stephenrollnick

Are you a part of TNT now? You are having a strong background with good experience.I am a new learner and it would be great help if you share your experiences with us.

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Hi Laura,

You can you can reasearch on "Issues related to parenting capacity and resource misuse".

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Hello! My name is Bert Bergström and i am from Sweden. I have worked in the field of addiction since 1984 so in some ways the guestion of motivation have been whith me and my clients over a long time. I began reading about motivaional interviewing around year 2000, then i participated in workshop 2+2+1 days training. Than i continued to train and are now intrested in and would like to participate in a TNT. When are the next time? I have a letter of recommendation from Carl-Åke Farbring and there will not what i now be any time in Sweden this year. Bert Bergström

Motivational Interviewing: Introduction & Update. 2 day workshop - 11th & 12th June 2012, Cardiff

Two-day workshop in Cardiff, Wales, UK
Monday 11th & Tuesday 12th June 2012.

This is a repeat one-off opportunity to learn about motivational interviewing (MI), and the latest developments, from its two co-founders, William R. Miller from Albuquerque, New Mexico & Stephen Rollnick from Cardiff, Wales. Professor Miller will return to Cardiff after a successful workshop in 2011. This will be of interest to both to newcomers and those more familiar with MI. A streaming system will be used to ensure that those relatively new to MI will get good opportunity to practice basic skills. It will provide:Clarification about the common and unique elements of MI

• A focus on client change language and how it guides the practice of MI
• An update on theory and research
• The presentation of a new 4-process framework for MI that allows for easier integration in diverse settings
• Opportunity to practice core skills for evoking motivation to change

For full information and registration, visit: www.misr2012.co.uk

Yap! I read his article, very impressively they explain the all points, love to read these. Where should I get other articles?

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Hey I am also a dental hygienist who is working in my own clinic here in Nepal. After completing my master in San Francisco dentists clinic I took an experience in the same clinic for a couple of years and came back to my own home country. Solutions is the side of medicine that is involved in the study, research, prohibition, and treatment of conditions, disorders and conditions of the mouth, maxillofacial area and the next and associated components and their impact on the body.[1] Solutions is widely considered necessary for complete general insurance coverage health insurance fitness. Doctors who practice treatments are known as dental offices. The dentist's aiding team – which includes dental staff, dental hygienists, dental experts, and dental counselors – aids in providing insurance coverage health insurance fitness services.

Have a look at the site:

http://www.dissertationsandtheses.com/dissertation-ideas.asp

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I have just had a really interesting consultation with a patient.  It was our fifth appointment together and at each meeting they have been explaining how frustrated they are that they want to lose weight so much but just can't seem to do anything about it.  We have spent time discussing ambivalence and then today after a long discussion again they mentioned, as a side line, that they had changed some aspects of their diet.  These were significant changes that have resulted in weight loss and yet when I pointed them out they discounted them as a half-hearted attempt.  When they then weighed and realised how much they had lost there was then change talk and commitment language.

I think the patient expected that they needed to be following a rigid regimen in order to lose weight and therefore could never achieve this, which resulted in ambivalence.  I really thought they were firmly stuck in ambivalence so I am shocked (pleasantly) about how the consultation went today.

Just thought I would share this.

I find this 4-dimensional framework VERY HELPFUL in perceptualizing a "therapeutic arena" where the interactive processes of MI would occur. To me, the dimensions of Engage & Guide form the launching pad, where the client gets stablized and oriented for change. Then the dimensions of Evoke & Plan (Negotiate) can be added forming the atmosphere above the launching pad where the client really explores the possibilities of change with all the how's & why's.

I would like to learn more about how you will be explaining the intricacies in MI-3. (About when in 2012 for the new edition?)

Would the Process of #4 PLAN, be better labelled NEGOTIATE, instead? It may be only semantics, but to me the spirit of MI is emphasized more in a process of negotiating a Plan (as with a partner) in contrast to a process of Plan development (more typically prescribed by the expert for the recipient to follow).

Dear Professional MI Trainers,

I'm working on a project to support volunteer MI Champions (see below) to advance MI among all change practitioners. The piece of this project with which I'm struggling is how to integrate Professional MI Trainers (like yourself) into the mix of resources and services. The concept is briefly described below. The objective is to greatly enhance YOUR Consulting Practice as an MI Trainer to ultimately improve the MI proficiency of all change practitioners, which would in turn improve the outcomes for all their clients who are struggling to achieve positive change and deserve competent guindance in their efforts - skills of which only you are in position to help fully develop.

Let me explain...

I'm studying David Rosengren's MI workbook for practitioners, Building Motivational Interviewing Skills, which includes a description for becoming a volunteer "MI Champion." As I understand it, a MI Champion promotes the learning and use of MI among their colleagues by forming a local study group and hosting live, peer-facilitated practice sessions on a regular, on-going basis and using standardized activities and currently available training DVD's on MI. I envision a type of "self-help" system for change practitioners to help themselves change (improve) the way they help their clients change.

I'm very enthused about this concept's potential for expanding awareness among ALL change practitioners regarding the need for and benefits of MI. But the self-help model obviously has it's limitations. Rosengren's workbook is excellent as a foundational guide, and the hosted practice sessions for learning how to apply MI skills proficiently makes for a great start. But after having realized the value and subtle complexities of MI, I believe MOST of the practitioners would further realize the benefits of truly MASTERING the skills of MI, which would be possible only through professional coaching services from MI experts - MINT-affiliated MI trainers.

I've already developed a rough-draft website that could support MI Champions - who are NOT MI Trainers, nor want to be - but who would have a vested interest in promoting self-help MI groups, as well as YOUR expert-coaching services that would go with it for their more serious participants.

My intent is simply to raise practitioners' awareness in regards to the value of MI and facilitate their efforts in promoting MI locally - a "grass-roots" effort across backgrounds and settings. My objectives include: 1) Introducing MI to all helping practitioners by providing a free on-line introductory course, 2) Providing free and convenient opportunities for all practitioners to practice their MI skills, and 3) Integrating this on-line resource and locally hosted support system (where practitioners would get familiar with MI) with professional MI trainers who would then (more effectively and efficiently) coach them in mastering their MI skills.

If you have some thoughts on how this integration piece would be most helpful in steering interested change practitioners toward professional MI trainers, please contact me directly, DrOpsahl@gmail.com, so that I can send you the link to the project's website (pre-launch). It has many built-in marketing tools that you would be able to use to promote your professional MI training/consulting services.

I would greatly appreciate your feedback regarding this project. I'll continue developing the website for MI Champions, and I'll post up-dates here, but ideally, I'd much rather integrate any of your professional needs/preferences now rather than later. Thanks.

Jon

Thank you so much Dr. Rollnick

I do agree that readiness ruler is practical and useful in clinical sense.  In 2005, Dr. Labrie had modified and test for the validity of the readiness ruler for alcohol consumption behavior.  I hope that I can test for validity and reliability of the readiness ruler for cardiac health behaviors in my poppulation.  It will make us much more confident to use the ruler.  Thank you so much for your suggestion and you article.

Pataraporn

Hi Stephen

My name is Laura, I am a Third years Social Work Student and as part of my degree I am required to complete a 10,000 word dissertation. I am currently undergoing a placement with an Alcohol Service in South Wales (UK) and am keen to tie my dissertation into this line of work. I have been thinking about doing a dissertation on MI although I have no prior knowledge or understanding of MI.

I am wondering if you could direct me in any way in regards to my dissertation and/or any areas which you think may be interesting to research relating to alcohol misuse or services provided to individuals who may be concerned about their drinking.  

Regards
Laura Williams

Dear Pataraporn Kheawwan

Its hard for me to remember, to be Honest. I think I came up with this idea when working clinically on a study of change in Type II diabetes, so i think the original reference is:

Stott N, Rollnick S, Rees M, Pill R. Innovation in clinical method: diabetes care and negotiating skills. Fam Pract 1995;12: 4: 413-418. I dont have a copy of this paper, so I cant send it to you. Sorry.

