task in which the practitioner tries to lay out the possibilities, and invites the patient to say what change topic they would like to talk about.  the idea is not to into any topic in too much detail, but to skim the surface at the beginning of a consultation, adding practitioner ideas too.  Then they agree about what to talk about, and even the order in which they will do thid, and get back to this agenda-setting process at the end of the consultation.

Its a quite specific task, agenda-setting. my partner Nina Gobat is doing her PhD thesis research on measuring this skill.  We also wrote about it in "Motivational Interviewing in Health Care".

Does this help, Elizabeth?

Kind regards,

Steve

I'm currently reading "Health Behavior Change" and am trying to distinguish the difference between building rapport and setting the agenda.  What are some examples that can define the differences???

Dear Orla,

I have come across plenty situations in which practitioners ask patients at the very first consultation about taping.  You obviously need to make sure that you have adhered to good ehtical practice, which I am sure you will (consent form; clarity about exactly who will hear the tape; freedom to wipe the tape if they change their minds, and so on).

let us know how you get on?

Steve

Antonio,

Apologies for the delay in replying.

I think I might get it!  So you will be in a trainer/facilitator role. You will be working with "managers" or senior people.  You dont say whether individually or in a group?  Assuming it in a group, you want to help them develop more flexible and compassionate attitudes towards others around diversity issues.  And in addition to helping them change their own attitudes and behaviour, you want to give them skills like eliciting change talk that they can use with others?

Its complex, these parallel processes you are working with.   You need skills to "change them", and you want to give them skills to "change others"?

This sounds to me like a legitimate and helpful scenario in which to use MI skills, for both you and them.  In principle, yes. It feels ethically solid to me, because your ultimate goal is the well-being of people who might come from different background and be at the receiving end of prejudice and poor management.

How you approach this is complex training challenge. i still dont want to go into any detail for fear of still not quite understanding your role, how much training and supervision you have had in MI, whether you are working with a group or individuals, whether its a taster educational experience or a workshop, of what length, and so on.

I certainly dont think its easy to train people in eliciting change talk unless they grasp the spirit of Mi, and then its only really possible if they have the skills to use reflective listening, hence my question about how much training time you have and indeed, what your experience of these skills are yourself?

Feel free to be more concrete..... and maybe we can construct some kind of framework...?

kind regards,

Steve

Hi Steve

I brought up the subject of taping future consultations with my patient this morning and they were very agreeable.  They said they would be happy to do anything that would help me because I have been so helpful (blow my own trumpet). 

I have a feeling it would be best to bring up the subject of taping after I have met with the patient on a few occasions, when I have gained their trust.  Don't know what you think?

Orla

Hi Steve,

Thanks for your reply.

Hope this is clearer.

I have been asked by an organisation to design and deliver some training around bias (diversity and inclusion). The training is designed to encourage open debate, awareness raising, and teach people skills around how to handle bias in the workplace. I thought that providing the group with some tools in eliciting change talk with a focus on how someone could change their behaviours towards others if they suspect they may have bias could be very powerful. The audience the training would be designed for are very well rewarded white males who may be resistant to changing their behaviours in the workplace as they consider themselves to be very good at what they currently do and how they do it. I suppose therein lies the challenge.

Do you think MI may fit into this picture somewhere?

Best,

Antonio

Yes please, more news soon from you would be good!

Steve

Orla, let us know how you get on!

Steve

Hi Steve Thanks for taking the time to respond, it is very much appreciated. I know what you mean, it just shows the benefit of this forum. I had not thought about having a longer discussion about the taping and the option to delete it after the consultation, if the patient would prefer. I'll give it a go with a patient I have in mind this week and see what happens. Many thanks Orla

Dear Orla,

we live in the same city and exchange ideas here on the internet!  I cant see any way around this other than locating a patient you already know perhaps, getting consent to tape,  and reassuring the patient that at the end of the session the two of you will make a decision whether to wipe the tape in case anything personal has come up that they would prefer to keep between you?

Or have I misunderstood you?

kind regards,

Steve

Hi Antonio,

yes, people have used MI in corporpate settings, although Ive seen nothing written and published on this topic. The obvious limitation is that MI is really for circumstances where the primary motive of the interviewer is the well-being of the other.

