Paul Burke Training & Consulting Group

Equipoise in Motivational Interviewing

Paul Burke — Tue, 10 Jun 2025 18:09:04 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Thoughts on Improved Practice (TIP) #1938

Sometimes, it’s just not possible, or ethical to use a “pure MI” stance with a client. Sometimes, the guiding and steering functions of MI should not be engaged – especially when neither the helper nor the client know the best direction to pursue! In such cases, learning to poise yourself in such a way as to give equal attention to both the pros and cons of the argument for AND the argument against change is the only way to help a client resolve ambivalence. Once the client has evolved her ambivalence into a decision, then MI can kick in again, and the two of you can move forward in a specified direction e.g. the direction decided by the client in the equipoise phase of the conversation.

“Equipoise” in MI work (eck-wah-poyz)

So – let’s examine two questions related to Equipoise work in MI conversations:

What is the “Equipoise” stance in MI work? and
In what circumstance would an MI helper assume an equipoise stance?

Guiding client’s in the direction of positive and healthy change is a laudable thing to do when it is obvious as to what constitutes “positive” for the client. Such is almost always the case when your client:

Is not taking a necessary medication as prescribed,
Is consuming alcohol or other drugs with painful and dangerous consequences.
Your jailed client is not sure he has what it takes to give up his involvement in gang activity so that he can be a better role model to his kids.
Is a teenager who knows that her bullying behavior is wrong, and yet is having trouble escaping the pressure to conform to the norms set by her bullying peers.

The “guiding” stance that is so central in most M.I. work is easy to adopt when the direction the conversation needs to take is obvious. Sometimes however, the positive choice, the right choice, or the healthy choice is much more difficult to determine. This is especially true in the early stages of an MI conversation. Consider, for example, the following situations:

A 50 year old father and business-owner can’t decide whether or not to fire his son who is a manager in the family business. He says that son recently stole a significant amount of money from the company
A married couple (Mary, age 38, and Don, age 29) are arguing a lot these days and they say their marriage is in serious trouble. Don wants them to have their first baby this year, and Mary has just begun a new degree program that will require her full time commitment for the next four years. At the same time, she is concerned that her “biological clock” is ticking.
Catherine is thinking of writing her daughter, Katie, out of her will. Catherine recently gave Katie a large sum of money to buy a new house so that the grandchildren would be able to grow up in a home close to their Grandma. Katie accepted the money, but now is planning to buy a house in another province because she has a new boyfriend there. Catherine is angry but feels bad about how the impact her decision to take Katie out of the will may have on her other two adult children.
Trina is 5 months pregnant with her first child. She has developed a life-threatening illness, and the doctor has told her that she may die within the next 2 months if emergency surgery is not done immediately. Trina has been told that if she has the surgery now, there is only a very slim chance that the baby will live. If she waits another 8-10 weeks, the birth has a good chance of success, but Trina’s illness may have progressed to a “hopeless” stage by then.
Mike had an affair on his wife four years ago. She knows nothing about it and due to the unique circumstances, his wife will likely never know. Even so, Mike says that his guilt and shame are becoming overwhelming. His wife has always said that the marriage would be over, without any discussion, it she ever heard about any infidelity on his part. Mike says, “I feel damned If I do and damned if I don’t”.

In MI-3 (2013, p. 231-242), Miller and Rollnick describe a helping stance that can be taken in such situations. The term for counseling people when a clear “best choice” is not available, or at least obvious, is “equipoise”. It means “equaling out” or bringing balance to conflicting positions. The less formal term for this approach to helping people resolve their ambivalence about two or more options is “counselling with neutrality”.

As part of motivational interviewing for healthcare, adopting an equipoise stance allows professionals to support clients in exploring their own motivations without steering them toward a predetermined outcome.

When using an equipoise stance, the interviewer “stays neutral”. In fact, the interviewer works very hard to “stay out of it” – while the client wrestles with the pros and cons of the various decisions and the consequences of each of those decisions.

Adopting an equipoise stance involves the helper reflecting back to the client, with “equal weight”, both the pro and con side of an argument about a potential change. At the same time, when practicing equipoise, the helper gives equal reflection of the upside and downside of maintaining the status quo (not changing).

For those pursuing a certificate in motivational interviewing, understanding when and how to apply an equipoise stance is an essential skill that can be particularly useful in complex decision-making scenarios.

The “Equipoise” approach is the logical way to be helpful when the client is “stuck” in their thought process and can’t decide, one way or another, what motivation is the right motivation in a particular situation. Sometimes, maintaining a balance between the various options by rigorously maintaining an equipoise posture can be much more useful, and ethical, than taking on the guiding/directional work of MI.

Counselling with neutrality is not a typical, or usual posture in MI work. Normally, MI helpers know the general type of motivation and the nature of the change that they are wanting to enhance. Still, in some situations, it is important to help a client resolve their ambivalence and come to a decision about changes around which we, frankly, have no business being involved. Of course, the directional work of MI kicks in once a clear decision has been made by the client. At that point, we can switch into MI mode and help guide the client toward the plans and the goals they establish.

A few tips about how to initiate equipoise:

Know that the decision to “stay neutral” means “staying out of it”. Even though you may have an opinion about what you think the client ought to do, you can choose to “stay out of it”.
You know that you are “staying out of it” when you ensure that you are reflecting with equal weight, both the pros and cons of a given option; when you are not favoring one option over another.
Always share with your client that you intend to give them “ a darned good listening to” and that your intention is to avoid influencing their decision in any way (so that they know what to expect, and not expect from you in the way of advice).

Be sure that it is ethical for you NOT to have an opinion in the matter at hand. (Staying neutral about a decision where the client is trying to decide whether or not to suicide, or to abuse a child, is not an ethical/appropriate place to assume the equipoise stance).

For those seeking Motivational Interviewing Consulting, working with an experienced professional can provide valuable insights into balancing guidance with neutrality in complex cases.

See y’all next time! (Remember – you’re welcome to call, anytime, with questions or ideas for future T.I.P.s).

Paul Burke Training & Consulting Group (www.paulburketraining.com)

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Deep Listening in Motivational Interviewing

Paul Burke — Mon, 02 Jun 2025 18:47:18 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Thoughts on Improved Practice (TIP) #1511

People who understand the MI way of having helpful conversations know that “Listening” is NOT the same thing as “hearing”. Listening to what people are meaning – and beyond just what they are saying is an important part of the MI conversation. So how does one train oneself to really listen to and to get a sense of where a conversation is headed?

Almost every time I facilitate an introductory workshop, several people comment on how surprised they are at how much effort is involved in listening in the MI way. In the closing round of training, many say that “I never realized how much reflection I need to do before I decide on what to reflect back to my client!” Others have been heard to say “a major part of learning to listen, for me, seems to be about learning to listen to what I’m saying to myself while the client is speaking!” Still others have commented on how it is that “in order to listen well, I’ve learned that I have to shut off the noise in my own head so that I can just be with the client for a while before I start worrying about how to get them to listen to me!”

It’s one of those “strange-but-true facts that it’s often very difficult to quiet what I call the “response talk” that chatters away while we try to hear the words of our client. It’s so easy to focus on how we want to respond to what the client is saying, and to what we think about what the client is saying, that it can seem almost impossible, at times, to simply listen! Creating an internal space within oneself so that there is room for the client’s point of view is an essential piece of the preparation work that is necessary to listen well. These are fundamental motivational interviewing skills that professionals must master.

