Finding the Honey in your MI Practice!
So you’ve read the MI book, been to the training, and practiced reflections until you dream in complex reflections.
Now what?
It might be time to make a tape of your practice for coaching and feedback. Maybe someone has asked you to do it. Maybe you are ready to bump up your skills. Maybe someone is asking you to supervise others. Maybe you understand that it’s the best way to improve strategizing in the moment with MI skills because you begin to witness yourself without judgment and change what you are doing if it’s not working.
If this sounds like you here’s how to proceed:
- Obtain verbal and or written permission from client based on your agency policy.
- Make a tape of ideally 20 minutes or more in length. If longer you may designate what section you would like the MI coach to listen to. If you are submitting a shorter tape it is possible to get some feedback but 20 is the standard.
- Have an identifiable target behavior (or change) that the clinician can ethically hold and collaborate on that would offer an improvement in health and/or well-being.
Practicing your skills with situations that a client is considering such as making a decision regarding school or moving works. However, in these cases you may not be able to test directional strategies.
These are situations when the clinician should maintain equipoise. When equipoise is being used, it is not possible for the rater to code either evocation or direction, since by definition there should be no “leaning” in one direction or another on the part of the clinician. This does not provide an opportunity for the clinician to demonstrate their evoking and guiding skills, which form the critical third process in MI. This could be a problem for work samples that are using a MITI coding instrument to demonstrate proficiency and coach for skills. (minus global scores on evocation and direction) would not give any indication to the reviewers of the full range of skills that the clinician may have in using MI. (2014 Ernst, Denise MINT TNT guidelines).
In general try to make meaningful reflections and explore areas around changing and not changing in vivid ways. It’s important to explore what the person believes about the change and what they value, and what they are most concerned about.
It’s typical of new practitioners to go on a data hunt with many closed questions. Many change conversations in healthcare travel a well-worn path of convincing and persuading. Theses strategies may lead to a person saying what they think you want to hear unless you create a space for them to think out loud in new ways.
One technique to try is to make at least 1-2 reflections for every question asked. Additionally, you can make data oriented questions more curious and open in the curious “tell me more” statement. The main goal is for the client to “think out loud” in new meaningful ways.
You can also keep MI spirit principles in mind:
- Autonomy
- Collaboration
- Evocation
Direction and empathy will come naturally with reflective listening but you can also emphasize these principles with word choices.
Be ready to step into the unknown with the client. Pretend that you are the man from Mars.
I don’t assume that I know. Find the answers together but don’t find them for your patient.
This is the honey in the beehive of change conversation.
The most valuable aspect of taping your MI practice is your willingness to share your practice, your mistakes along with your brilliance and witness it for yourself.
Taping will develop your MI skills, intuition and reflexes more than anything else.
And one last tip: test your equipment. Once you have determined that the recorder is working, turn it on and forget about it. You will hear yourself in a new way when you allow an MI coach to listen and offer feedback.
This article was written by Annie Fahy, LCSW, RN