If I consider your posting, I get stuck on your description which I dont really understand!  if you could help us clarify what you mean by "to design a programme for a very resistant, successful group of people around targeting unconscious bias in the workplace", .then let's have a go at seeing how MI could be helpful!

There's a business school in Paris, quite a famous one apparently, that even had Bill Miller fly over to talk with them....

Kind regards, Steve

Dear colleague,

we sometimes are able to help, usually with a reduced fee, but please write to us via email and well will have a look at the circumstances.

kind regards,

Steve

Hi

I am a community dietitian based in Cardiff and working mostly with chronic disease and weight management.  I was introduced to MI in 2004 and have really embraced it in the last 2 years.  I am observing improved consultations and also improved outcomes.  My problem is this, my most effective consultations are those were the patient shares some very personal information am I afraid that by asking to tape consultations patients will hold back.

I am really keen to receive support from MI Campus, which would involve taping consultations, however I don't want to prevent progress with the patients.  I would be grateful if anyone has any suggestions or ideas they can share fom their practice.

Kind regards

Orla

Dear Steve,

I thank you very much for your precious advice!

I have been quite busy this week, but I have just sent an e-mail to Mr. Barth and Ms. Näsholm. I'll keep you informed of what happens...

I didn't know that Hal Arkowitz was such a precursor and that he even supervised Bill Miller! Thus I think it's really worth that I send him another e-mail...as I still haven't gotten any news from him. It is the same for Ms. Fortini, who must be, as you noted, very busy right now. Time will tell!

I contacted two other Professors (Henny Westra, David Hodgins) and I'm about to send an e-mail to Teresa Moyers, whose work on the "active ingredients" of MI are really interesting for someone like me!

I realized that the main problem for me, as a psychologist, to learn MI and then to develop it and have it admitted as an effective "method" for the treatment of psychological problems, is that MI is still mostly seen as "a technique only useful for addicted people". Very few psychologists in Switzerland are really involved in the dissemination of MI and its applications for a wide range of psychological problems. Indeed there are much more physicians practicing MI than psychologists and their use of MI is almost exclusively focused on substance misuse issues.

My "MI-quest" is far from being over... But is beginning quite well, thanks to your advice and your workshop, which I am looking forward to attending this October!

More news soon!!

PS: I apoligized because I involuntarily posted my last message twice, and as I couldn't delete it, then I changed the text of the second one so that it doesn't appear one more time.

Hi,

I work as an organisational psychologist in the UK and have recently been given a challenging assignment which is to design a programme for a very resistant, successful group of people around targeting unconscious bias in the workplace.

I know that this is traditionally not a space in which we use MI but I was wondering whether anyone has used MI in the corporate space and if so whether you could point me in the right direction.

Any other tips or help would be muchly appreciated.

thanks in advance,

Antonio

I am very interested in attending the MI 2 day workshop in Cardiff in October but am unable to get funding via work. I would be very grateful if anybody could let me know if there are any other funding sources I could tap into. Thanks

Dear Julien,

I have no idea about why you are apologising for "mishandling"?  No need as far as I can see.

Your progress will be of interest to others, for sure.

You located Hal Arkowitz in the USA, and he is the grandpapa of MI.  I have never met him.  Bill Miller has been supervised by him in his early days, and Hal is a brilliant man.  Bill describes Hal as his mentor.   if you can get anywhere near him or his clinic, you might well strike gold.   You also mention Terri Moyers, who is in Albuquerque, New Mexico, and who effectively took over the research "lab" when Bill retired.  Great place to visit.

MI-Campus could suit you very well.

As for contact in Europe?  Tricky. If you could get near Tom Barth in Bergen Norway, or Christina Nasholm in Sweden, they are the best MI psychotherapists I know.

Christiana Fortini just down the road from you in Lausanne is excellent, but she might be incredibly busy right now.

Kind regards, keep going, keep us well posted!

Steve

I apologize for this mishandling!

