2019 Motivational Interviewing Network of Trainers Forum: Perspectives from ATTC MI Trainers
Motivational Interviewing (MI) is an evidence-based practice that practitioners use to help people resolve their ambivalence about change. The ATTC Network is fortunate to include a number of skilled MI trainers who are helping to expand use of this effective practice in the treatment of substance use and mental health disorders. Three of them, Laura Saunders (Great Lakes ATTC), Paul Warren (Northeast & Caribbean ATTC), and Bryan Hartzler (Northwest ATTC) attended the 2019 Motivational Interviewing Network of Trainers (MINT) Forum, held in Estonia, Latvia in September. They share their perspectives on the experience in the following articles.
It’s Not All in Your Head: Motivational Interviewing and Sudame Pidu
Laura Saunders, MSSW
Program Manager, WI
Great Lakes ATTC, MHTTC, and PTTC
The 2019 Motivational Interviewing Network of Trainers (MINT) Forum, an annual gathering of the international group of motivational interviewing (MI) trainers, was held in Tallinn, Estonia, at the end of September. This year’s meeting included 337 MINT members from 28 countries. As usual, the week-long event featured a Training of Network Trainers for inductees, pre-conference workshops, multiple breakout sessions, and a forum with keynote speakers that included the original architects of MI, William R. Miller and Stephen Rollnick. Everything was aimed at increasing MI trainer knowledge and skills. Our Estonian hosts gave us a warm welcome to Tallinn, an ancient city with cobbled streets. Tallinn is also listed as one of the top 10 digital cities in the world.
Having attended all but two forums since 2007, I have enjoyed the event as an annual pep talk, a check-in, and a perfect way to refresh my passion for MI. A fellow “MINTee” describes the forum as “feelings camp.” We joke about it being a bit of a lovefest for MI devotees.
This year my role went beyond participating as an attendee, as I was accepted to be a Trainer of Network Trainers. Our training group, Colleen Marshall (US), Danny Lang (Canada), Kiril Bosnogov (Bulgaria), and I (US), were assigned 40 people from 12 countries, speaking many languages. The trainees were invited into the MINT after completing a rigorous application and submitting an MI practice sample. To honor our host country, we as group leaders chose the Estonian title “Sudame Pidu,” which translates as “party of the heart,” as our group name.
As seasoned trainers, we made decisions about our three-day curriculum, knowing that we didn’t need to train the new MINTies on the basics of being trainers; their applications indicated that they were already quite good at that. Instead, we planned three days of sessions that kept the participants in their hearts rather than in their heads. Their heads were already fully stocked with everything they needed to know about MI. What they needed was to believe in themselves as trainers and establish connections with their fellow group members. Having a solid relationship with the MINT organization and fellow MINTies is beyond useful for maintaining an MI training practice.
Despite differences in culture, first language, and profession, the trainees connected with each other in many ways. Empathy is not about having the same experience. I observed this group being lovingly kind, accepting, and empathic with each other. Pairs of trainees took turns demonstrating training on Day 2. To improve their skills, the trainees got strengths-based feedback and one suggestion for change. Our final day wrapped up with a visit from the MINT board of directors and an informal and exceptionally informative Q & A session with Drs. Miller and Rollnick. To celebrate our time together, we passed small acrylic hearts around a large group circle. Each person touched every heart, and everyone left with one. Hopefully, these hearts will serve as reminders of safe a place to turn to when sharing MI with others gets tough.
The MINT Forum also stressed that MI is an evidence-based practice: More than 100 meta-analysis and 1,300 clinical trials support the effectiveness of MI, and a growing number of professionals are seeking MI training. It’s just that it’s not all in our heads: Our training at this year’s MINT forum encouraged participants to work from their hearts when delivering a science-based practice that supports another person’s exploration of and eventual resolution of ambivalence toward change.