This was a simple 10-step scale from 0 to 10 for readiness to change any of the behaviours under discussion.

Now I had no intention at the time of linking this explicitly to the stages of change you mention. Indeed, i developed it as a more fluid clinical tool precisely because I was worried about people's reported stage of change being variable and dependent on the clinical context, and even the way they were spoken to.

if you want to measure stage of change, across behaviours, then I guess you are talking about a quite complex set of scales, one for each behaviour, and I have no idea whether anyone has developed this.

I wonder if this helps you?

The readidness ruler has since been inserted into a number of books by me, as an aid to clinical practice - see:

Rollnick S, Mason P, Butler C. Health Behavior Change: A Guide for Practitioners. Edinburgh: Churchill Livingstone, 1999

Rollnick S, Miller W, Butler C. (2007) Motivational Interviewing in Healthcare. New York: Guilford Press.

With kind regards,

Steve

Dear Rona,

the addictions field in the Uk is not huge, and consists of quite a range of services, charities and counselling initiatives.  Some use MI, some not. There are folk on this forum who can advise about becoming a member of MINT - indeed, probably some postings that might help, as will www.motivationalinterviewing.org.

For getting into the addictions field, I would consider heading out into the services in your local area, and offer your services as a volunteer.....? I suggest this without knowing of your qulaifications, which is an important issue?

Kind regards, Steve

Dear Travis,

thanks for asking, yet I cant give any permission because the copyright is held by the BMJ.   You could either check that it is still free on-line, in which case I cant see the problem, or check with them for permission.... the latter is your safest route I guess?

Kind regards, Steve

Dr. Rollnick,

My name is Travis Bell and on behalf of the Community Partnership of Southern Arizona, I would like to ask you for your consent to post this article on our intranet.  We would like to make this material available to our contracted behavioral health providers as a best practice reference.  Your consideration is appreciated.

Respectfully,

Travis Bell

Hi Eveyone
 
Last year I attended a two day workshop on MI and was vey impressed with this perspective.  Since then I have been reading up on the approach and am about to attend another workshop in October.

At the moment I am a volunteer Health Trainer and now would like to get into the field of working with behaviour changes in clients in the treatment of addictions.

If anyone has ideas of how I can approach this I will be interested to hear.

My aim is to train as an MI trainer so information on opportunities for this will also be gratefully recieved.

Warm regards

Rona

Hi Alan,

Have you tried Motivational Intervewing Supervision and Training Scale (MISTS) ?

Sincerely,

Ivaylo

Persistant I am,

Thanks Stephen for your reply and your brutal honesty, which I respect.

I am actually happy with what you have said, believe it or not.

So I am going to leave it at that for now and put my question and expierence/s down to incompetency without comapassion and empathy on the trainers part,
 which sadness me I might add, to think that that is even possible.

Well done for persisting!  I had been locked out of my own website!

What a topic you raise.  I wonder whether you have had experiences of people presenting MI with perhaps not such a good grasp of it?

Sounds defensive of me to suggest that, but I honestly feel that practiced with compassion and empathy, its not manipulative to steer a conversation in a direction that you genuinely feel is in the best interests of the client. If you are either not genuine or you have chosen an horizon that the client find difficult to travel towards, you should notice this in their response and body language. if in any doubt, ask them....

I bet you are still worried about this reply, so let's hear why?

Best wishes

Steve

PS Just to clarify, I dont run a sort of information service on Mi and training in MI, and dont feel that i should, could or want to have the last word... this forum is for anyone to chip in.... and say what they feel.....

I noticed I got a lot of views on my last topic, but no replies,

The reason I want to put this up for discussion, does Motivational Interviewing come across as soft manipualation?
Is simply because at present, I am studying social care and what has come to my attention, as I said to Stephen him self via e-mail, who went on to suggest that I should put this up for discussion,as this topic is familar and that people can learn from eachother.

I am all for each and everyone of us as humans we have the right to our own decisions and choices in life,
so by right we should all have the right to have the choice to decide on what therepy/treatment if you like is to be applied.
Is there a wrong way to apply M.I and if so what types of effects can this have on the client?,
also if the spirit/essense is gone out of the therepy sessions what then?

and again I ask what negective effects does this have on the client?.

Hi,

I understand that the training in Sheffield is full, but do you have any idea when/where the next one might be? I am doing some strategic planning for next year and my organization has agreed in principle to the idea of sponsoring me to become a MINT trainer. Next year's schedule is already filling up, so I want to plan ahead! Also, could you give me a ballpark figure for the cost of the training.

Thanks and keep up the good work.

Russ T.

Hi I was wondering, does anybody else find that Motivational Interviewing can be some what manipulative?
I would like to put this topic up for disussion, and see were it takes us from there.
Kind regards Christine.

Thank you so much for your responses (and congrats on the new baby!!) I think maybe there are no good answers yet. It feels like we (dietitians) are just in the beginning of even understanding what we can do with MI, how complex it is to learn let alone evaluate if we are grasping the approach.
And thank you Orla, you have been very helpful. You have described just what I have been experiencing in my work with patients, just an attitude shift, they seem to leave with a feeling of relief as well as more motivation! So I guess that is definitely one way to evaluate yourself (although I am much more aware of what I am doing, I do struggle sometimes to NOT fall into that old way, forgetting to ask first before educating, etc but I know that being aware is half the battle!).....My thought was that we need to eventually get to the point where we can do some good research over time to see what works best for us as far as gaining skills. Just not sure the best evaluation tool to use, as in our department no one is really qualified to use the MITI, etc. I have thought of sending our tapes out for evaluation but that would cost too much to do for everyone. So for now we are just looking at the basics (focusing on the first stages of MI, 1, 2, 3 and 5-since rolling with resistance is so important in our field!). As for the "can of worms" that is just what we try to do...have resources to refer people to. But even recognizing that line and how to re-focus the session, I think needs to be a required skill for those of us who are not therapists. Not always an easy task for some of us! anyway, I love that everyone is so supportive of eachother in the MI world. So thank you for that! My goal is to continue to spread the word as much as possible in my flield, I feel we desperately need to do things differently. I will be sharing some of what we have been working on at Connecticut Children's Hospital, and some of the resources available (the books, websites, etc) at the FNCE conference in San DIego in September...hope to get lots of dietitians hooked!! Thanks again,
Joanne

Hi Joanne

I forgot to add a little about the can of worms concern.  This is a common worry that my colleagues raise and we discuss that we do not need to solve people's problems for them.  We have found that having a good knowledge of what services are available is helpful should a person need additional support.  However I have generally found that simply listening to someone is enough for them and they often say it is a relief to get something off their chest.

Not sure if this is of any help,

Orla

Hi Joanne

Apologies for not replying before now.  I too am a dietitian who is embracing MI and changing my approach.  I don't know if I can offer much but I can tell you how we are developing our skills in Cardiff.

The main challenge for our profession in the UK is to train dietitians to be patient-centred and to have basic listening and communication skills.  These are skills that I was not trained in at University or on placement and like many of my colleagues struggled with supporting patients with change.  It came to a point in my practice when I felt there must be another way to practice or to give up and find another profession.

I was then trained in communication skills for behaviour change and introduced to MI.  I began reading about it, attending workshops, trying it and constantly reflecting on my consultations. Of course this is an on-going process.  The main indicator of how I was progressing was feedback from the patients.  Consultations feel completely different, with patients attending more appointments, improved outcomes and comments from patients about how helpful they find appointments.

Myself and my colleagues get together and discuss the skills, practice them and watch dvd clips. 

I don't think I can suggest anything more than you are already doing but it is great to know such an effective approach is being embraced by colleagues in your part of the world as well.

All the best

Orla

I am looking for some guidance on sourcing tools to measure MI consistancy/skilfulness in participants who are to receive MI coaching after having undertaken a 2 day introduction to MI training course. I am aware of VASE, MISC and MIA STEPS. Any other suggestions?