Dear Steve,

I appreciate that you took time to answer me! Your suggestions and encouragement are very precious to me!
I contacted Christina Fortini earlier this week, I am waiting for her answer.
I also went back to MI-campus, and it looks like things are starting up, so I requested information about MI-3 MI-4 MI-6, to learn more about "good practice" of the MI... I also contacted Prof. Arkowitz from the University of Tucson, to express him my enthusiasm for his MI practicum (one semester of theory: readings, role playing, video coding and one semester of clinical practice consisting of following multiple clients under his supervision) and his work on ambivalence.
I also plan to contact Theresa Moyers, and other active MI-researcher across North America. And Europe if you or any body else know engaged MI clinician who might been interested in working with a very motivated psychologist toward the development of MI as a clinical method as such!
And I'll send an e-mail to Pascal Gache to ask him about his work here in Geneva!

I'll post the results of my "MI-quest" regularly, hoping that it might help other people!

See you soon!

Apologies, there is a newer and more comprehensive collection on this page:

http://www.motiverandesamtal.org/ICMI

Steve

if you would like to look at videos of some of the presentations from the 2nd International Conference on Motivational Interviewing (ICMI2), then just go to:

http://www.motiverandesamtal.org/ICMI/Equipoise

Bill Miller and I presented a new a simple framework for MI, and there's many other interesting presentations, on research and clinical topics.

Steve

Dear Suzan,

you dont say what country you live in, but just to let you know that a group of us are presenting in Glasgow on July 2nd at the dental conference.....

Steve

Dear Jan and Melanie,

great to realise that someone with Melanie's expertise lives so close to Jan in South Wales...... good luck and do share your experiences here in this forum if you want to.

Steve

Dear Jan,

MI-campus has now been launched, so go for it if it suits your needs!

Steve

Dear Julien,

yours is exactly the kind of query this forum is designed for, so please remain engaged if its helpful. i fo through periods of being to busy to reply, but in time I hope others will join in discussions.  The furm is new.

Julien, there is no formal programme I know of, yet I bet there is one somewhere, such is the growth of MI.  Among the ideas that spring to mind are to get the support of MI Campus (www.mi-campus.com), the most through effort to provide certification that I know of. they also offer other services, like peer support and feedback, so its worth looking into.

You could keep a blog of your progress on this site if you like - a wild idea, but it might be fun for others and very interesting.

I know quite a few MI trainers and practitioners in Geneva and Lausanne, but have no idea about supervision.  Cristiana Fortini in Lausanne is worth contacting - she works with Jean-Bernard Daeppen - both are good friends of mine.

let us know how you get on?

Steve

Hello!

I am a young graduate student in clinical psychology from Switzerland (Geneva).
I have been working in a specialized centre for alcohol and other substances addiction throughout the two semester of the Master of Advanced Studies in Psychological Evaluation and Intervention that I am undertaking. I had to write a thesis on two clinical cases coming to the centre for treating their alcohol dependance. In this context I remembered an introduction to MI I attend a few years ago, by Dr. Pascal Gache (MINT Trainer), during an internal training day ot the Phenix Foundation. I was thrilled by the spirit of MI and the enthusiasm that Dr. Gache conveyed speaking about it. Thus I decided to borrow the only MI-related book at the library, the loriginal 1991 edition of the "Motivational Interviewing". It was the beggining of my journey in the MI universe! Then I bought and read all the Gillford books on MI...And started to wonder how to get more proficiency in MI as there is very few training opportunities here in Geneva. The supervision offer is really limited and none of my colleagues, but one, have had a MI training. I try to improve my skills on my own, with much help from my client's feedback!

So...here is the point: except the two-days introduction workshop, which I plan to attent to this fall, is there any university doctoral or clinical program I could take part in, in order to get more proficiency and direct supervision, which I think is of great importance? I would be glad to acquire more clinical experience in MI in the wide range of psychological problems people are searching counselling for.

MI is what I was looking for when I decided to study psychology; its spirit and principles match my own values and I really want to learn it properly in order to develop its use in various aspects of the psychological counselling here in Switzerland.

I hope my post "fits" the purpose of this forum.

Thank you beforehand for your listening and advice.

Julien Flückiger

Hi Maurice,

that's a good one, that question.  I have loads of personal experiences of being with doctors who describe a change in their attitude and approach, but systematically gathered evidence?  My memory does not retain enough of what I read!  There is some evidence on this question.  I'll have a think!

I found that paper quite difficult to write!