The Four Process of MI: Focusing = “Get rid of the Blur!”

Engaging with your client; with their logic; with their way of understanding things and their situation, is a first and necessary step in constructing an MI conversation. Once engaged however, it’s crucial to bring an “issue” into focus. The issue or topic-of-focus within the dialogue aids both the helper and the client by ensuring that they are both working on, or toward, the same purpose in the conversation. An “issue” can only be worked on, or worked toward, or worked around – if both parties are clear about “what’s in focus”. Similarly, only when both the MI helper and the client find a mutual focal point can directionality be established or measured in an MI interview. If you can’t see what’s in focus, how will you know that you are moving in that direction? Assessment interviewing may be part of the focusing process. In my experience, so long as some skillful work with reflective listening and open-questioning has been done to facilitate the process of engaging with the client (and engaging the client in the MI conversation at hand), assessment interviewing can be a useful asset to bringing sharper focus to what needs to be discussed and worked on in an MI session. Of course, like the engaging process, and like assessment itself, focusing never stops! In MI, bringing focus to a conversation, sharpening that focus, and modifying it over time is the way that we know a conversation is moving in a planned (specified) direction – and in a helpful and strategic direction! Without knowledge of the focus for a conversation, you and your client may well end up chatting away, in a highly engaged manner, but with very little “collaboration”, or “partnership” focus. Partnership and collaboration involve two people moving forward, together, in the same general direction. Focus is what provides the all-important “general direction” that is, by definition, an essential part of motivational interviewing courses.

Much of the process that drives successful MI conversations is allowing our clients to use us as a mirror – so that they can better hear (and sort out) their thinking. It requires that we help clients hear themselves (including the quiet and suppressed voices within that often speak only in whispers with statements like “I wish things were different” and “I need this to change”. Listening work in MI involves listening to what clients say and then reflecting on what that means (relative to the change target). It requires that we reflect on what would be helpful for the client to hear again (Content? Meaning? Intent? The “other side” of what they are saying? The hope inside of their words? Change Talk? Reasons for change that may be implied, or hidden inside statements made by the client?). Then we:

Compose a reflection that represents what we have reflected upon
Reflect our reflection
Allow the client to reflect on our reflection
Invite a client response to the reflection we have made after they’ve had time to reflect on it a little.

Attending motivational interviewing workshops can help professionals refine these techniques and build their ability to listen deeply.

Oddly, what often gets in the way of skillful listening for many of us is our experience in the field! The more experience we have in working with our previous clients and in helping them find solutions to problems, the more likely we are to use past experience as a substitute for listening to this client. It is very important to keep in mind that much of the value of reflective listening work in MI stems from the client “listening back” to what you are hearing! If you are listening only to your own past experience, or to a summary of all the memories you carry from previous client conversations, it’s entirely possible to make the mistake of buying into one of the following three myths that get in the way of effective listening:

MYTH #1: I have heard this same story several times before
MYTH #2: I don’t need to hear this story, because I know the plot and I can see where it is heading
MYTH #3: I know exactly what to recommend, based on the stories of others, so as to create a different (and more positive) ending

Now, here are the facts!

FACT #1: You have NOT heard this same story ever before. Not even once. This story belongs to this client and her interpretation of it, and the meaning that she gives to it is what is most important. The experiences and stories of each client are unique (and important) to them.
FACT #2: While it may be true that you don’t need to hear this story, your client does! In MI it’s often the case that it’s not so much what the helper is hearing that matters. MI works by helping the client to hear important elements of what they are saying – and of what they are not saying. We listen to clients so that we know what meanings, and values, and wishes, and hopes, and concerns need to be heard by the client. We need to be clear headed enough to be able to discern what it is from within the client’s speech that they we need to “listen back” to them.
FACT #3: MI is not about prescribing alternate endings to client stories. Rather, MI involves helping clients to hear themselves in ways that invite collaborative planning and solution- seeking. The idea that we have to listen only until we can “figure out” how to prescribe a solution is very problematic when trying to foster the collaborative, evocative, and autonomy- supporting spirit that drives the MI bus.

Many professionals turn to experts like Paul Burke motivational interviewing to enhance their approach and ensure they apply these principles effectively.

This week, my invitation is to think a little about what you have to do to prepare yourself for hearing – beyond just “listening”. Here are a few things you might try:

Before you begin a new MI conversation, take a minute to have a brief conversation with your own thoughts. See if you can find a way to remind yourself of your intention to make the upcoming conversation more about the client – and less about you. Is there a gentle way that you can make a wish for the conversation?
1. My wish for this next conversation is to be open and receptive to the concerns, and worries, and hopes, and wants, and needs of my client.
2. I wish to turn down the volume of the noise in my head enough that I can hear change talk when it enters into the conversation – even when it only whispers!
3. I wish to be totally present for this client. I wish to hear his words, and his meaning, and to give attention to the important things he says and means that he may be missing.

2. Before you begin each new conversation, take a few moments to “empty yourself” so as to create space for the client’s thoughts, feelings, ideas, hopes, worries, and needs. Some people find it helpful to close their eyes and do a minute or two of deep breathing. Others initiate a self-directed visualization of some kind that facilitates the evaporation of thoughts and worries

and ideas that would otherwise crowd out what the client means. Imagine placing your inner self-oriented conversation in a balloon and let it drift up to the ceiling – just until you and your client find your focus.

3. Learn to activate a “Beginner’s Mind”. This approach involves letting go of your “social and professional biography” for a while. It involves learning to set your ideas, theories, opinions, logic and beliefs about change on a shelf for a little while – on purpose! Yielding to a fresh, beginner’s mind means allowing yourself to “not know” for a while. It means allowing yourself to get genuinely curious about what the client is thinking; how she sees the situation; what she wishes and hopes for. It means shifting the focus from your thoughts about her experience to simply yielding to understanding her experience.

Activating your beginner’s mind recognizes that our thoughts often distort and manipulate what the client is saying and meaning. Thus, instead of assuming that we know what the client is thinking and experiences, we assume the dual positions of “I don’t know” – and “I want to know” – all at the same time.

To truly master MI, many professionals choose to learn motivational interviewing through structured training and ongoing practice.

Some people argue that “listening deeply” is an advanced MI skill. I disagree. I think that listening with deep interest, deep curiosity and deep compassion is the very essence of good MI conversations. It doesn’t take much skill to hear the words that someone speaks. To hone the ability to get ourselves out of the way so that we can listen for what the client wants, for what they need, for the reasons that support positive change, and for the voice of hope that fuels their willingness to talk with us – is a sign that you are present in the conversation. Being present is an art. It is also an honor. And a gift.

See you next week …

Paul Burke Training & Consulting Group (www.paulburketraining.com)

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Focusing in Motivational Interviewing for Effective Change

Paul Burke — Tue, 15 Apr 2025 15:06:00 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Thoughts on Improved Practice (TIP) #1307

“In order to be an effective guide you need to know where you are going. With at least the basic groundwork for engagement in place, the next process in MI is to clarify the goal toward which you will move together” (p. 91)

My experience in facilitating motivational interviewing workshops has been that too many people work very hard at engaging with the client and with his/her point of view and then, once there, jump all the way into planning for change. Others engage and then they “leap-frog” into eliciting the client’s ideas about how to pursue a change – long before the client has heard himself describe what it is that he would like to focus on in this particular conversation!