Alan

I took my son and three teenage friends to the Latitude festival last week, and we lived in mud for 4 days, and saw and heard Ed Sheeran, a wonderful new musician who is sweeping the UK music scene. He deserves it, because he's supremely talented and has fresh and solid values.

if you work in the drugs field, take a look at the video of his A-team song. The best ive seen.  It would be a brilliant prompt in school health education.

http://www.youtube.com/watch?v=UAWcs5H-qgQ

Steve

Dear Joanne,

I see that 130+ people read your post and no-one replied.  That's awful!  I was hoping that poeple could talk with each other in this forum, but I'm a web novice so maybe I dont understand why or how people behave in a forum.

I'll get back to your interesting post very soon.  Weve just had a little baby, which is why I have been otherwise engaged!

Steve

I would like to share an issue I am struggling with as a registerd dietitian. MI has been identified as an "evidenced based" practice and so the ADA (American Dietetic Association) has been recommending we use this as one means of intervention. Although they have provided some great workshops (using MINT trainers), I feel we as dietitians are not understanding that with our background/training this is not something we can just go out and learn. I DO however totally love the approach and believe we can still develop skills and over time grasp the meaning of the "spirit" of MI. I just worry that there is more work to be done as far as "training" than we realize. I also believe in evaluation of skills, and have done lots of reading as far as the instruments that exist(such as the MITI), but do not feel most of us who are not MINT trainers will be able to get to that level. I have been fortunate to have worked under the supervision of pschologists for many years and so I may have a greater appreciation for the counseling field and the fact that it takes years of education, training and practice to develop these skills. I worry that with asking open ended questions, RD's may open a can of worms and not know how to redirect the patient. There probably needs to be some type of skills evaluation that takes this into consideration. Fortunately, where I work, my supervisor supports us gaining knowledge and skills in MI, and since I am the lead on this, I have been focusing on trying to educate our group on understanding and appreciating the complexity, working toward some doable gain in skills, such as even rolling with resistance vs shaming someone (what our patients seem to expect). I have started individual supervision with a MINT trainer, which is great, but most of us here can not afford this. Any advice on what other health professionals such as RD's can do to evaluate themselves to be sure they are doing the right thing? Thanks for any feedback!  Joanne

Dear Steve

Thank-you very much for that, I will e-mail her this morning.

All the best

Orla

Dear Orla

that video clip!   Its part of an old video that weve stopped selling, I think. You could email Jo Sloan (sloanjmatcardiff.ac.uk - I spelled out the at sign to avoid spammers locating her email address). She sellls the video apparently, but I dont get any of the proceeds..... if you fail, contact me and maybe I can download it from my machine and pass it on to you somehow.

Steve

Its just one study, but its an interesting one.  Here's a news report:

July 1, 2011 — A type of talk therapy called motivational interviewing (MI) that has been shown to improve mood and reduce mortality 3 months after a stroke continues to be beneficial at 1 year, a new study suggests.

"Not only did this intervention reduce depression and mortality in the short term, but the effects were still apparent 12 months after the stroke," said lead study author Caroline Watkins, PhD, professor of stroke and older people's care, University of Central Lancashire, Preston, United Kingdom. "That's important because it's a brief psychological intervention delivered in the first few weeks after the stroke."

The study was published online June 23 in Stroke.

After motivational interviewing, trained therapists encourage patients to talk about their adjustment to stroke and to be more realistic about the future. "It may adjust patients' expectations of what can be achieved and help them to feel comfortable with that," said Dr. Watkins.

The single-center trial included patients who were admitted to a hospital with a stroke unit between July 2002 and January 2005 with an acute stroke. They were randomized to receive usual care (n = 207) or usual care and up to four 30- to 60-minute sessions of MI that began within 4 weeks after the stroke (n = 207).

Researchers used questionnaires to monitor improvement, including the 28-Item General Health Questionnaire (GHQ-28), a widely used questionnaire related to mood, and others that assess activities of daily living and beliefs and expectations of recovery (Stroke Expectations Questionnaire [SEQ]).

In the MI group, the odds ratio (OR) at 12 months of having normal mood (or GHQ-28 score <5) compared with the control group was 1.66 (95% confidence interval [CI], 1.08 – 2.55; P = .02). There was also a protective effect of MI on death (OR [alive relative to dead], 2.15; 95% CI, 1.06 – 4.38; P = .03).

However, because data on cause of death were not obtained for the study, the protective effect of MI on death may be a chance finding, commented the study authors.

Beliefs and Expectations

There were no significant differences between groups on mean SEQ beliefs score (adjusted difference in mean [intervention relative to control], 0.5; 95% CI, −1.4 to 2.4; P = .61) or mean SEQ expectations score (−1.0; 95% CI, −3.2 to 1.2; P = .37). This, said the study authors, may be due to the SEQ's inability to detect change.

The difference between SEQ beliefs and expectations reduced over time in the MI group, suggesting that those who received this therapy might be, on average, more realistic about recovery than those receiving only usual care, commented the study authors.

There was no demonstrable effect of MI on activities of daily living, which is surprising given that the intervention influenced mood and mood is related to poststroke function. "We only measured fairly basic activities, which may reflect severity of stroke, and those things may not be able to be changed dramatically," explained Dr. Watkins.

The study did not measure participation rates in social and leisure activities, which may better reflect improved mood. These, said Dr. Watkins, will be measured in future studies.

It's possible that those assigned to only usual care didn't do as well as the MI group simply because they were aware that they didn't get the intervention or that those receiving talk therapy got better because they knew they were getting extra attention.

Helping to Adjust

Dr. Watkins pointed out that MI works not just because it's based on talk therapy. Studies of cognitive behavior therapy, which also incorporates "talk" to change behaviors, suggest that this therapy doesn't seem to work to improve mood in stroke patients. "So there is something about this particular talk-based therapy [MI] that is helping people to adjust and not to feel so depressed about the future."

That "something" may be that MI doesn't just change behaviors but also expectations and encourages patients to come up with their own solutions. "It's about allowing people to set the agenda, to talk about the things they want to talk about, and giving them room to actually talk through things," said Dr. Watkins.

MI has been used to change behaviors in people who depend on alcohol, food, and cigarettes, she said.

The timing and frequency of the MI sessions may have contributed to the benefit of this therapy, and additional sessions may be even more effective. "Some people may benefit from having a longer intervention period, but we don't know that just now," said Dr. Watkins.

MI is relatively easy to learn, and various healthcare professionals can be trained to practice it. In this study, none of the therapists had experience in psychological therapy, although they were trained by neuropsychologists. They included 2 nurses and 2 psychology graduates.

The study had patients with some speech and language problems so the therapy does not have to be restricted to stroke patients with unaffected communication skills. In fact, said Dr. Watkins, “some preliminary analysis seems to show that not only have those people benefited, but it may be that they actually benefited more than the people who had normal communications.”

It's not clear why this would be, but it may have something to do with patients knowing they're being heard. “We wondered whether it had to do with having somebody who is prepared to sit down and actually listen to what you're saying and try to show by using reinforcement that they've heard what you've said and then allowing you to talk more about it.”

The mechanism by which MI was effective and how it influenced mood and survival require further exploration, said Dr. Watkins.

The next step for her research team is to see if the therapy works outside their center. She wants to perform a multicenter study possibly including centers in Australia.

Striking Benefit

Asked to comment, Howard S. Kirshnerm MD, professor and vice chair, Department of Neurology, Vanderbilt Medical Center North, Nashville, Tennessee, and a member of the American Academy of Neurology, said he found the "most striking benefit" of MI was reduced mortality at 1 year.

"Depression scales showed less benefit, and activity of daily living measures did not show a difference at 1 year," he wrote in an email to Medscape Medical News.

His greatest criticism is that the investigators only used measures of attitudes or optimism and didn't include a quality-of-life measure because improved quality of life may be the ultimate aim of the therapy.

The study authors have disclosed no relevant financial relationships.

Stroke. Published online June 23, 2011.

Dear Steve

The review sounds very interesting, obviously a subject close to my heart.  I will have a look at that. 