Steve

Hello Bec -

Thank you for your information about the certification process, this sounds exactly waht I was hoping for.  I used the word 'accreditation' without a great deal of thought and your definition of 'certification' certainly describes what I'm seeking.  I am trying to find a way of demonstrating to myself and others that I have reached (and am maintaining) a level of competence in the use of M.I. and have not merely attended a workshop. 
Jan

Hi Melanie - thanks for your reply to my post.  I have approached my line manager to check whether confidentiality issues could prevent recording of sessions with customers and we plan to discuss it in more detail.  All being well, I may be very interested in your offer of supervision and I'm very grateful to you for making it! Jan

Hi Steve
  All of us who are in daily contact with busy GP or residents or medical students will, I am sure, use this paper as a model for skillful reframing  of the requests  for quick "how to fix" all kinds of health problems. I have already sent it to a few of my colleagues. I must say that I am unable to evaluate how often the seeds that we throw in the winds of exchanges lead to what Balint called "a small but significant change in personality" of the physicians. You are undoubtedly the most specialised MINTie in this field and I cannot figure anybody who could best answer the question : Any evidence of the changes in famiily physicians who have been exposed to good MI training ?
  Warmly
             Maurice

Hi Sam

I am a little confused by your post.
Are you saying that you would like to become a trainer in Motivational Interviewing? The MINT is an international group of MI trainers and the focus of the group is on supporting each other in the provision of good quality MI training.I belong to this group and the generosity of the members in sharing ideas, expertise and training exercises and much more has made a huge difference to my confidence and the quality of my training workshops and is well worth the modest membership fee.

All members of the MINT have attended a three day trainer for trainers (TNT) event and then pay an annual subscription to become a member of MINT. These events are listed on the website and the event for 2011 is in Sheffield UK, 2010 is in San Deigo USA. The application process is open to all who have an interest in becoming MI trainers.

Hi Jan
I am based in South Wales and have recently trained in the MITI tool mentioned by Rik Bes in his response to your other thread. I have been delivering MI training and supervising staff using MI in their practice in substance misuse for a number of years and I think that the coding audio tapes with the MITI tool and then discussing the results in either face to face, telephone or Skype coaching session is a great way to develop MI skills. I would like to practise my new coding and coaching skills if you would be interested. 

This thread has been set aside for any comments and discussion relating to 'Motivational Interviewing' by Rollnick, Butler, Kinnersley, Gregory and Mash published in the BMJ.

Dear Jan & Steve,

Thank you for raising this subject.
In my view, learning how to become, be and stay competent in Motivational Interviewing is not something that is done through following a workshop (however well delivered) at one point in time, and then afterwards just 'do' it. It takes continued attention, preferrably through observed practice, intervision and/or supervision. Ideally, also a more formal check of competency could be done from time to time, by having your conversations coded with the MITI.
Now to addresss your question more directly: indeed, me and my colleague Jeff Allison are in the process of starting up our new initiative named MiCampus. Through MiCampus we will offer an online opportunity for practitioners who would want to have their competency in MI certified. In general, this certification procedure asks from the practitioner to submit a number of recordings of his/her actual work with clients/patients (by means of audio/video files and detailed transcripts) and the writing of a 'self-appraisal'; a critical analysis of the samples provided. After a thorough review of the samples provided and of the self-appraisal, our examiners will be able to decide whether or not to grant certification to the practitioner. This initial certification will be published and will be valid for 3 years, after which a shorter re-certification procedure will be executed, to possibly extend the certification.
By the way: I am using the word 'certification' and I notice you use 'accreditation'. Maybe it's because of the differences in language (my first language isn't English, but Dutch), but it could very well be that we are not talking about the same things.
In my country - the Netherlands -, accreditation means that any course, workshop or educational event is recognized by authorities and gives a certain number of 'points' to the practitioner participating, needed each year to keep one's license as practitioner. These point-earning educational events usually do not check competency, or give any form of certification. Certification does check knowledge & competency thoroughly and should be repeated after a number of years to check if the initial competency & knowledge is still there and didn't wear off.
Ok, so much for linguistics.

Kind regards,

Rik Bes,
Micampus.

I am an Occupational Therapist and practitioner in a Condition Management Programme (CMP) in South Wales, interested in the use of M.I. in this field.  The CMP works with people in receipt of sickness benefits and our role is to help them manage their health conditions more effectively, to improve their well-being and help them realise their aspirations to return to work.