If you were to go to a theatre where the movie was completely out of focus – you would demand that the projectionist start it over again – and get rid of the “blur” so that you could see what was going on. It’s the same in motivational interview training. It’s necessary to reduce the blur to a sharp focus – where you and your client both have the same picture of what is supposed to be “in focus” as you work together!

The Four Process of MI: Focusing = “Get rid of the Blur!”

A metaphor that I have found useful in understanding the focusing process is that of the trekking guide whose job it is to work alongside the hiker – to help him keep moving in the right direction. A good guide assists her client to help him avoid tangents that might get him lost. In this scenario, a good guide might need to use a pair of binoculars from time to time and focus on a point somewhat off in the distance to bring more clarity as to which direction the hiker ought to be going. In MI conversations, as in all journeys, all roads can lead to Mecca – provided that someone knows where Mecca is! Of course, it’s also helpful for both the trekker and her guide to know that Mecca is the destination of choice! (Sometimes there are landmarks along the way to the ultimate destination and a good guide will keep tabs on these as well – in order to free her client up to do the hard work of the trekking!

Sometimes the process of focusing is a simple one – because the client comes into the conversation with a clear sense of the intended goal; of the intended destination and even some of the landmarks that line the way. Other times, the process is not as easy.

Imagine that your client comes in to see you because his wife insists that unless he gets help soon, she will leave him. He says that she feels that he drinks too much and that his alcohol use is interfering with the intimacy and sense of “partnership” that they used to enjoy. He disagrees. He says that while his drinking may have increased a little in the last few years, he thinks it has more to do with physical health problems. In the last few years, he says he has not slept well at all. He gets fewer than 5 hours of sleep each night. He often wakes up very early in the morning. His appetite has also been very poor. He has lost nearly forty pounds since his son was killed overseas while serving in the armed forces a few years ago. He worries a lot about their financial future as well – made worse by the fact that his boss has hinted that there may be more layoffs coming in the year ahead. His sex life has “tanked” and he says that for the last year or more his wife has insisted that he sleep in the spare room, given that his sleeping problems keep her awake at night. He hasn’t talked to his doctor about any of this. He hasn’t seen a doctor in over four years, he says, because he doesn’t want a “lecture” about his cholesterol problem and high blood pressure again.

The above situation may sound complex. It is. Most situations are.

So – where does one begin to focus? Is this a case for marriage counselling? Motivational interviewing for substance abuse? Depression assessment? Substance abuse intervention? Grief work? Sex therapy? Referral for medical assessment?

In truth, it is likely that all of this client’s issues and concerns are connected. But – where to start?

It is beyond the scope of this introductory TIP on focusing to describe the myriad ways that you and your client might begin to bring focus to the conversation. For now, suffice it to say that if you and the client begin to “map” the variety of agenda items that could be brought into focus, in time it will become obvious to both of you as to the most logical place to start. After all, as I say in virtually every workshop – “the hip bone is connected to the thigh bone which is connected to the knee bone which is connected to the …”. As you and the client begin to explore the variety of “issues” or “concerns” that are possible within the conversation, a mutual focal point is very likely to emerge. For the client example used here, it might be that “taking steps to get back to feeling good again” is the beginning focus, along with a goal of completed a comprehensive biopsychosocial assessment process that might shed some light on which roads might most efficiently lead to Mecca.

Focusing is a process that arises out of engagement. It is all about determining the “North Star” for a conversation so that you, and your client, and your clinical expertise can make decisions about what constitutes forward momentum.

After you and your client have engaged, remember that identifying a focus is what determines what you will start to “evoke” as the next process kicks into gear.

See you next week …

Paul Burke Training & Consulting Group (www.paulburketraining.com)

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Becoming a Moyers or Midler in the Practice of MI

Paul Burke — Fri, 04 Apr 2025 14:44:45 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Developing Competence in MI: Part 1

One of the more wonderful gifts that the Universe has provided me of late was the opportunity to see Bette Midler, aka “The Divine Miss M” in concert in Vancouver. Seeing and hearing her perform 50 years’ worth of her amazing music was a thrill, a privilege, and an awe-inspiring spectacle – the likes of which I have experienced only a few times in my life.

For me, witnessing the polish and the perfection that radiate from people like Bette Midler, Elton John, Tina Turner, Mick Jagger and other masters of their craft, evokes a very deep sense of respect for the “thing” that they bring to their work.

When I got back to my hotel room after the show, I reflected a little on what that “thing” is all about. I realized how impactful it is to watch someone who is able to “dance in her competence” the way Bette Midler does.

Excellent MI practitioners are like that too. I guess it’s no coincidence that “MI” exists at the very beginning of “MI-dler!”

I marvel at people who take the time, to work so hard, to make it all look so effortless! Seeing Ms. Midler in concert got me to thinking about times when I’ve been lucky enough to take MI training from one of the most talented, skillful, knowledgeable, and practiced MI trainers on the planet. Like the Divine Miss Midler, Dr. Teresa (Terri) Moyers (MI instructor and Assistant. Prof of Psychology at University of New Mexico) inspires awe when she practices, demonstrates and teaches MI.

She too is a woman who is able to dance with her competence – with all the skills and concepts and the foundational spirit factors that are the basis of MI. Seeing her at work always inspires me to keep practicing, and to keep learning. Her work is proof that mastery comes from practice, and sticking with it until it all becomes part of our second nature. Developing strong motivational interviewing skills is a process that requires ongoing effort and refinement. (Dr. Moyers is the woman who interviews the “rounder” (pink shirted cowboy trucker guy who has a problem with his drinking) on the DVD sample that I often show in the intro workshop – one of the best MI examples I have ever seen. If you ever get a chance to participate in a motivational interviewing course with Dr. Moyers – do it! She’s Rolls Royce.)

So – this week, I invite you to so some thinking about how you can get the Moyers and Midler phenomenon going in your own practice. Skill at the level of those who have mastered their craft does not happen by natural talent alone. It comes from conscientious, dedicated, hard work. It comes from practice-til-perfect, and then more practice, and feedback on practice, and then more practice again!

I’ll be writing several T.I.P.s this year on how to move to competence in your practice of MI. For this initial installment, I’ll begin with the need to develop skill in “Cultivating Change Talk” (CCT). From the new MITI 4.2 coding manual (Moyers, T., Manuel, J., Ernst, D., 2015, available online at casaa.unm.edu/download/miti4_2.pdf) I’ve copied and reproduced here the criteria that are used to determine overall competence in evoking, encouraging and embellishing change talk. Your “CCT Score” is a fundamental marker of your capacity to “dance in your competence” with MI skills. I encourage you to review it here, and give a little attention this week to working on this aspect of MI skill. If you can get to the point where you have reason to believe that you are a Moyers or a Midler with this component of the work, – then it will be time to move on to add strength to your “SST” score (Softening Sustain Talk).

Cultivating Change Talk

Low

High

Clinician shows no explicit attention to, or preference for, the client’s language in favor of changing

Clinician sporadically attends to client language in favor of change – frequently misses opportunities to encourage change talk

Clinician often attends to the client’s language in favor of change, but misses some opportunities to encourage change talk

Clinician consistently attends to the client’s language about change and makes efforts to encourage it

Clinician shows a marked and consistent effort to increase the depth, strength, or momentum of the client’s language in favor of change

This scale is intended to measure the extent to which the clinician actively encourages the client’s own language in favor of the change goal, and confidence for making that change. To achieve higher ratings on the Cultivating Change Talk scale, the change goal must be obvious in the session and the conversation must be largely focused on change, with the clinician actively cultivating change talk when possible. Low scores on this scale occur when the clinician is inattentive to the client’s language about change, either by failing to recognize and follow up on it, or by prioritizing other aspects of the interaction (such as history-taking, assessment or non-directive listening). Interactions low in Cultivating Change Talk may still be highly empathic and clinically appropriate.