On another note, there was a video clip that you played at a workshop in Cardiff a couple of years ago with Chris Butler discussing heart disease with a patient.  Is that clip available anywhere?

Many thanks

Orla

There's a new review and meta-analysis out on MI for weight loss, the subject of a large current study and training effort here in our Department in Cardiff.

Here's the link http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2011.00892.x/full, and here's the summary:

Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obesity Review, 21 Jun 2011, DOI: 10.1111/j.1467-789X.2011.00892.x

Summary

Motivational interviewing, a directive, patient-centred counselling approach focused on exploring and resolving ambivalence, has emerged as an effective therapeutic approach within the addictions field. However, the effectiveness of motivational interviewing in weight-loss interventions is unclear. Electronic databases were systematically searched for randomized controlled trials evaluating behaviour change interventions using motivational interviewing in overweight or obese adults. Standardized mean difference (SMD) for change in body mass, reported as either body mass index (BMI; kg m⁻²) or body weight (kg), was the primary outcome, with weighted mean difference (WMD) for change in body weight and BMI as secondary outcomes. The search strategy yielded 3540 citations and of the 101 potentially relevant studies, 12 met the inclusion criteria and 11 were included for meta-analysis. Motivational interviewing was associated with a greater reduction in body mass compared to controls (SMD = −0.51 [95% CI −1.04, 0.01]). There was a significant reduction in body weight (kg) for those in the intervention group compared with those in the control group (WMD = −1.47 kg [95% CI −2.05, −0.88]). For the BMI outcome, the WMD was −0.25 kg m⁻² (95% CI −0.50, 0.01). Motivational interviewing appears to enhance weight loss in overweight and obese patients.

Congratulations on your new baby!!

I am quite familiar with your book, MI in Health Care as I have read it cover to cover.  Great book!

I am looking for an example of a MI conversation related to diet that I might use as a handout.

It is difficult as you are probably aware to fit these things on a slide.

Thanks again for your help.

Julie

Dear Julie,

dont forget to check www.motivationalinterview.net for all sorts of resources.  How would you want to present a case study?  In dialogue? How much time do you have and what exactly do you want to illustrate with the case? What aspect of practice would you like to highlight?

I dont mean to promote my books in public, but have you looked at Motivational Interviewing in Health Care?

Forgive the delay. new baby this side!

Kind regards, Steve

Dear Jennifer,

Please write to me back channel, but it might not be of help because I dont do travel training any more!  preserving my time for family and writing.

kind regards

Steve

Hello Dr. Rollnick!

I would love to have you present MI to professionals (doctors, nurses, psychologists, LCSWs, MFTs, dietitians, school nurses, etc) during Eating Disorder Awareness Week in March 2012.  The San Diego Chapter of the International Association of Eating Disorder Prevention organization will host a community event to educate and train professionals on how to talk about obesity without triggering an eating disorder.  Our goal is to bring the eating disoder and obesity communities together to work collaboratively and provide professionals with the best tools in the industry to succeed in patient care and outcomes. 

Might you be interested in presenting to us and being the highlight of our conference?

Warm regards,


Jennifer Torio-Hurley, LCSW
Healthy Within, Inc.
Incoming IAEDP President San Diego Chapter
jtoriohurley@hotmail.com

Dr. Rollnick,

 

Thank you for your email. 

As I mentioned previously, I am preparing for a professional lecture on "Motivational Interviewing, Strategies to Promote Adherence to Diet."  I am speaking to a group of lipid specialists.  I am interested in whether you have a case study or other resources that I can share with your permission with my group. 

Sincere thanks,

Julie

 

Hi Stephen,

This is an interesting idea!

Best wishes,

Ivaylo

Wonderful post Marie!  With your title, and a completely blank posting, maybe this is some kind of post-modern Zen-like joke on your part?

Steve

Dear Ivaylo,

that's a great idea, having different levels of sustain talk.  We will probably find that its been tackled by researchers like Terri Moyers, who has run so many studies on the process-outcome relationship in MI.  But clinicians might find this helpful.

Ivaylo, here's a slightly wild idea: if you and I share this concern about a term like resistance because it pathologises the client, are we not guilty of this trap by only focusing on client aspirations, like sustain talk and change talk?  In other words, what about the counsellor's aspirations?  Why have they not been described and studied?   Here's a suggestion: in any conversation about change both parties have aspirations for change in the client. These can be positive and negative, and they can vary in strength.  Funnily enough, very strong counsellor aspirations, unlike strong client ones (like change talk), might not necessarily be productive, because counsellors too often push clients towards change when their aspsirations get too strong.......

All best wishes

Steve

Hi Stephen,

Thanks for your sharing.

I agree with you about the archaic meaning of the term "resistance" in the context of MI. I think the expression "discord" as a good substitute for what happens between us (consultants) and client and this gap between us which occurs for various reasons.

On the other hand I think the need to distinguish between different levels of sustain talk as it is in change talk (DARN ACT).

I look forward to MI-3.  Keep up the good work.

Best wishes,
Ivaylo

P.S. I hope one day Bulgaria to host MINT forum again.

Dear Ivaylo,

how good to hear from you in Bulgaria.  We had a good training the trainers workshop in Sofia some years ago, and I even appeared on that Friday night chat show, and experience I hope never to repeat!

Ivaylo, its been a struggle, finding the useful terms for things that are so hard to understand. A bit like swimming across a coral reef, seeing all the colour and life, then coming up and describing it. Our understanding is far from complete, and Miller and I are not the "last word" on the subject!

Hal Arkowitz is a psychotherapist who Bill Miller describes as his mentor. A wonderful man.  His work is well worth absorbing.

Bill and I have agreed that it might not be helpful to use the term resistance at all, because it could pathologise the client, the term coming from the depths of psychoanalysis. Moreover, we have also agreed that its a mistake to view the expressions of ambivalence as in any way a problem.  We now use the term sustain talk to describe the clients arguments for no change, and change talk for the opposite.  Very normal expressions.

Then what term do we use to describe little and larger breakdowns in the relationship, that occur for all sorts of reasons at various times? We wonder about the term discord.... but that's another story...

Ivaylo, it is hard enough trying to share ideas about what's going on in the coral reef, but quite how you do this in your second language just amazes me!

Warm greetings,

Steve

Hi,

Recently I found an article "Vewing Resistance as Ambvivalence: Integrative Strategy for Working With Resistant Amvivalence" by David Engle and Hal Arkowitz; Journal of Humanistic Psyholog 2008 48: DOI: 10.1177/0022167807310917.

To me sounds very logical, but is it appropriate phrase "Resitant Ambivalence" to be used in the context of MI?

Or maybe the right question is How in MI should be describe this expression?

Sincerely,

Ivaylo Raynov

P.S. I am a Bulgarian and apologize if the questions do not sound logical in English.

Dr. Rollnick,

Thank you very much for your help and taking your time to look these articles up for me.  That and Ruth's name is a help!

Sincerly,

Bonnie

Dear Bonnie,

I dug up these references - some might be helpful.  There's a large list of references in the HIV field, but I cant see one related to compusivity.

I dont know what country you are in, but Ruth Mann is a name in the UK for sure.

Kind regards, Steve

Mann, R. E., & Rollnick, S. (1996). Motivational interviewing with a sex offender who believed he was innocent. Behavioural and Cognitive Psychotherapy, 24(2), 127-134.

Del Giudice, M. J., & Kutinsky, J. (2007). Applying motivational interviewing to the treatment of sexual compulsivity and addiction. Sexual Addiction and Compulsivity, 14(4), 303-319.

Golin, C. E., Davis, R. A., Przybyla, S. M., Fowler, B., Parker, S., Earp, J. A., et al. (2010). SafeTalk, a multicomponent, motivational interviewing-based, safer sex counseling program for people living with HIV/AIDS: A qualitative assessment of patients’ views. AIDS Patient Care and STDs, 24(4), 237-245.