Our team has received training in the use of M.I. with our customers, both individually and in group settings and we have found it very effective in helping to resolve ambivalence about health behaviours and lifestyle habits.  I would like to develop my skills in the use of M.I. and have submitted a separate post enquiring about accreditation of practitioners on this forum.

I would also be interested to have a discussion with anyone else using M.I. in the field of Condition Management/Vocational Rehabilitation, as this seems to be a very relevant area for the approach.  Is M.I. widely used, I wonder, and what is the evidence for its use in this setting?

All the best,
Jan

Thanks very much for your reply to my query - it's good to know there may be an accreditation process before too long.

With regard to the use of  M.I. with our customers (i.e.people on sickness benefits who may or may not be considering a return to work), yes I have witnessed its effectiveness!  As health professionals our team's primary concern is to help people manage their health conditions more effectively - hopefully we can enable them to return to work, though many people are not ready for this and often our role is to improve their general well-being and move them closer to being ready for work.  However, I think it's fair to say that our customers are sometimes suspicious of the motives of the programme, having been referred to us by advisors in the Job centre - some are under the impression that our role is to return them to work, like it or not.  This can put them 'on the defensive' from the outset and advice-giving and attempts as persuasion are even less likely to succeed in these circumstances.  The use of M.I. techniques (though I hesitate to use that word) can help to resolve ambivalence, but just as important is the philosophy of the approach, which offers them respect and 'polite attention' at a time when they may feel particularly under-valued and marginalised.

I would be very interested to hear from anyone else working in this field who has been using or would like to start using M.I.
I'll submit another post with a more meaningful title to encourage discussion.
All the best,
Jan

Dear Jan,

The truth is that there is no single body that formally co-ordinates the training and accreditation of MI practitioners.  The closest one gets to is MINT (www.motivationalinterview.org) which is run by volunteers in a network of MI trainers. But they have not been able to take on an accreditation scheme.

The result of this vacuum, if you like, is that others, many members of MINT themselves, have made considerable efforts to set up a system.  One such, about to be launched in a matter of weeks (I believe), is MI-Campus (see www.mi-campus.com).  I have been on the non-paying advisory group, along with many other colleagues and including William Miller.  Then there are others, which I cant for the moment list for you..... I'd have to dig this information up....

Good to hear from someone in the occupational rehabilitation field.  Its not the first time I have come across this interest. i am not sure there is any research evidence yet, but I would bet that a gentle engagement with someone ambivalent about the return to work will produce better outcomes than standard practice (giving information and advice).

Feel free to post a specific comment with your field in the title..... it should over time pull in other folk in your field. I'll keep an eye out, and be as helpful as I can.

Kind regards,

Steve

Hi, Steve:

No, I never applied to MINT.  The MINT trainers I had were excellent.  But as a public sector therapist with the typical crushing workload and small paycheck, I never thought MINT membership would provide me much that I couldn't get from the website.  Plus, (BIG plus), the highly volatile populations I have worked with through the years seemed to call for an MI not clearly represented in the standard literature.  As a result, I've had to find my way largely on my own, with little more than the beacon of the "spirit of MI" to guide me.  Since then we have begun to see an impressive offering of MI in correctional settings, very much including the free e-book offered on the MI training webpage.  But as have continued to evolve, I find myself very close to normative MI even within a correctional context.  We need more research with MI in correctional populations.

So... I may well shake the dust off my list of trainers, contact them for a reference, and apply.   Maybe my experiences in MI modification could serve others, as you, by generously giving me your ear recently and all of us with your oeuvre in general, have blessed the world.  Thank you, Steve.

Dear Sam,

I’d be very interested to understand what your experiences of MINT have been. Have you applied for the Training for New Trainers course which entitles one to join MINT? Did you fail to get in? is that why you say,

I could never understand why a 2-3 day face- to- face training qualified one for the MINT but an extended supervised training via a distance environment did not. After all, for slow learners  like me, the latter seemed ideal, not to mention the plus of having ongoing supervision, even from a distance, over a longer haul than 2-3 days.

Perhaps you can explain the context of this concern of your?

Needless to say, please don’t see me as having any kind of official voice in MINT, let alone over their selection of candidates. I used to do this in the “old days”, but it is now much bigger, with others involved (more on that later).