Verbal Anchors

Clinician shows no explicit attention to, or preference for, the client’s language in favor of changing.

Examples:

Asks only for a history of the problem
Structures the conversation to focus only on the problems the client is experiencing
Shows no interest or concern for client values, strengths, hopes or past successes
Provides education as only interaction with the client
Supplies reasons for change rather than encouraging them from the client
Ignores change talk when it is offered

2. Clinician sporadically attends to client language in favor of change – frequently misses opportunities to encourage change talk.

Examples:

Superficial attention to client language about the change goal
Fails to ask about potential benefits of change
Lack of curiosity or minimal interest in client’s values, strengths and past successes

3. Clinician often attends to the client’s language in favor of change, but misses some opportunities to encourage change talk.

Examples:

Misses opportunities to encourage client language in favor of change
May give equal time and attention to sustain talk and change talk, for example using decisional balance after momentum for change is emerging

4. Clinician consistently attends to the client’s language about change and makes efforts to encourage it.

Examples:

More often than not, acknowledges client reasons for change and explores when they are offered
Often responds to change talk with reflections that do not encourage deeper exploration from the client
Expresses curiosity when clients offer change talk
May explore client’s values, strengths, hopes and past successes related to target goal

5. Clinician shows a marked and consistent effort to increase the depth, strength, or momentum of the client’s language in favor of change.

Developing strong motivational interviewing tips and techniques is a journey. Over time, with persistence and dedication, we can all learn to refine our approach and improve our ability to guide meaningful change conversations. See you next week!

Examples:

Over a series of exchanges, the clinician shapes the client’s language in favor of change
Uses structured therapeutic tasks as a way of eliciting and reinforcing change talk
Does not usually miss opportunities to explore more deeply when client offers change talk
Strategically elicits change talk and consistently responds to it when offered
Rarely misses opportunities to build momentum of change talk See you next week!

Paul Burke Training & Consulting Group (www.paulburketraining.com)

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When Should I Be Asking Questions in an MI Conversation?

folksdigital — Tue, 16 Apr 2024 17:53:11 +0000

A common question that often arises in motivational interview training sessions is, “how soon during the interview should an interviewer start asking questions?” The short answer is simple. “You should ask questions of your client whenever you need to – in order to help along the particular process within which the conversation is operating.” The key here is to always be strategic with your question-asking and to use the questions to facilitate the specific process you are facilitating when you need to pose the question. (If this seems confusing to you, please read on!)

In the ENGAGING PROCESS, questions are asked that will help the interviewer obtain a better understanding of what the client is thinking, feeling, and doing. Questions in the engaging stage are not designed to bring a focus to the discussion or to evoke change talk. (It’s not possible to know what change talk is until you have a focus!). Similarly, when working within the engaging process, questions are not meant to help construct a plan for change. Instead, when engaging, questions serve to help the interviewer develop a deeper empathy with the client’s thinking. Such questions come from a place of curiosity, where the intent is to understand the logic behind the client’s point of view.

At other times in an MI interview, when working within any of the other three processes, questions serve to aid in the fulfillment of the specific process that the interviewer is facilitating. Asking questions that are designed to bring a mutual focus to the conversation between interviewer and client is essential and necessary when working within the FOCUSING PROCESS.

Similarly, the questions that you will ask in order to evoke change talk, once a particular focus has been established, will have different characteristics than engaging or focusing questions.

EVOKING QUESTIONS serves to give clients a “hand up” so that their answers will help them to begin hearing their desire, ability, reasons, need, and commitment (DARN-CATS) for a change related to the focus. Evoking work is an essential element of effective MI practice – so much so that it is almost always a major component of all motivational interviewing courses.

Finally, questions asked in the PLANNING PROCESS are designed to transition the conversation from “change talk” to “change action” (or, in other words, to the design of action steps.) You can imagine the problems that arise in interviewer-client dynamics if you were to begin asking planning questions when you and your client are still working to engage. Moving to higher process questions while working within a lower process presents real problems in MI work.

So, simply put, feel free to use process-matched questions any time; they will help you achieve the conversational process you are facilitating. That’s what is meant by the “strategic questioning” in MI work.

Below, I’ve provided a few examples of how different questions could be asked in response to specific “bits” of client speech, depending on the process the interviewer facilitates. Look at the examples, and then complete the following exercise (starting on line 5).

Try constructing a few logical questions to facilitate the two processes noted below each client statement. Take your time to think your questions through. You’ll get better and quicker at this the more you practice with strategic question-asking. Give me a call if you get stuck, and we can try putting both of our heads to it. This approach is integral to motivational interviewing for professionals who are working to enhance their ability to guide conversations effectively.

I don’t like the idea of taking that medication, even though I know I probably should take it. My doctor says I should take it all the time – not just when I have the symptoms. I guess it needs to build up in your bloodstream or something. But I don’t know. It messes with a person’s brain chemicals, and that seems a bit scary to me. (Target = medication compliance)

A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:

What is your thinking about the effect that the pills have on how your brain works?

A USEFUL QUESTION TO FULFILL THE EVOKING PROCESS IS:

When you say that you know you should be taking the pills, how do you think that might be helpful for you? This question reflects one of the key to motivational interviewing skills, focusing on the client’s perspective.

There’s an elder in our community who I kind of respect quite a bit. He has a lot of wisdom about certain things. His name is Frank. My Mom wants me to go see him and tell him about my problem. He really has a lot of knowledge about this stuff. In fact, he had this kind of problem too – a long time ago. We’ll see. Maybe I just need to get up the guts to call him. (Target = obtaining community support)

A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:

When you say you kind of respect Frank, what do you mean by that? How so?

A USEFUL QUESTION TO FULFIL THE PLANNING PROCESS IS:

What would you have to do to get up the guts to look into what he has to say? [Engagement in community support is often encouraged in highlighting the importance of external resources as part of planning.]

I’m just so angry all the time. I know everybody is saying that I’m depressed. To be honest, though, I think anger is a bigger issue for me. I don’t always show it, but on the inside, I’m always just itching to bite someone’s head off. I wish I could figure out what’s up with me. (Target = obtaining a mental health assessment)

A USEFUL QUESTION TO FULFIL THE FOCUSING PROCESS IS:

So, there might be two different concerns here. Depression and also some anger or irritability. Do they seem to be connected in any way? Is there a relationship between them?

A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:

What can you tell me about that tendency to keep your anger on the inside? What stops you from showing those feelings more? These inquiries are part of the foundation for focusing on client self-exploration.

I don’t like any of this. It’s all b.s. as far as I’m concerned. Everybody is telling me what to do and how to do it – and even when I should be doing it. Everybody thinks they are an expert about me and my problems. Nobody gives a crap about what I think about any of it. They only care about what they want me to do. (Target = development of a treatment plan)

A USEFUL QUESTION TO FULFILL THE EVOKING PROCESS IS:

Yah. I could see how that would be pretty frustrating, all right. So, let me ask you this. What do you think you should be doing? What’s your take on the next steps here?