Parsons, J. T. (2005). Motivating the unmotivated: A treatment model for barebackers. Journal of Gay and Lesbian Psychotherapy, 9(3-4), 129-148.

Petersen, R., Payne, P., Albright, J., Holland, H., Cabral, R., & Curtis, K. M. (2004). Applying motivational interviewing to contraceptive counseling: ESP for clinicians. Contraception, 69(3), 213-217.

Hello,

I was wondering if MI has been applied to working with Sexual Addiction (about research in this area and any clinicians who have done this?)

Thank you much!

Hello,

I was wondering if MI has been applied to working with Sexual Addiction (about research in this area and any clinicians who have done this?)

Thank you much!

Dear Orla,

easy as it is to blame others for poor training, a depressingly frequent experience from what I hear, I am struck by the place I might have in this: Bill Miller & I never designed a proper certification procedure from the outset, which I am not sorry about but feel bad about the consequences of, and secondly, is our writing clear and unambiguous?

Ehmmmmm.

Steve

Dave,

good to hear from you and about your progress.  Feel free to discuss any issue here, anything but perhaps not to do with commercial promotion, if you know what I mean!

Good people to contact to answer your question are Tim Anstiss and Melvyn Hillsden.  They are at the centre of the GP scheme.

Look forward to hearing from you, Steve

Apologies forum readers for this correspondence that I'll take back-channel.

Steve

Dear Lauren,

Bill Miller & I are completely re-writing the basic text on MI, and it should be out early next year. Kind regards, Steve

Were you planning on re-releasing your book anytime soon?

Hello, my name is Shawna Hervey. I am the Administrator at Valley Vista in Bradford, VT. We are an Inpatient Chemical Dependency Treatment facility that sponsors a two day, statewide Substance Abuse conference every fall. The conference committee is beginning to line up keynote presenters for this year’s conference and we’d love for you to join us up in the beautiful green mountain state! The conference dates are October 6^th and 7^th, 2011. The event is being held at the Lake Morey Resort in Fairlee, VT.  Is speaking at our conference something you would be interested in? Please respond to my email or call me at 802-222-5201. I look forward to hearing from you soon. Thank you SO Much for considering Vermont as a location for one of your speaking events.

Kindly,

Shawna Hervey

Administrator

Valley Vista

23 Upper Plain

Bradford, VT  05033

802-222-5201
SHAWNA.HERVEY@VVISTA.NET

Hi all,

Is there anyone working within GP Exercise Referral Schemes utilising MI, for example, Phase 3-4 Coronary Rehab. Technogym are working with a number of PCT's around the counrty GP adherance programmes with a study at Kings College.

Anyone out there working on exercise adherence?

Kind Regards,
Dave
dgerrish@technogym.com
07584 280 940

Its time to move very very quickly if you want to get on this course. Like do it today if possible, or tomorrow...... Steve

Hi Stephen,

Hope and trust you are well, to jog your memory I attended the Rhode Island Train-the-training and may remember me as the "As you were" individual from the evening sketch show.

Since Rhode Island I and Brett have trained over 250 exercise professionals in the principles of MI to overcome the barriers associated with exercise compliance. I would welcome the opportunity to discuss MI within the exercise industry and how I can take this fwd with my new Company to aid rentention within the fitness industry to Wellness Programmes.

Kind Regards.
Dave Gerrish, Technogym UK.

Hi Christopher,

www.motivationalinterview.net

TNT registration is slated to open on Monday, March 21, 2011 at 12 noon EST (5pm UK, etc.)

Best wishes,

Ivaylo

Does anyone know if the Trainers event mentioned earlier for later this year is being advertised yet and where?  I would be keen to attend and in the year end style there seems to be a small pot of money for something like this but details must be in by 25th March.

Hi Steve

I attended a weight management course today which I have to say really stretched credibility of MI.  Worryingly the course leaders were "teaching" MI as part of the course without a clear understanding of what it is.  I will stop before I say anything else but it is very frustrating.

Orla 

Steve

EARLY MARCH - if you want to apply for the Training for New Trainers to be held in Sheffield in 2011 (September), you can start preparation now.  Places fill up very quickly.  The best thing to do now is download the application criteria from this website:

www.motivationalinterview.org

There, on the front page you will find this information, including a link to the application crtieria. See the last tewo lines I have pasted in below.

Regards,

Steve

A call for applications to attend the TNT workshop will officially open in March, 2011.

At that time a link will be provided where those who are interested can submit their applications online. The application questions and evaluation criteria to be used by the review committee are attached in pdf format to help prospective applicatns prepare their responses in advance. Please not that the TNT workshop is designed to help skilled MI practitioners enhance their MI training skills, and expects applicants to demonstrate their skillfulness in delivering the clinical method of MI. applications will be reviewed in the order they are received.

For additional questions about the application process, please contactmint.tnt.applicant@gmail.com

Application Questions
Application Evaluation Criteria

Hi Steve

Yes, I agree with you about discussions about change being unhelpful and circular and most colleagues in my profession will also voice this. 

I have been practising again in clinics this week with really positive results.  For some follow-up patients, even asking towards the end of the appointment what would be helpful to focus on at our next meeting they have been coming up with specific ideas which is really helpful.

There have been three patients this week who have had multiple health problems and the process of agenda mapping has helped both of us to see where they want to focus and also the links between the other struggles in their life and eating behaviour and weight.  It certainly makes me feel more focused.

I will reflect on these three particular patients and e-mail them to Nina, if that is ok?

Many thanks again

Orla 

Dear Orla,

Those experiences you are having with agenda mapping are of great interest to Nina and I.  She and I share a clinical intuition that the focus or direction of consultations about change is often blurred, circular and unhelpful. We also feel that there must be naturally good practice out there, without any reference to MI, and some of the tapes we gathered during that recent workshop, before we got into MI, confirm this. Good practice exists, with skills yet to be unearthed.

If you are finding that agenda mapping is helpful, any tapes you gather will be like gold dust for us. Moreover, what about your reflections? Single paragraphs, like a log, that describe your brief reflections after a consultation?  if you are inclined, why not gather them, perhaps without any personal client details revealed?

Fascinating. Thank you so much.

Steve

Here's a possible EXAMPLE NO 2.

See www.michaelpantalon.com

This book apparently purports to be an adaptation of MI.  And on the front cover it says: "How to get anyone to do anything fast" and "the only motivational approach scientifically proven to succeed in less than 7 minutes".

if this is in any way an adaptation of MI, or derived from it, the fundamental misunderstanding of MI could not be stronger. MI is not something done to or on someone, but with them. Its not about getting someone to do something that they would otherwise not want to do. I could continue.....

Leaving MI to one side, is behaviour change in clients that simple that anyone can aspire to the subtitles quoted above?

Has credibility been stretched here? The science?  I wonder how many trials of this "7-minute method" in the book have been done, of what quality and among what populations?

I might ask Dr Micahael Pantalon to join this discussion to explore with us in an open and respectful way some of the answers to these questions. I dont mean in any way to be personally disrespectful here to him, but I do believe that credibility might have been stretched?  or have I misunderstood something?

Steve

Hi Steve

Thank-you so much for taking the time out to listen to my tape and to get in touch.  That has to be the ultimate compliment, coming from yourself, so thank-you.  I am also glad to hear I'm not completely off the mark.  The patients respond so positively and I can now say I really enjoy my job, I am commited to continuing to develop my skills.

It would be so helfpul to have feedback on my tapes and once I get the trust's agreement on this I will take you up on your offer.

I have had plenty of practice on agenda setting and mapping over the past 3 days with quite amazing results.  One patient said it was so helpful to have a plan for future appointments together and took a copy of the agenda map to look at before our next meeting.  In addition I have been using affirmations more after listening to your simulations with also amazing responses.  One particular patient who was using sustain talk last week, and I admit I was building myself up to this mornings appointment, responded so differently and was actually using commitment language by the end.  So thank-you to yourself and Nina for such a helpful workshop.

I will let you'se know how finding focus goes.