The Power of Learning MI in Peer Groups: A Facilitator’s Reflection
Paul Warren, LMSW
Senior Trainer and Technical Assistance Provider for the Northeast & Caribbean ATTC
Program Manager for the Training and Practice Implementation Institute
Research Project Director, New York State Psychiatric Institute at Columbia University [email protected]
During the recent MINT Forum in Tallinn, Estonia, William Miller offered a provocative keynote speech about what we currently know about Motivational Interviewing (MI) and the future of this evidence-based practice. He noted that, at present, findings from nearly 1,300 scientific studies confirm the effectiveness of MI to support behavior change. It’s not at all surprising that in the field of substance use services, we have an urgent drive to train our workforce to use this proven method of behavior change support.
Dr. Miller also noted several consistent themes emerging from the research that warrant the attention of all who train and provide technical assistance to promote the implementation and refinement of this deceptively simple practice method. Of particular note is the positive impact that particular and identifiable qualities of the provider and their counseling approach has on the effectiveness of the collaborative partnership and the outcome(s) of the counseling conversation(s). This theme harkens back to Dr. Millers’ original research and the progressive evolution of the practice of MI. “Provider qualities and approach” are factors that continue to draw attention and also shine an especially important light on the current training interventions being used to teach providers the practice of MI.
The greatest balance of training, as it is currently provided, has not served the practice of MI. What present training methods have achieved, is to convey basic knowledge of MI and to encourage providers to equate the micro skills of MI—Open-Ended Questions, Affirmations, Reflections, and Summaries—to the practice of MI. While having these skills is essential for the implementation of MI, the use of them alone does not demonstrate the actual practice of MI.
If we seek to support behavior change and to impact the devastating consequences of substance use, we must execute educational, adoption, and implementation support interventions that explicitly provide opportunities to ‘practice’ MI after the primary training event. To adopt and use MI, providers must have supported practice experiences and receive practice-specific feedback. MI implementation studies confirm that to reach and demonstrate MI proficiency, providers must receive informed and MI consistent feedback on their use of MI.
As trainers and technical assistance providers, we have the opportunity to unlock the potential of MI more effectively and to have a greater impact on the substance use epidemic. One method, currently being implemented in New York City and presented at a workshop in Tallinn by the author, is the Group Practice Session (GPS). This method of implementation support uses a group model to stimulate MI adoption and practice refinement. GPS groups are conducted after the completion of a 12-hour (two-day) MI overview training. Trainees are composed of groups of eight to ten providers. Groups occur twice a month, once in-person and once via video conferencing. GPS groups play out (practice) and discuss “real life” use of MI. Trained facilitators lead the groups and capitalize on the consistently occurring synergy between peer learners. In addition to GPS participation, each learner receives individualized strengths-based feedback, drawn from the review of audio recordings, on their conversations with clients/patients. To find out more about this post-training implementation intervention, please don’t hesitate to contact the author.
Ain’t That A Kick
Bryan Hartzler, PhD
Director, Northwest ATTC
During recent travels to Estonia for the Motivational Interviewing Network of Trainers (MINT) Forum, I encountered an emerging area for MI—coaching competitive athletes. In advance of this trip to Tallinn, I had identified within the presentation schedule a workshop on the final morning entitled “The Use of MI to Promote Helpful Conversations in Elite Sport,” with two longtime MINT colleagues, Jeff Breckon and Sebastien Kaplan, as facilitators. When the time came, Jeff and Seb did a typically masterful job of discussing rewards and challenges of applying MI in an elite sport context, integrating informed opinions from Steve Rollnick (see Coaching Athletes to Be Their Best: Motivational Interviewing in Sports) and others in the room, and inviting experiential audience participation. Historically, MI has offered a style and structure for collaborative conversations that resolve one’s ambivalence and strengthen internal motivation for behavior change. The innovation in an elite sport context seemed to be the application of MI principles to build trusting relationships with athletes that nurture talent, affirm capabilities, and increase self-efficacy for success. With interest piqued, my mind ran through how this might influence my future coaching efforts in roles as an educator, consultant, and mentor. Little did I know, further immersion in the athletic field—via personal experience—awaited.
A dozen football-fanatic MINTies—including Jeff, Seb, and Steve—had arranged to attend a local derby match later that day. After arriving at the stadium, we watched the first half of the match, all the while voicing MI-adherent statements to affirm efforts of these competitive footballers—admittedly at times flirting with the boundaries of useful spectator commentary.