A USEFUL QUESTION TO FULFILL THE FOCUSING PROCESS IS:

So, if you and I agree that the focus here needs to be on what you want, and given that you’re more of an expert on you than anybody else is, how would you like to get started? What should we be talking about in our chat today? This approach emphasizes the principles taught in motivational interviewing workshops for people who practice MI.

It’s weird to me that I am getting sort of interested in giving up the cigarettes. I’ve never really worried too much about smoking, but ever since my daughter was born, it’s different. I feel guilty about it. I think role modelling is important for young kids. But wow, quitting is no picnic in the park. I’ve tried before, and it’s not something I look forward too. Besides, I love smoking. (Target = smoking cessation)

A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:

A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS:

I’d kind of like to sign up for that “Big Results” group at my husband’s gym. It’s a special exercise class for bigger people. I like that idea because I hate being in there when there’s all these fitness buffs working out and there I am – packin’ 40 extra pounds in all the wrong places! But I don’t know. What if I sign up and I’m the biggest one there? (Target = increased exercise)

A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS:

A USEFUL QUESTION TO FULFIL THE PLANNING PROCESS IS:

I sort of feel like my wife doesn’t understand me. She doesn’t seem to appreciate how hard I work to put bread on the table and get all our bills paid every month. I have a lot of pressure on me and that’s why I’m so testy all the time. She never listens when I tell her about all of that. (Target = couple’s counselling)

A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:

A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS:

Well, they were saying I should look into getting some help! Hah! What a joke! Help for what? Where am I supposed to start? My marriage is only running on three cylinders. My boss says that if I ever get caught with alcohol on my breath at work again, I’ll be out of a job. My son says he doesn’t want to talk to me again unless I’m “stone cold sober,” as he puts it. And, on top of all of that, now the doctor says my blood sugar is all out of whack, and I need to get some tests done to see about that. The list is longer than that too – but you get the picture, I’m sure. I don’t need support. I need a bloody miracle! (Target = obtaining assessment of major life areas)

A USEFUL QUESTION TO FULFIL THE FOCUSING PROCESS IS:

A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS:

The post When Should I Be Asking Questions in an MI Conversation? appeared first on Paul Burke Training & Consulting Group.

Hooking Your Reflections To The North Star

folksdigital — Thu, 11 Apr 2024 18:01:38 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Hooking Your Reflections To The North Sta

An advanced practice skill in MI involves learning to listen for how you can “hook” what the client is saying to the “north star” (intended direction) of your conversation. How can you take what the client has said and connect it to the focus issue of the discussion? Learning to “hook” your reflections to the topic at hand not only helps you to keep the conversation moving in the right direction, but can save a lot of time and can prevent

tangents. Paul Burke motivational interviewing techniques emphasize this approach, helping professionals refine their ability to guide conversations effectively.

Try this exercise derived from common scenarios in motivational interviewing courses. It showcases how to construct ‘hooks’ for more targeted conversations.

TARGET: Follow-through on conditions of probation order:

My Probation Officer says that if I don’t finish that stupid “Emotional Self-Regulation” workshop before the end of the month, I will have to repeat all three sessions all over again. That is just ridiculous. I did two of the three didn’t I? Why should I have to take those first two again? I get so worked up over crap like that. I mean, what’s totally funny about it is that they were talking about that very thing in session two. They were saying sometimes when people get so worked up, they start running on adrenaline power and not on brain power! It’s when your emotions get so loud they don’t leave any room for your thoughts that the trouble starts. It’s so boring though! It’s way too much information all at once. I don’t know how come my emotions get so powerful anyway.
I’m not an emotional person, really. I just get all fired up at times.

Response Option 1

You really hate that Emotional Self-Regulation workshop, but you know
that you either follow the order, or pay the price

Response Option 2

You don’t see any reason that you should have to take the first two sessions a second time. It’s almost like you need an Emotional Self-
Regulation Workshop just in order to deal with you reaction to having to go to the workshop.

Response Option 3

You’re thinking that this is one of those situations they talked about at the
workshop. Your emotions are getting so loud that your thoughts can’t get heard. The adrenaline has you fired up and you know that your thoughts need a darned good listening to here too! If you were listening to your
thoughts, what would they be saying about finishing the workshop? Motivational Interviewing Workshops often focus on techniques to help individuals navigate these internal conflicts and find clarity in their decisions.

TARGET: Improved self-monitoring of blood pressure.

My Dad had a heart attack when he was only 53. I was 13. It scared us all pretty bad. Especially him. The doctor said it was only luck that saved him. We lived 3 minutes from the ambulance station at the time. You’d think that would be enough to make me want to take my blood pressure readings the way the doctor wants me to. And yet, I don’t. I mean, here I am at 49, and sometimes I think “what am I doing?” My cholesterol is borderline, but my blood pressure just goes nuts sometimes. You’d think I’d learn. Even my daughter begs me to keep my blood pressure log. She
says “why don’t you just start taking it three times a day, with your meals. Then you’d remember to do it.” It’s like I’m playing the odds with my life for Pete’s sake. But then there are times when I can play 18 holes of golf, and not even blink. I feel healthy as an ox when I’m on the course. I love it. I guess you’d say I am a bit of a fanatic about it. I shot 5 under last week and I almost always get
a Birdie on the 5th and the 8th. I bought a new 9 iron last week. Titanium head. Best $500 I ever spent.

Response Option 1

You’re saying that you know your Dad’s heart attack should be a reminder
that life is short if you don’t take care of yourself.

Response Option 2

You’re looking for a way to get the same focus on tracking your blood pressure scores as you do for your golf score. Golf is important to you, and so you keep records to track your progress while you experiment with ways you can improve. You’ve got some real good evidence now, in black and white even, about how that new 9 iron has impacted on your overall performance. If you could start to think about your blood pressure scores and your experiments with how to improve them in the same way that you do with your golf game and other things that are equally important to you,

you’re thinking you might become more committed. Motivational interviewing for healthcare professionals often focuses on helping clients make these mental shifts by drawing parallels between their existing interests and health goals. What kinds of things do you do to remind yourself to record your golf score after each hole?

Response Option 3

You’re playing the odds with your life. It worries you, because you know that regulating blood pressure is no game – at least not in the same way that golf is. You invest a lot of time in improving your golf game, and yet you can’t find the self-discipline to find ways to improve your hypertension. I bet you would find that keeping a blood pressure journal would be a great

“9 Iron” for you in terms of your health.

TARGET: School Reinstatement.

Doing online homework assignments suck. Ever since I got kicked out of school, I have to do all my assignments online. It’s boring. It’s a lot of keyboarding. My keyboarding skills kind of suck. I always hit that tab key thingee and then my spacing gets all wonky. I was thinking maybe I should just pack it in for now and then maybe next year when I am back in school I can do the

assignments the normal way. You know – by just doing the book report presentations instead. I am way better at presentations anyway. The only problem is then I have to repeat all of the English

Concepts section all over again. That would suck. It would be nice to have it over with once and for all. That class sucks. It is just stupid to study all these old poet guys and try to figure out what they mean. If I never read any more crap by an old poet it will suit me fine. Why can’t they just make you read poetry from a guy like DJ Funky Fred? Now there’s a real poet. He said he’ll never get married because rap is his only true love. Wild! He said the only thing that he can’t make a rhyme for is the word “orange”. None of them old poet guys could make a rhyme for “orange”, either, I

bet. It’s just a hard word to rhyme, that’s all.