All the best

Orla

Well, I see that they have taken "Certified MINT Trainer" off their advertisement, which is a relief. I believe that a colleague wrote to them about this. Nice outcome.

They still have "interactive exercises" in the literature, which remains a credibility stretching puzzle.

Steve

Dear Orla,

I couldnt find your email address.

Well, Ive now had the privilege of meeting you, when you attended our exploratory workshop this week.  Do let Nina Gobat or me know if you want your tapes listened to....... there's a couple of teams in our Department wanting tapes to practice coding on.... but whether you can elicit agreement for this from patients could be a challenge.

Anyway, I had the privilege of listening to a tape you made in the workshop, and just hope that you can continue to develop your skills, feeling as I am like a talent spotter of MI skillfulness, which you have in spades full!  I learned so much from your tape and those of others, a subject I might share on this forum sometime.  How do practitioners establish focus?  Quite a fascinating journey.

All best wishes,

Steve

thank you for your response.  I have also not found much on using it in supervision as a tool.  I work for The Butler Institute in Denver COlorado an am creating a curricula to try and help child welfare supervisors motivate their caseworkers in various aspects of their job.  Many Child Welfare agencies say they use a MI model with clients so it should be mirrored in supervision.  Yet it is a different type of relationship and different issues.  What would you think are the 3 or 4 best techniques to use in this environment?  I was thinking that is they are having a difficult client you would help them explore the ambivalence with reflections.  It is just difficult on how to mold it to use in this supervisory forum.  I will try and contact

I understand that the application process for the Sheffield TNT will be opened in March.  I'll do my best to provide more information as it comes to my attention.

Steve

Having tried hard to avoid stretching the credibility and scope either of MI or myself as a trainer, my jaw sometimes drops at the credibility stretching that goes on in the name of offering this or that service, idea, book or training workshop.

Sometimes I end up writing to people asking them why they are stretching credibility. Its frustrating, and in any case, I have no wish to be seen as the policeman of "incredible" claims.

I decided to list an example here, without stepping into legal difficulty I hope.  I might well list others. Feel free to add to this list - just make sure that you ask questions rather than make accusations that make you or me vulnerable to legal threats....

EXAMPLE NO 1: HAVE A LOOK

http://training.aso-online.com/

Here are two questions:  Firstly, how can an organisation advertise a "certified MINT Trainer" when no such thing exists?  Why would they want to do that?  The answer seems obvious, but it would be nice to hear from them.

Secondly, if you look at the content of this advert, essentially for on-line learning, the account includes "interactive exercises". Most trainers know that interactive exercises involve observation of practice and feedback from a trainer. What do they mean, I wonder? Are they suggesting that they will do this on-line? If not, why use the phrase?

I'd be interested to see the certificate of completion. I just hope it doesnt claim that the trainee has learned MI.

Other examples will follow when I come across them.

Nice to have that off my chest!

Steve

Wow Elvind! Great question.

This forum on MI & SDM is going through a quiet phase, and I am trying not to dominate it. Its for others to use and enjoy.

We might have some have motivational problems among many of the key people in MI & SDT who are not contributing to this forum as yet - they have the competence, they should feel nicely related and at home here, yet their autonomy is expressed elsewhere! That’s just a joke. People are clearly busy, and its also possible that so many questions have been raised in this thread that its hard to know where to begin. I certainly feel that.

To receive a specific question like yours is therefore really helpful:

SDT: I’d like to hear from SDT folk about whether your characterization of SDT is one they are happy with: “a nondirective humanistic and organismic approach (SDT)”.

MI: You characterize MI as “a more directive and behavioral approach”. I think you will find a range of views here within the MI field. Few would characterize MI as simply as a “behavioural approach”. My personal view is that there is an inevitable convergence between the practitioner’s aspirations for change and those of the client. Hence my efforts to describe good practice in change conversations as being based on a guiding style (see MI in Health Care book), in which there is a frank and open effort to clarify and agree on the focus for change. From the outset, Miller & I described motivational interviewing as “client-centred and directive” (see Rollnick & Miller, 1995).

My suspicion is that when it comes to practice, MI & SDT are overwhelmingly compatible. The former is a method with ongoing efforts to explain it, the latter is a theory with ongoing effort to apply it. Hence this forum space for anyone to contribute to. Barriers between therapy forms in the psychology world have left a legacy of competition and bitterness that we should avoid at all costs. Open debate in a generous spirit – let’s go!

Kind regards to you Elvind, Steve

Dear Crista,

you dont say where you are and what country and language you work in?  I ask because most developments I know of are taking a bottom-up form in different countries, in which supervisors are being trained to use MI in supervision in everyday practice. Little has emerged in the research literature to date.  When I plugged "MI in supervision" into google, I found a paper by Scott Walters in the criminal justice field. There might well be others if you look more thoroughly.

In most places where MI is being used by supervisors it is also being used by practitioners.  No surprise there, because the parallel processes are obvious - both practitioners and their clients struggle to adjust and change.....

I know of work in your field in Cardiff in child welfare, if you live in the UK. Sweden too. Definitely in the US people will be doing this. Melinda Hohman is the person I would turn to. She's in San Diego. Child welfare, social work practice and motivational interviewing is her special interest, and she is a really top rate person, writer and researcher.

Happy to talk more in this forum.

Steve

Dear Anne, see my reply to a very recent post on exactly this question.

kind regards, Steve

Dear Chris and colleagues,

A new website for the MINT organisation will be up shortly on  www.motivationalinterview.org . Meanwhile, browse this site for information about MINT.

1. If you want to go to a TNT (training for new trainers), study this website.

2. You can post an email to put your name on a mailing list for notification of the advert for a new TNT.   See http://www.motivationalinterview.org/training/mint.htm . This is important because when this advert comes out, you need to move quickly.

3. The next TNT is in Sheffield UK, 5-7 September 2011.

The year after that there will be one in the US.  I am not involved in any aspect of the planning or delivery of TNTs.

Do let me know if I can help any further.

Steve

Hello.  I am looking for any direction around how to utilize MI in supervision of child welfare workers.  I am not talking about supervising people who are providing MI services, just using the techniques as a way to motivate workers.  Any direction of materials would be helpful.  thanks - c

Hello, I am very pleased to be joining the new forum and thank you for your guidance. I'm not sure this is the correct place to post this query but I will go ahead anyway.  I understand from the site that there will be a TNT course in the UK this year. I was wondering whether any dates had been confirmed yet.

Many thanks.

will there be a 2011 training of trainers in the us and if so do you know when and where this will happen?

I have been inspired by the mutual benefits of combining MI with SDT, and have read the two theoretical papers with great interest:
Markland, D., Ryan, R. M., Tobin, V. J., & Rollnick, S. (2005). Motivational interviewing and self-determination theory. Journal of Social and Clinical Psychology, 24, 811-831.

Vansteenkiste, M., & Sheldon, K. M. (2006). There is nothing more pratical than a good theory: Integrating motivational interviewing and self-determination theory. British Journal of Clinical Psychology, 45, 63-82.

There is an important question that seems unanswered by the papers as I can see it: The metatheoretical contradictions between a nondirective humanististic and organismic approach (SDT) and a more directive and behavioural approach (MI). It is possible that I may have misunderstood, but I think it is important also from a clinical point of view (I am a MD). I think that the danger of nondirective counselling may be liberal indifference or "soft manipulation", and the danger of directive counselling is authoritarian misuse of power and resistance. MI seems to address the last pitfall without withdrawal from the responsibility of directiveness in counselling. Has SDT changed its metatheoretical foundation? I hope someone might clarify this question for me? Is it an irrelevant and constructed disaggreement?
Eivind Meland, UoBergen

Thanks Steve, I was aware of some of the work of the FNP programme I will check out with the nurses you speak of from Derry what their experiences are. I have had a few nurses from the Surestart schemes in Northern Ireland attend trainings I have provided and I recall they worked specifically with targeted groups of young mothers who were struggling to grow into the demands of becoming a mother. They had a few ideas about becoming more curious with the young mothers about how they could achieve the aspirations they had fro their babies.