I will come back to your other points soon. My gut reaction, for what its worth, is that if you were rejected, that’s dam unlucky if it was on the basis of not being adequately qualified. But I am not sure what happened.

Kind regards,

Steve

Sam,

thank you so much. There's a lot in this post of yours.  I'll give it some thought and get back to you in this forum. I appreciate your efforts to understand the forces that drive training!  I need to think about what you have written, so bear with me. Soon, I'll be back.

Kind regards,

Steve

Update:

This post has been moved to its own topic:

http://www.stephenrollnick.com/index.php/component/ccboard/view-postlist/forum-1-discussion/topic-11-concerns-about-mint-training-and-some-mint-trainers

A posting arrived in this forum from Sam Young, which he inserted as a reply to the advertisement about MINT training for new trainers (another topic). he then wrote to me and suggested that he might have put it in the wrong place, and I really agree with him.

It deserves a title all of its own.  So I gave it one here, and here below is Sam's posting. I shall give it some thought and reply soon. Feel free to weigh in yourself, anyone with an interest in this topic. Here is what Sam says:

Hi, Steve:

Whenever I see a training announcement like this (MINT Training for New Trainers), I reflect on why I’m not in the MINT after getting first rate training in it from several MINT trainers in the past. Right off the top, the most likely reasons are that I am not much of a joiner in the first place, but in the second, I could never understand why a 2-3 day face- to- face training qualified one for the MINT but an extended supervised training via a distance environment did not. After all, for slow learners  like me, the latter seemed ideal, not to mention the plus of having ongoing supervision, even from a distance, over a longer haul than 2-3 days. So I pretty much practiced on my own, with profound results that I fully attribute more to the power of the therapy than my particular skill. It really is the most difficult—and rewarding—approach I have ever used.

Having said that, I’m deeply concerned about how MI is being manipulated in some quarters. I have experienced MINT trainers who identify themselves as “MINT certified” even when faced with website data that confirms that MINT as an organization does not certify trainers. I have experienced MINT trainers and/or their marketers try to snatch MI trainees from other non-MINT MI training venues because the former’s trainer was supposedly “certified” by MINT.

Licensed doctoral level professionals mandating that their staff assimilate MI skills without question (lowers the risk of litigation, don’t ya know…). Bureaucrats who don’t know MI from the man on the moon mandating MI interventions to avoid paybacks. I fear that institutionalized MI is poisoning the (for me) quite sacred MI well…

Where am I going wrong, Steve? And what needs to be done?

Hi, Steve:

Whenever I see a training announcement like this, I reflect on why I’m not in the MINT after getting first rate training in it from several MINT trainers in the past.  Right off the top, the most likely reasons are that I am not much of a joiner in the first place, but in the second, I could never understand why a 2-3 day face- to- face training qualified one for the MINT but an extended supervised training via a distance environment did not.  After all, for slow learners  like me, the latter seemed ideal, not to mention the plus of having ongoing supervision, even from a distance, over a longer haul than 2-3 days.  So I pretty much practiced on my own, with profound results that I fully attribute more to the power of the therapy than my particular skill.  It really is the most difficult—and rewarding—approach I have ever used.

Having said that, I’m deeply concerned about how MI is being manipulated in some quarters.  I have experienced MINT trainers who identify themselves as “MINT certified” even when faced with website data that confirms that MINT as an organization does not certify trainers.  I have experienced MINT trainers and/or their marketers try to snatch MI trainees from other non-MINT MI training venues because the former’s trainer was supposedly “certified” by MINT. 

Licensed doctoral level professionals mandating that their staff assimilate MI skills without question (lowers the risk of litigation, don’t ya know…).  Bureaucrats who don’t know MI from the man on the moon mandating MI interventions to avoid paybacks.  I fear that institutionalized MI is poisoning the (for me) quite sacred MI well…

Where am I going wrong, Steve?  And what needs to be done?

The next MINT sponsored Training of New Trainers will be in San Diego, California, US on October 4-6, 2010.

Places are filling up, so if you want to apply, go to www.motivationalinterview.org and look on the front page.

Steve Rollnick

Just click the "Registration" button on the top right-hand side of the main page menu

Welcome to the new discussion forum. It replaces an older one on an earlier site.