Response Option 1

You’re trying to decide whether to pack in the English Concepts class for this year, or not. There is some advantage to getting it over with online, but then you have to deal with all the keyboarding hassles. On the other hand, having English Concepts out of the way by the time you go back to school

next fall would be nice. Which way are you leaning?

Response Option 2

There be poets that are old … and poets who are dead. There be poets that be boring … but not good ol’ Funky Fred! He’s a modern day master – and he’s a major funky scribe.

He tells it like it is – and he doesn’t have a bride.

He can rhyme…all the time… which is no crime… ‘cause he’s so fine…All his poems really shine!

Fred be phat. Fred be kewl.

But Funky Fred can’t get you back in school! Fred be nimble – and Fred be quick,

but Fred don’t make your Tab Key stick!

You need your school … and you need that class …

so open up your browser baby – …or you’ll just be an ass!

Response Option 3

On the “suck-o-meter” of life, your keyboarding skills get about a 5. English Concepts class rates sucks way beyond that though. Suck-o-meter wise, English Concepts gets a solid 8, or maybe even a 10. You really don’t want to repeat that course all over again, partly because you’ve already had to endure a lot of the reading you have to do. Motivational interviewing skills can be useful in helping you navigate decisions like this—focusing on what matters most to you and finding ways to get through the challenges. If you could just figure out a way to make that Tab Key a little less of a pain, you’d be able to “rap” this thing up pretty quickly, if you’ll pardon the pun! If you did decide to try to get your keyboarding skills a bit lower on the old “suck-o-meter”, what kinds of things could you try in order to get this course out of the way so you can start fresh next fall without having to go through this crap all over

again?

Target: Adherence with medication prescription

Yah. I hate those pills. Every time I take them they just remind me that I am not a “normie”. It’s like every day when I wake up, I have to pop a pill and all it does is say to me “yep – you’re a

mental case alright”. And it just starts me off thinking that way for the whole day. Why can’t I just be normal? Normal people are lucky. They have a life. They don’t have to remind themselves

every single morning that “there is something wrong with me”. They just get up in the morning and brush their teeth and then they start their day and focus on what they want to do. They just have a regular routine. Normies are lucky because they don’t have mental illness stuff on their mind all day long. Like – “did I take my pills this morning?” Like – “I wonder if I’m going to have an episode today just because I forgot?” A lot of people just take being able to live in a routine for

granted. They don’t have constant reminders that they have problems.

Response Option 1

You’re aware that there is a difference between you and people who don’t have mental illness. Other people don’t have as much hassle in their daily routine because they don’t have to take pills every day and be reminded of their illness. You worry about the consequences of not taking your pills each time you forget to take them, but at the same time, you hate them.

So what do you think you’ll do here?

Response Option 2

Your saying that If you could have a routine every morning, just like most people do with brushing their teeth, where taking your pills was just a simple part of your routine, like putting the toothpaste on the brush, you’d be free to just focus on the rest of your day, because the pills would just be a small part of your routine. If taking your pills became a habit for you like brushing their teeth is for others, you wouldn’t have to worry about whether you were going to have an episode or not. So, I wonder what kinds of things you might be willing to experiment with a little to try to establish

a routine around the pills?

Response Option 3

The number one reason that people end up back in hospital after their diagnosis is not taking their pills in a routine way. “Normies”, as you call them, don’t have to worry about taking their pills. That’s true. But that’s

life. They don’t have to worry about it, because they don’t need pills. You do. I’m hearing you say that.

Team Leader,

Paul Burke Training & Consulting Group www.paulburketraining.com

The post Hooking Your Reflections To The North Star appeared first on Paul Burke Training & Consulting Group.

THOUGHTS ON COMPLIANCE

folksdigital — Mon, 27 Nov 2023 17:49:41 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Thoughts on Improved Practice (TIP) #1708

The “spirit” (or “context”) within which an MI conversation can emerge yields a number of “vital signs” which, when all operating and synchronized, facilitate the purpose or intention of this form of “motivational midwifery”. Evidence of partnership is one such vital sign

MI “…is not something done by an expert to a passive recipient; a pupil, a master to a disciple. In fact, it is not done “to” or “on” someone at all. MI is done “for” and “with” a person. It is an active collaboration between experts. People are the undisputed experts on themselves. No one has been with them longer, or knows them better, than they do themselves . . . . The method of MI involves exploration more than exhortation, interest and support rather than persuasion or argument. The interviewer seeks to create a positive interpersonal atmosphere that is conducive to change but not coercive.” (MI-3, Miller & Rollnick, 2013, p. 15)

A Few Thoughts on “Treatment Compliance”

These days, at almost every MI workshop I facilitate, someone asks if we can do some role play work involving the issue of “treatment compliance”, or “medication compliance”, depending on the setting for the training. That concept needs to be wrestled with a little, in order to understand its relationship to MI generally, and more specifically, to core MI practice (promise) of partnership/collaboration.

An online dictionary offers some hints as to why the concept of compliance pokes at my value system a little when it comes to MI work. For example, it says that compliance is “the act of conforming”, or “a tendency to yield readily to others, especially in a weak and subservient way”. It goes on to suggest that compliance is an act of acquiescing; of conformity, and of “obedience”.

Yikes!

I suspect that most of us would prefer that our clients/patients make decisions about their behaviour and their health based on internal motivations, and not because of a need to “obey” their helper! Most of us would not want our clients to behave in a “weak or subservient way”. To the contrary, those who practice the art and science of Motivational Interviewing work hard to support the autonomy of our clients. We look for every opportunity to affirm their competencies, and not to highlight or pay undue attention to their shortcomings, or weakness. MI is all about understanding and empathizing with people’s motivations (motives) for engaging in various behaviors. It is not about finding ways to bend people to the will of a treatment provider, or of a treatment plan.

When a client/patient is not following through on a previously agreed-to treatment regimen of some kind (regular use of a prescription medication, involvement in a counselling program, or doing recommended physiotherapy exercises at home every week, between appointments), the critical issue in MI work is to examine the “motives” behind such lack of follow-through. People engage in change when they are (1) ready to, (2) willing to, and (3) able to. These are the three critical ingredients that, together, create motivation to pursue a specific change, even when that change is adherence to a treatment plan. Thus, when a client is faltering a little (or a lot) with follow-through on a plan for which they previously showed commitment, the helpful question is not “why is this person not obeying?” Rather, when it appears that a client has become motivated to break their adherence to any sort of planned action, it’s important for a Motivational Interviewer to explore “what motivational obstacle is getting in the way of my client sticking with this plan?” Is it:

that she is not ready to engage with this strategy (meaning, perhaps, that she has lost her awareness of its importance, or that other variables in her life have become more important and are now taking priority for her)?
that she is not willing to continue the treatment protocol (meaning, perhaps, that she has identified a down-side to continued engagement, and an upside to discontinuing)
that she is not able to adhere to the regimen – for any of a huge menu of reasons including such real challenges as lack of money, lack of time, competing demands for her attention, clinical depression that has triggered fatigue, lethargy or lack of hope

Really, when it comes right down to it, “failure to comply” simply means that the motivation for continuing has been turned to the “off” position. When that is the case, there is always a reason, and only very rarely is it because the client has decided to frustrate you into an early retirement! Likewise, “non-compliance” rarely implies that the person has no interest in achieving success by overcoming the problem s/he is working with you to address. It means that something has come along that has gotten in the way of staying on track. There’s been an obstacle on the path somewhere along the line. Working with your client to discover that obstacle (readiness, willingness, or ability), rather than trying to force compliance and subservience, is the what
partnership is all about. It’s the “stuff” of Motivational Interviewing, and it’s a wonderful way to develop empathy for your client’s perspective, when her motivational switch has flipped to “off”.