I have been thinking a lot about the trap you describe and about how not being broad in developing a conversation about caring for the child could undermine any good work/aspirations of the practitioner/mother. It is top of my agenda to find a helpful way of exploring with these midwives how they can raise the subject in a way that doesn't elicit resistance or scream of the righting reflex by assuming their aspirations of parenting are narrowly determined by how the mothers choose to feed their babies. Their practice experiences have been guided by an approach that are typical of many contexts - ensure you assess/address a,b&c so moving to an approach that requires the practitioner to be more flexible and demands good skilful listening will be central to all other work.

I too will have to be mindful of my aspirations as the trainer - doing a few simple things well in the one day workshop I have with 5 different groups - about 100- 120 midwives/health visitors working in maternity units/community settings!  I am hoping to encourage them to use this discussion forum to share their experiences and expand on their thinking around these practice challenges, it would be really something if the FNP colleagues you speak of could add their voices!

Thanks again

Kathy

Here are some questions, several which I've circulated previously and many of  you have commented on. I thought it might be good to post them here in the official forum. If those who answered previously would post their responses that would provide a nice archive of the discussion....I have tweaked a few of them, which might tweak a few of you...he he....

So happy to see this rolling

Ken R from Ann Arbor (12 degrees F today)

FROM MI TO SDT
How does SDT conceptualize RESISTANCE and REACTANCE, and what would the SDT practitioner do to mitigate them clinically?

How does SDT conceptualize AMBIVALENCE, and what would the SDT practitioners do to mitigate?

• Are they above manifestations of AMOTIVATION or CONTROLLED motivation?  Can a client be autonomously motivated and still ambivalent or resistant?v
• Given the SDT continuum, can a person be at multiple positions along that continuum simultaneously?

Why, from an SDT perspective, is reflective listening, particularly rolling with resistance and amplified negative, so darn effective?
Why, from an SDT perspective, is change talk so important in behavior change?

• How do you conceive change talk?  Why is the actual verbal expression important in buildng autonomous motivation?

Can autonomy be retained even when the practitioner is directive?

• What is the difference between autonomy support and volition?
• Given MI is now defined as GOAL ORIENTED, does that conflict with the concept of autonomy in SDT?

How does the MI clinician balance the three needs of competence, autonomy and relatedness, particularly when they may collide. Example, pt. with low efficacy asks the doc for highly directive advice about HOW to do something.  SDT seems to have shifted focus more on AUTONOMY than the other two needs. 

FROM SDT TO MI
How does (or should) MI incorporate the concept of ENERGY (used in SDT) as it relates to motivation and behavior change?  Is the change talk crescendo, shown to predict outcomes recently, really a shift in ENERGY and or HOPE?

Is AMOTIVATION too difficult to change even for MI?

Is building discrepancy through values clarification borrowing ENERGY from one domain and lending it to the behavior change at hand?

Does MI adequately account for/focus on, etc AUTONOMY support and VOLITION?  We obviously talk about it, but maybe we need more targeted training activities in this regard.

Is our goal orientation in any way inconsistent with AUTONOMY support and VOLITION?

What is the role of COMPETENCE and RELATEDNESS in MI? Perhaps the former has a discrete role (ii.e, the 0-10 ruler) while the later may be more subsumed within the therapuetic alliance.

Should MI distinguish between TYPES and therefore quality of change talk,  CONTROLLED vs. AUTONOMOUS (and do we need to care about the difference)?  We seem to focus on amount more than quality.

Should we devote more effort to SDT constructs in our coding systems such as MITI? Automony is already a global but less so competence.

Wonderful Julia. I loved the simplicity of your question. let's see how others feel about this.  I also feel a little ignorant of the nuances of intinsic motivation. Steve

Hi,

I have read a little and am interested in SDT (particularly related to sport and exercise settings) and whilst I agree with the reams of literature suggesting that intrinsic motivation is an extremely desirable quality (I will have to read more on MI!), I also wonder how can I enhance someone else's intrinsic motivation? If I were to 'interfere' then surely I would by definition be influencing the individuals' extrinsic motivation, which again according to the literature can undermine intrinsic motivation? Is this a dilemma or am I just stuck in the maze of my limited understanding?

Almost (but not quite!) answering/reflecting on the above, the process of internalisation may use this extrinsic motivational influence and over time assimilate it into the indivduals thinking. Under the right circumstances this could move towards a more integrated motivational approach which itself may enhance intrinsic motivation... but should it just be left to 'chance'?

Is this where MI comes in?

Apologies if I have moved off task!
thanks for listening
Julia

Dear Kathy,

Everything you describe as being useful here makes good sense to me. The scenario is also familiar.

I can see a trap that many a well-intentioned MI practitioner and project have fallen into however. A single change focus. One sees this in countless evaluations of MI, and the rationale goes along these lines: "Let's try to improve ---- (smoking cessation; breastfeeding; exercise.... etc etc).  Let's use MI."

So the practitioners, with a firm change agenda and good MI skills raise the subject. Resistance, and poor outcomes.

The problem could be that the focus is too narrow, and the subject is not raised in a broad context.

The best example of genuinely generic intervention with mothers I have come across is the Family Nurse Partnership (there is a team in Northern Ireland, by the way - I met them; a great bunch of people from Derry). These nurses are trained in MI, and lots more. Their focus is on the heart's desires of the mothers. Breastfeeding will be discussed in that context.

You can learn about this lovely programme via google ( see for example, http://www.dcsf.gov.uk/everychildmatters/strategy/parents/healthledsupport/healthledsupport/).

The founder of this programme, David Olds once described to me the place of MI thus: "Its a powerful ingredient in the fuel that drives good practice". No more, no less!  Its good practice that were all after.

if you get hold of that team in Derry, maybe they can help?

Kind regards, Steve

Dear Greg,

thanks so much for coming into the discussion. I hesitated to reply because I want others to join in and dont want this exchange to revolve around me!

Nevertheless, maybe I can restrict myself to clarifying aspect of MI......

Definition(s) of MI. You express a concern that ...." intrinsic motivation does not seem to remain in the definition for MI in the upcoming revision, which I understand is a work in progress".  Bill Miller and I are busy reconstructing a framework for MI, shifting around the pieces of a puzzle about what we imagine MI is or could be. Its always been this way for us, relying on the clinical insights of ourselves and others. Definitions are tricky. You cant include everything in a definition. In any case, they are merely pointers to what's inside MI, not the last word on the subject. Yet intrinsic motivation is at the heart of MI for sure. Definitions? We will probably use three!  A lay person's definition, a pragmatic practitioner's one, and a technical one.  Our current lay definition (& and this is only a provisional one, not for citing in publications yet etc etc) is: Motivational interviewing is a collaborative conversation to strengthen a person’s own motivation for and commitment to change

Are you happy?

Having noted this, only a brief scan of SDT leads me to realise that my understanding of he dynamics of intrinsic motivation is very limited. That's why I am so keen to learn from the SDT field. Please help anyone, with a pragmatic practitioners guide to intrinsic motivation from an SDT perspective!

Then we might move on to autonomy.  Enhancing this feels fundamental to MI, whether its in the definition(s) or not. Again there will be nuances about autonomy that the SDT field can help us all with.

Finally, let me say that I have been reviewing recently theories of behaviour change and their relevance for health psychology with a group of colleagues. I'm disappointed about how little attention is pad to SDT in the literature. Its seems to be that so many social cognitive and value expectancy models ignore relatedness and autonomy. I'm shocked. There's also an assumption that change is linear in many models, which goes against what I know to be a circuclar, dynamic and process, filled with what I have called irrational coherence, which takes me back to the concept of ambivalence as a core construct......... that's for another discussion.....

Long may we champion the role of client values and needs in understanding and promoting change that makes sense to them.

Kind regards, Steve

Steve,

Thanks for the forum, and for this discussion. I had seen a journal article where you were a contributor suggesting that SDT might be a theoretical framework for MI. Let me say that I don't have a great grasp of SDT, and consider myself a student (still learning) about motivational interviewing.

