Ask an Expert: Motivational Interviewing, David Rosengren, Ph.D.
The Wisconsin Motivational Interviewing Conference is coming up soon: May 6-7, 2019, Wisconsin Dells, WI. Laura A. Saunders, MSSW, Wisconsin project manager for the Great Lakes ATTC, MHTTC, and PTTC, is a trainer with the Motivational Interviewing Network of Trainers (MINT). Laura will be co-presenting a two-part workshop at the Wisconsin MINT Conference titled Self-Assessment of Your Practice. The session is designed to help motivational interviewing (MI) practitioners evaluate their own skill development.
The conference will also feature David Rosengren, Ph.D., as keynote speaker. In this Great Lakes ATTC Ask An Expert column, Dr. Rosengren shares insights he’s gained over the past two decades as an MI trainer.
Dr. Rosengren, you were a member of the first Training for MI Trainers in 1993, and have been training since then. How has MI evolved since the early days?
My first exposure to Motivation Interviewing was through Project MATCH(an eight-year study of alcohol use disorder therapies funded by NIAAA; it ran from 1989 to 1997). The three interventions that Project MATCH studied were a coping skills model based on cognitive behavioral therapy, 12-step facilitation, and MI. Project MATCH used motivational enhancement therapy, which was based on MI.
MI was relatively new at the time—the first article about it was published in 1983, and William Miller and Stephen Rollnick were writing the first edition of their book, Motivational Interviewing in Health Care: Helping Patients Change Behavior. We saw the MI book coming out in rough draft
Like any model, MI was based on what was known at the time, and as more data has become available, the model has changed. For example, we took Rogers’ idea on client-centered therapy, and then began to think about ways that practitioners can influence the process in a more intentional way to help people more toward their goals, with an awareness of the practitioners’ need to balance their own agendas with the need to respect the client’s autonomy.
MI terminology has changed. For example, “self-motivational statements” has been replaced with “change talk.” The original model had five principles; those have gone away. We now have four processes that did not exist when MI first came out. Also, “resistance” was part of the initial conceptualization, but the most recent MI book uses “discord” to reflect more accurately what’s going on between the client and the practitioner.
From 1983 to 1993, any training on MI was being done by Miller or Rollnick, and the first Training of Trainers was a way to meet the increasing demand for MI training. When I did the initial training I was not very good, but I wanted to learn more about MI. MINTgrew out of that first group and today requires trainees to meet specific standards and demonstrate skills. If today’s standards were applied in 1993, I wouldn’t have been accepted for the training!
Has MI expanded to use in fields outside of behavioral health?
The initial focus of MI was in alcohol and drug use, and it’s been moving into a range of other fields. Expansion began quickly in the early 90s. A colleague of mine was using MI with outreach workers in Zambia on safe water handling practices. Today, MI is widely used in criminal justice, with the two-pronged task of keeping society safe and keeping people out of jail. There are practice groups using MI in schools, social work, child welfare, and a variety of social service settings, as well as many other fields.
What are three things that you would like all behavioral health professionals to know about MI?
First, MI is not something we do to people, instead it is how we “be” with them in a particular way. We have conversations with people that help them bring forward what they want, and then we support them in the process. We help them sort through this stuff together, shoulder to shoulder on a project of mutual interest.
Second, MI is simple, but it’s not easy. You can pick up the basic concepts in two hours, but learning how and when to use them is another thing. This is especially true about reflective listening—by far one of the most important skills we can have. Continuing to refine and practice that skill makes a huge difference. If people are not able to feel empathic to clients and communicate that through reflective listening, it makes it really hard for practitioners and clients to achieve goals.
Third, MI is a learned skill. It’s not something that any of us are born with. At times all of our professional training can clutter our minds, and we make it more complicated than it needs to be. I remember once when my youngest child, who was seven at the time, was listening to my older daughter talking about taking a dance class in college. She talked about how much she enjoyed this and how much she missed it. My youngest looked at her and said, “You just really love to dance.” He really understood her deeply and communicated it well. We all can do this as well as a seven-year old, but sometimes we get in our own way.
Because MI is a learned skill, it also responds well to practice, coaching, and feedback. Going from good to great takes a lot of hard work.
What are some supplemental resources that practitioners can turn to for more information on MI?
The great news is there are a lot of great resources. A good place to start is the website for the Motivational Interviewing Network of Trainers (MINT). YouTube has many examples of videos so people can see MI in action. Psychwire offers an online course for health professionals so they can learn directly from Miller, Moyer, and Rollnick. For those who like to read,Guilford Presshas a lot of books. My most recent edition of a skill-building workbook is available on Guilford and on Amazon.
The ATTC Network HealtheKnowledge online self-paced learning portal includes the course, Tour of Motivational Interviewing, in the category Substance Use Disorder Basics. Face-to-face motivational Interviewing training is also available through the Great Lakes ATTC and other ATTC Network Regional Centers and National Focus Area Centers.
Any final thoughts you would like to share about MI?
Well, one thing is why would a busy practitioner even bother to learn all this stuff? Why, when you have so much to do, would you learn this in particular? The answer: MI helps with the common problem of ambivalence. Even if clients want to change, things can get in the way. MI has the potential to help practitioners with something they deal with every day when working with clients.
MI helps us look at the big picture and gives us the tools to help a client, while recognizing that we can’t do it for them. We cannot control outcomes, but we can influence them in a way that respects a client’s autonomy, but still helps them make a change.
Finally, we are so often tempted to give advice, because we believe clients need to change their behavior. With MI, the goal is not to deliver advice but to change behavior. That means we really need to understand how change happens and the most powerful ways we can deliver the information that will help clients decide to change the behavior. And it’s not usually telling people what to do, but instead listening carefully and offering information people want to hear.
April 25, 2019
Maureen Fitzgerald, Editor
Great Lakes ATTC, MHTTC, PTTC