Halftime came, and stadium announcers declared—in Estonian, mind you—a contest for three ticket-holders. As luck would have it, my match ticket identified me as a contestant. Local Estonians sitting nearby recognized my language barrier, sharing that contestants were to take the field and each kick from the penalty spot. A new pair of football cleats awaited anyone able to hit the crossbar with their shot attempt. I had played competitive youth soccer while growing up in Seattle, but standing in this foreign stadium, I was acutely aware of being several decades removed from “lacing ‘em up.” Perhaps sensing my dissonance, fellow MINTies offered affirming comments and pats on the back—now intended to enhance my athletic performance.
Entering the field, I threw a hopeful wave back to my fellow MINTies and the neighboring Estonians. Little did they know an inner monologue had emerged, in full bargaining mode about my participation in this unexpected behavioral experiment: “You don’t need those cleats, or to try and hit the perfect shot. Just don’t make an arse of yourself.” Would I be led by such tentativeness? Or recognize in this unique circumstance the opportunity to challenge myself and go for it?
The two other contestants—one a local from Tallinn, and the other a visitor from Russia—walked ahead of me a few paces as we made our way to the penalty spot. Along the way, I glanced down to see the familiar black loafers donned throughout the MINT Forum, prompting the inner monologue to groan incredulously: “Ugggh……you couldn’t have packed athletic shoes?” I briefly contemplated a barefoot shot attempt, abandoning the idea due to the already wintry Baltic temperatures. The Russian was up first—surprising us all with a spirited sequence of preparatory jumping jacks and push-ups. Unfortunately, all of this athletic prowess did him little good, as his shot pushed the ball directly sideways from the penalty spot and nowhere near goal.
Now, it was my turn—the referee handed me the ball, I placed it at the penalty spot and lined up for the shot. In this moment, the inner monologue offered a mix of sentiments—some self-deprecating, some words of encouragement offered by fellow MINTies in the stands, still others the recitation of wisdom from coaches of the past. All had the power to influence my behavior now, and I recognized it was up to me to attend to those likely to be most helpful in this moment. Would I later remember this insight about selective attention in my future coaching efforts? I stepped through and struck the underside of the ball, watching eagerly as it floated toward the top of the goal. Unfortunately, it ultimately curled about 18 inches over the crossbar. The inner monologue resurfaced, providing immediate feedback on the shot: “Damn, you got under it a bit.” I glanced down at the penalty spot, then again at the goal, and visualized the corrective precision needed for a successful shot. A more forgiving inner monologue surfaced: “Not a bad effort, under the circumstances.” Next came the Estonian, whose yeoman effort sent the ball skidding across the turf toward goal but without much elevation needed to reach the crossbar. No prize would be awarded in the stadium today.
As we contestants shook hands and departed the field, applause from the stadium crowd offered solace for any lingering feelings of disappointment. I looked toward my fellow MINTies in the stands, a few of whom pumped their fists in seeming approval of the effort. The inner monologue reassuringly repeated, perhaps for emphasis: “Yeah, not a bad effort at all.” Making my way up the stands, I felt something unsteady and looked down to see that my swipe at international football glory had separated the shoe leather and sole of my loafer. A more humorously reflective inner monologue now noted: “There’s irony in this, you destroyed a pair of shoes trying to win those cleats.”
Rejoining my fellow MINTies in the stands, I was greeted with a barrage of “atta boys” and some good-natured ribbing while watching the second half of the match with a persistent smile on my face. Had I uncovered the critical ingredients to applying MI in athletic coaching, and put technology transfer in action? Probably not. Had this personal experience deepened my empathy for those who seek out performance-focused coaching? Sure. Had it all been worth it? Totally.
Motivational Interviewing Resources from the ATTC Network
A sampling of MI resources from across the ATTCs:
From the ATTC Network Coordinating Office:
- Tour of Motivational Interviewing (HealtheKnowledge)
- Motivational Interviewing to Address Hepatitis C-Vignettes
- Motivational Interviewing (Special Topic)