I've recently read Daniel Pink's Drive, which is centered around motivation, and specifically the value of intrinsic motivation. This seems where the likely intersection between MI and SDT exists, and in my mind offers the greatest potential. In a recent post on another forum, there is mention of a study about integrated CBT and MI. One of the findings is that MI influences readiness to change 12 months later, but that it seems to be diminished somewhat at 24 months. Perhaps an increase in intrinsic motivation is a key ingredient for sustaining this impact.

Intrinsic motivation, at least according to Pink and others, addresses mastery, autonomy, and purpose. MI would seem to intersect well with the first two through self efficacy and choice, but not sure about the match with purpose/relatedness - connecting someone to a sense of belonging (I'm certain this is way too simplistic). I would think that a focus on helping someone develop intrinsic motivation would be key in seeing readiness to change extend long term.  How might this be accomplished with MI or some other therapuetic approach? I don't have an answer, just wanting to learn from thosse who might have ideas about this.

This strikes me as a particularly interesting conversation at a time when intrinsic motivation does not seem to remain in the definition for MI in the upcoming revision, which I understand is a work in progress.

Greg Sumpter

I am doing some work in planning workshops with a regional public health nurse who is developing ways of implementing policy and practice in the area of infant feeding that is directed at increasing the rate of breast feeding. A recent piece of research evaluating mothers experiences of how midwives and other health professionals have approached the issue of infant feeding choices has shown disappointing results regarding the approaches to date (a check-list approach that has been adopted to cover the 'must do' standards of information giving related to breast feeding).

A lot of the experiences expressed by women in this qualitative study (prenatal and in the first year after birth) have described feelings of being judged, not listened to, not believed etc when in conversations about this delicate subject. There are many factors that are believed to influence how effective individual nurses or midwives are in conducting these conversations  - how they have fed their own babies or been fed themselves, how confident they feel in raising the issue in the first place, pre-conceptions about the mother's previous choices and so on.

We are setting out to invite these practitioners to reflect on how they may try to engage in a way that is more constructive and I have some ideas that I think will be useful - adopting a guiding style, key communication skills of asking, listening, informing and some strategies such as agenda setting, exploring importance & confidence, EPE information exchange.

I wondered if anyone on this forum had any experiences of working in this area as a practitioner,researcher or trainer that they have found helpful in helping mothers make important choices about infant feeding.

Warmly

Kathy

Steve, I wonder what the primary aim of the letter was? I can't imagine with so much knowledge in health promotion theory and practice the DOH was targeting parents with children who suffer obesity problems to effect positive change!

I fear such a letter is more about a propensity toward poorly designed strategies to guard against child protection litigation - crudely reflecting the growing adoption of 'fault finding' to compensate people who feel their human rights have not been protected by the state!

This is probably not the forum for discussing the political contributory factors to health system design but when I read your post I shuddered as I have listened to a number of debates on the pro's and con's of strategies intended to make parents more accountable when it comes to their child's health. The moralistic, 'back covering' voices are getting louder in the current landscape of financial recession and conservative administration sadly!!

Pragmatically, in my own struggle to ward off becoming pessimistic and jaded, I think training to try and counter this assault on collaborative working is even more important to protect a threatened culture of using every encounter to be more helpful/constructive/guiding in nature.....not MI but with the qualities of MI!

Maybe this is misguided energy as it masks the core problem (sending the letter in the first place) but the analogy that I use is the situation of a person with an alcohol problem being 'sent' to an addiction service and being angry they have been judged to have a 'problem'.................how I respond to this is critical if I am not to alienate this person even more!

'Interesting times' to use a much over used euphemism................from a frozen Northern Irish friend gazing out at the freezing fog wondering what challenges are on their way!

Kathy

You will find this report by Christine Barrowclough and colleagues in the latest edition of the British Medical Journal (2010, 341, c6325).

I will try to locate the colleagues who delivered the intervention in this trial for their refections on what it was like to combine MI & CBT in a very tough client group.  I think it was Paul Earnshaw and Rory Allot.

Steve

OK, SDT colleagues, here's a really ignorant question:

Is there a form of counseling or intervention that you have developed from SDT?

Interesting secondary questions include what does it look like, have you devised a measure of competence and do you have audiotapes of sessions?   I then get to wonder how different thes sessions might be from an MI session....

Regards, Steve

Can I make a suggestion: when you contribute, say in a few words what your principle focus has been; e.g. MI, SDM, clinician, researcher, and so on.

One step we'll take soon is to ask Ken Resnicow for a list of questions he posed in an email some weeks ago. be good to have a focus?

Regard

Steve

Hi

I'm excited about opening up this exchange of thoughts. I think there are several points of convergence between MI & SDT but there are also some differences with potentially important therapeutic implications. At this moment, a group of scholars is trying to get a special issue published on MI & SDT as a follow-up of a sattelite meeting in Sintra in 2009 organized by Pedro Teixeira & Antonio Palmeira. The special issue is likely to come out in 2011 in the International Journal of Behavioral Nutrition and Physical Activity. A couple of years, two independent groups of researchers wrote a theoretical paper on the convergence of SDT & MI. Those papers may offer some thoughts for discussion on this forum.

Markland, D., Ryan, R. M., Tobin, V. J., & Rollnick, S. (2005). Motivational interviewing and self-determination theory. Journal of Social and Clinical Psychology, 24, 811-831.

Vansteenkiste, M., & Sheldon, K. M. (2006). There is nothing more pratical than a good theory: Integrating motivational interviewing and self-determination theory. British Journal of Clinical Psychology, 45, 63-82.

Maarten

Grateful for this forum!  Curious about many things, one is to learn more about SDT, one is that I read in the latest Runners World magazine (where Deci is quoted about motivation around running possibly starting as extrinsic and becoming intrinsic) that we can think of athletes having three principle drives, for competence, relatedness and/or autonomy, that we have each of these drives to greater or lesser extents and that boosting our intrinsic motivation may be a matter of aligning with which one is the highest for us personally.  So, I'm wondering what SDT thinks about this way of conceptualizing intrinsic motivation.  Are these three categories (competence, relatedness, autonomy) useful ways of thinking about it?

Thanks in advance.

Steve,

I love the image of a diamond with its facets. In the most brilliant cuts there are hundreds of facets. They are different but each one makes a contribution to the brilliance of the diamond. That is the way I think about MI and SDT. I would also add SOC and Relapse Prevention into the mix. Each one catches the light differently and contributes something unique.

There are obvious areas of convergence between SDT and MI. In SDT the focus on relatedness and autonomy is a clear overlay. There are also differences. SDT pays more attention to competence than does MI. SDT is concered with the satisfaction of basic needs as motivational energizers whereas MI is more of a motivational technology.

I teach SDT when I teach MI because I see them each contriobuting something unique. I think that SDT explains to some extent why MI works. I was fascinated to see in the presentation at San Diego that Bill had mapped out SOC against MI.

However, I don't see this as a convergence of theory as much as contributions from different facets of motivational theory. It doesn't matter to me that SDT and SOC both claim to be meta-theories. I think a grounding in each of these approaches is helpful to both the practitioner and the researcher.

Vaughn Keller

Like-minded is one way of describing colleagues involved in these two areas.  That's the origin of this forum space: a small group of us decided to open up an exchange that anyone can take part in.

What can self-determination theory and motivational interviewing offer each other?

How compatible are they?

Can MI practitioners, researchers, trainers and theorists learn from the work of colleagues in the SDT field, and vice versa?

Feel free to raise questions and express your views.  The rules are simple!

Try to write simply and clearly, bearing in mind an audience who might not be specialists in these fields. Respectfulness goes without saying!

Bon voyage,

Steve

Thank you for your reply Nina. 

I have been given agreement (and more importantly budget!) to develop my proficiency in MI.  Another colleague and I are going to really get to grips with the theory then try coaching each other as well as seeking expert help to get better.

Charlotte