Sadly, I often hear folks in workshops explain that they hope that learning MI will help them to “get better compliance”. These people often have an obvious tone of defeat in their voice, and they almost always seem frustrated – sometimes, seemingly, to the point of exhaustion. Years ago, I was conducting a workshop for a group of folks who work with people with Type II diabetes, someone in the group said “I just don’t know what to do anymore. I’ve tried everything I can think of to talk this patient into complying with the medication regimen that her doctor has ordered.”

Amongst the learning group, we debriefed the situation a little. We decided that in the next meeting with the patient, it might be helpful to “try on” the useful MI posture of “intense curiosity”. The idea there is not to assume that it is logical for the patient to comply, but instead that, for some unknown reason, it has become logical for this patient not to comply! The useful track, that can then guide the way you interview the client, then begin to center around things like:

What is the downside for this client in staying on top of this plan?
What is the upside (through her eyes) for not following-through? (These two questions help to determine what might have to be done to “tip” the scales of ambivalence in favor of getting back on track.
How important is it for her to get back on track (the Importance Ruler works well here, as this helps assess whether or not more awareness, patient-education, or consciousness raising is needed)
How confident is she that she can, indeed, get back on track and maintain long-term followthrough (The Confidence Ruler can work well here to surface any kind of ability obstacle that may be getting in the way).

Taking a collaborative approach to working with clients who have fallen away from a previously agreedupon plan of action means exploring, listening, understanding, inquiring, encouraging, supporting, reengaging, focusing, evoking, and planning. And – that’s a whole lot of verbs!

Yep – working to help people get back on track, or to adjust the track, if that is part of the
problem, is more work than warning, threatening, cajoling, persuading, and brow-beating! Giving people a darned good talking to is easy – but it’s rarely effective! It eventually spawns frustration – for both you and your clients! The antidote is helper curiosity. It involves walking alongside your client in an atmosphere of safety, respect,
autonomy support, empathy, and compassion while your client explains the logic behind her decision to break with the treatment regimen that she previously agreed to undertake.

Until next week …

Paul Burke Training & Consulting Group (www.paulburketraining.com)

The post THOUGHTS ON COMPLIANCE appeared first on Paul Burke Training & Consulting Group.

DANCING WITH DISCORD

folksdigital — Tue, 21 Nov 2023 16:29:58 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Thoughts on Improved Practice (TIP) #1705

Sometimes things just don’t match up.

And sometimes, it’s nobody’s fault.

Sometimes, things just get off track.
Sometimes, there just ain’t no harmony.
And – when there ain’t no harmony…
That’s discord!

“Discord is about your relationship with the client”(Miller and Rollnick, MI-3, p. 197)

Dancing With Discord (Part 1)

In the picture above, ask yourself, which sock is at fault for the mismatch? Which one is in the wrong? The simple fact is that in two-person conversations, things sometimes end up in a spot where our current thinking, ideas, goals, and targets are not quite matched with the current thinking, ideas, goals, and targets of our clients. When this kind of a dance occurs between an MI helper and a client, we call it the dance of discord! Discord means that “things are out of synch”. They are “out of whack”. They clash with one another. Trying to decide which sock is at fault is pointless! The bottom line is that when a mismatch occurs, it’s best just to recognize it, and then make a decision to “match up again” – and then look for opportunities to move together – in the same direction!

Think of discord as a musical concept. When several musical instruments are all in tune, and all playing together, from the same music and with the same conductor, there is harmony. When one of the players starts playing from a different place within the music, or when someone begins playing to the beat of a different drummer (so to speak), the disharmony becomes obvious – quite quickly.

That kind of disharmony when applied to MI conversations is called “discord”. When it occurs, disharmony is a simple form of communication that tells you that it’s time to back up a little. Discord means that, as a helper, you are not listening to where, within the music of change, the client is focused. It tells you that you have probably gotten a little bit too far ahead of where your client is focused, and that it’s time to slow down (maybe even back up the bus a little) and get back into harmony with the way your client is seeing things – or about how s/he is feeling about the situation you are discussing.

Discord has a sound. You can hear it. Sometimes it’s more subtle. Other times it’s as clear as a bell. When clients are actively arguing against what you’re saying – that’s discord. It means the two of you are not on the same page. When clients begin to interrupt you, or cut you off within a conversation – that’s discord. It means that the two of you are not on the same wavelength. When clients become annoyed, or even angry, that you’re not reflecting their point of view and you seem to be “siding” against their position – they let you know, through the communication of discord, that you are not currently in a position to be helpful.

Almost always, discord is a signal that you are trying to pound a square peg in a round hole. That’s a major problem in MI – because as you know, MI has almost nothing to do with “pounding”. That’s because you simply can’t pound change into people. When you try, there is friction, and tension – and the pounding or pushing approach takes far more effort than simply re-arranging things and finding a way to create enough harmony that movement in the direction of change can continue.

Some people think of discord as a phenomenon of “resistance”. They suggest that when the sound of discord emerges in a conversation it is because the client is “resisting”. In MI, such thinking is not particularly helpful, partly because it blames the client for a problem that originates in the relationship itself, (not within the client), and partly because it is almost always the MI helper who has the ability to change the dynamics of the conversation in order to get things back in synch. I have never heard a client say “Gee, Paul, I think you are not quite understanding why I am favoring the argument for maintaining the status quo here, and I suspect you are more focused on your own point of view! Paul, I think we are at a mismatch. I guess it would be much more helpful if you could just slow down a little and get your head around my way of understanding this!” Instead, what they usually say is something like “well, maybe that’s your idea, but it’s not mine”. Or, they say “for such a smart guy, I’m amazed that you could be so wrong”, or, “Yah, well, ‘whatever’! I totally disagree – but you’re entitled to your opinion I suppose!”

In MI-3, Miller and Rollnick write that:

“You can experience discord when a client is arguing with you, interrupting you, ignoring you, or discounting you. Note the presence of the word “you” here …. Discord is about you or more precisely about your relationship with the client – signals of discord in your working relationship with the client. In music, as in all relationships, discord requires at least two participants. A single voice cannot yield dissonance [or discord]” (p. 197).

What this means is that MI helpers need to be able to take responsibility for discord when they hear it emerging in change conversations. That is not to say that MI helpers need to take the blame. Rather, it’s helpful to think of responsibility as “Response-Ability”. When discord emerges, MI helpers need to have the response-capability of responding – with ability! I’ll be writing more about developing skills in responding to discord later, but for now, it’s important to think about what is fueling the discord. What
is the source of the mismatch:

Am I being sensitive enough to this person’s motivational obstacle? (Readiness, Willingness, or Ability?)
Am I wanting this person to change their behavior more than I am wanting to understand what is getting in the way of their changing?
Have I engaged with this person’s logic? How much time have I invested in the engaging process?
Have I prematurely focused on the “problem” (as I see it), before I have helped the person articulate what they see as “the problem”? (The Premature Focus Trap)
Am I using my experience with past clients to fast-track my understanding of this situation so that I can “prescribe” a change rather than help to give birth to it? (The Expertise Trap)
Am I open to seeing this situation through the eyes of my client, or am I overly focused on my understanding of what is going on, and on how I think it ought to change? (Expert Trap)
Am I in such a hurry to see this person change that I have to change him/her, because I have no time to invest in helping him/her to work through the process of change? (Hurry Up Trap)

Until next week …

The post DANCING WITH DISCORD appeared first on Paul Burke Training & Consulting Group.

