Module 6 Outline:
We move on now to another example of what used to be labeled resistance, but is far more complex. A hugely sensitive man is facing possible punitive measures for hitting his wife. He's that sensitive and troubled that he won't even look at the interviewer, Dr. Miller. It's a roleplay without rehearsal.
This is an interview across cultural barriers, not uncommon in mental health treatment. Dr. Miller conducts the interview relying almost solely on reflective listening. Notice how the reflections amount to hypotheses or guesses about how he is feeling and what is going on. Also notice when he lifts his head for the first time.
Working hard to keep up with the pace is routine in mental healthcare settings. Add to that a few requirements from above, like intake forms, assessment and a string of difficult, consecutive appointments, and it's no wonder that practitioners feel under pressure.
How can MI be used to save time?
It sounds paradoxical, but reflective listening can do just this. The next two videos illustrate this. The first, a real account from a busy doctor in Singapore. The second, an unrehearsed demonstration of needing to raise a tough subject with an angry man.
There are now over 450 reports of controlled trials using motivational interviewing. This is a tricky business, interpreting the findings across so many fields. One of the chief problems is that just because a report says something like "MI was used..." does not mean that it was.
How well were the practitioners trained? What standard of competence was achieved and maintained?
You can shortly view a conversation between myself, Dr. Miller and Dr. Terri Moyers, in which we cover this whole terrain. Put simply, it's not enough to simply run a controlled trial unless you monitor exactly what was delivered. Fortunately, Dr. Moyers is one of the leading researchers in this field of process research, so her insights are worth catching.
Finally, the biggest challenge of all: what ever the research tells us from trials conducted in often carefully monitored conditions, how does one integrate MI into busy everyday practice? Take a look at this exchange and see what you think.
In the next series of clips you will get a chance to think about yourself and the organization you work in. What will it take for you to learn MI? What about your colleagues? Does it matter if some people in a mental health service don't use MI?
It's probably best to acknowledge that not everyone takes to MI. It takes a particular quiet focus on listening and bringing out the best in clients. Some colleagues might have talents that lie elsewhere.
Then there's the question: Should everyone practice MI?
Views will differ here. Mine is that this might be a mistake. It might be better for those who do want to learn MI to take this really seriously, with passion, without leaving others feeling that they are in some way deficient if they don't learn and use MI.
Finally, consider this before you view these next clips: do you see MI as a discrete method, distinct from other approaches, or can you develop MI as an underlying style that permeates all of your work, allowing you to integrate an MI style with other approaches like CBT?
My preference is for the latter, and I strive every day in my practice to be flexible, to stay close to the style of a guide, even if I am using CBT with a client.
Stephen Rollnick, Ph.D., is on the faculty in the Department of Primary Care & Public Health at Cardiff University, Wales. He has also worked for many years as a clinical psychologist in the British National Health Service. With a background in the addiction field, his interest turned to consultations about behavior change in wider mental health & healthcare practice, where practitioners try to encourage clients to change their lifestyle and use of medication. Dr. Rollnick’s research and teaching activity is now focused on the behavior of practitioners and other topics. He has trained practitioners in many countries and continents, and has published a wide range of research papers, articles and books.
Financial: Stephen Rollnick receives compensation from PESI, Inc. for developing course material, speaking, and product sales.
Non-Financial: Stephen Rollnick has no relevant non-financial relationship to disclose.
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