FOUR DEFINITIONS IN ONE PAGE!

folksdigital — Tue, 14 Nov 2023 20:33:08 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Thoughts on Improved Practice (TIP) #1704

In MI-3, (2013) Drs. Miller and Rollnick provide three potential definitions of MI. Determining which of these makes most sense to you might depend on whether you are a practitioner, a layperson, or a student of change. In addition to the official three, I’ve been so bold as to include my own, fourth possible definition. It’s one I sometimes use in training. How would you define this “thing” that you’re learning?

The Layperson’s Definition

MI is a collaborative conversation style for strengthening a
person’s own motivation and commitment to change.

The Practitioner’s Definition

MI is a person-centered counselling style for addressing the
common problem of ambivalence about change,

The Technical Definition:

MI Is a collaborative, goal-oriented style of communication with
particular attention to the language of change. It is designed to
strengthen personal motivation for, and commitment to, a specific
goal by eliciting and exploring the person’s own reasons for change
within an atmosphere of acceptance and compassion.

Paul’s Definition

MI is a strategic way of communicating with people that helps
them to become more curious about their reasons, hopes, desires
and needs for making specified changes in the way they live. It
involves several disciplines of communication that serve to help
the client to hear and to think through their thinking about various
pros and cons of pursuing the targeted change. Ultimately, MI
helps clients reach conclusions that result in their planning for a
specific change.

The post FOUR DEFINITIONS IN ONE PAGE! appeared first on Paul Burke Training & Consulting Group.

STRATEGIC SIMPLE REFLECTIONS

folksdigital — Tue, 07 Nov 2023 16:51:21 +0000

Paul Burke Training Group

Telephone: 1-250-385-6468. Toll-Free: 1-855-MI-TRAINERS

Web: www.paulburketraining.com

E-mail: info@paulburketraining.com

Beyond training: Looking at learning MI in a whole new light!

Thoughts on Improved Practice (TIP) #1703

Practice Simple Reflections

Learning M.I. can overwhelm people who try to learn it “all at once”. Like learning to play the piano, it’s best to practice your new M.I. approach “one piece at a time”. Our trainers are fond of telling people about “MI chunklets” – small skill sets that can be practiced one-at-a-time, in brief periods (perhaps for a week or so each). In time, as you feel more comfortable with various “chunklets” you can start “stacking” them in practice. That way, over time, you begin playing more sophisticated pieces as it were – by gradually putting all the components
together.

One the most important chunklets required for the competent practice of MI involves the use of Simple Reflection. Some have suggested that “Simple Reflection” is something of an oxymoron – given that there is little that is “simple” about deciding which elements of a client’s statement ought to be reflected, when, and how best to simplify the statement (usually by shortening it as much as possible). Still, everything difficult eventually becomes simple with practice!

So – to kick off a brand-new year of practicing with MI, and remembering how important it is to “KISS” (Keep It Simple – Silly!) – this would be a good week to go back to the absolute foundations of MI and practice with making simple reflections of the important elements of what your client tells you. Once you get in the habit of doing that (and doing it as least twice as often as you ask questions!) – you can then begin to practice “reflecting with strategy”.

Strategic use of simple reflections while you’re working within the Engaging Process involves reflecting on what your client has just said. Next, you reflect upon what words you might offer back to your client to demonstrate that you understand. (By doing this, you also “test out” the accuracy of your understanding and you demonstrate that you are engaging with her point of view and with any “content” that she is offering regarding any particular “topic” or concern. If your client confirms your understanding (by nodding, or continuing to speak without correcting you, or saying something like “yes, that’s what I’m saying (or equivalent) – then you are “on track”. Of course, because you are using simple reflections (not complex), you won’t be worrying about reflecting back various elements of what the client might mean, or how she might be feeling, or the implications of what she is saying. To do so would demonstrate complex understanding (thus the title “complex reflection”) of what your client has said.

Strategic use of simple reflection serves other purposes when formed and offered while working through various other processes with a client. For example, in the “Evoking Process”, if a client were to utter some change talk (desire, ability, reason, need, or commitment), you might offer a simple reflection – just to help your client hear, and be impacted by that change talk a second time. For example:

Client: Yah, I’ve been thinking a lot about looking for work. I’m gonna* dust off the ol’ resume and get it up to date first thing Monday morning.” *Commitment Language

Interviewer: You’re decided to get to work on that resume first thing in the week.

Client: I’ve gotta* cut back on all the chips and all that deep-fried stuff! My daughter’s having her first baby soon and I wanna be around** to be a Grandpa. My doctor says that may not be too likely if I keep it up with all the fatty foods. *Need language and **Desire Talk

Interviewer: You’ve got a real desire to experience life as a Grandpa* with your first grandchild. And – it sounds like one thing you need to do** to make that happen is reduce your intake of fried foods. *Desire Talk **Need Talk

Similarly, simple reflections can serve strategic purposes when you are working within the Focusing and Planning processes as well. The following short exercise invites you to form a simple, but strategic reflection for client statements that might be made in each of the four processes. An example is provided for you. (You get bonus points for making very short reflections here!)

Engaging

Client 1: Well, I can see that my drinking is a problem in some ways. I mean everybody else always tells me that it’s a problem. I’m a bit scared to be honest. My Dad died of alcoholism when I was just a kid.

Interviewer: “It scares you.”

Focusing

Client 2: I decided that this would be my year to get it all sorted out, but I honestly don’t know where to start. It’s crazy. There just so much on my plate right now. Taxes. Thinking about our upcoming move. Getting some money together for an RRSP. Buying a new car. And my Dad’s in the hospital and so I wonder if I should take some holiday time and fly down to see him. I worry about him. He’s getting up there in years and…. Well, you know. My kid just got diagnosed with a learning disability and I gotta get him into some special classes to see if he can make up what he missed from his reading last year. My blood sugar is through the roof and I should probably see my doctor about that ‘cause that can really get me screwed up. My wife is on my case to sit down and make a list and prioritize it. That’s how she does everything. Lists. She’s very organized that way. I don’t know, I just seem to be going in circles.

Interviewer: “Prioritizing.”

Evoking

Client 3: Well, there’s one thing I could do, I suppose. I’ve been thinking about it. Maybe I could get in with one of those counsellors at that Centre. You know, maybe call up and see what they say about all of this. They will see a person for free – but you need an appointment and that can take 2-3 weeks. Mind you, I suppose they get cancellations too, so who knows that might speed things up a bit. Yah, I could call them, but then again, maybe a person should just wait it out and see if things improve.

Interviewer: “You’re saying you could* give them a call”

*Ability Talk

Planning

Client 4: There’s no point in me talking to my husband about any of this. He’s not good at this kind of thing at all. For me, I just need someone who I have to answer to – you know like a mentor, or a coach or something. I’d have to ask around to some of my friends who have those “Accountability Partners” in their jobs. Somebody who will kick me in the butt if I don’t follow through.

Interviewer: You’d have to ask around a little.

(Begins an invitation to make plans around the “asking” task.

Try SIMPLE REFLECTIONS this week! Experiment with them. They are strategic tools and if you learn to use them effectively, can make your motivational conversations much more effective and efficient. See you next week!

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