I recently received a link, from a MINT colleague, to a reading of the children's book The Rabbit Listened by: Cori Doerrfeld (2018 Penguin Putnam Inc). This sweet, simple story highlights so many of the ways that listening punches way above its weight in its ability to truly assist when meeting with someone experiencing struggles. You can access a link to the story in this editorial and observe what resonates with you about the power of this vital skill. I'll offer some thoughts as well for your reflection.
In this Issue, I am very excited to be offering a video recording of a lecture by MI co-founder Prof Steve Rollnick recorded in Cape Town South Africa this March. This presentation was hosted by the South Africa HIV Addiction Technology Transfer Centre (ATTC) and explores the clinical applicability of Motivational Interviewing (MI) in various contexts ranging from harmful substance use, ARV adherence and mental health. In this presentation Steve tries to answer the perennial question for all of us involved in the work of assisting others to be their best version of themselves: 'What does helpfulness really look like?'.
Prof Rollnick is Honorary Distinguished Professor in the Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University. I would like to express my gratitude to Steve for confirming permission to share this wonderful learning opportunity with you all.
To tune in to Steve's wisdom click through to this issue below.
This Autumn issue features content from guest contributor and dear colleague Molly Kellogg LCSW CEDRD. Molly is a Psychotherapist, Certified Eating Disorder RD and a MINT member based in Philadelphia USA. In this article, Molly explores the challenge of staying on topic with clients. Whilst Molly's focus is on assisting nutrition therapists with this task, this challenge is raised as a universal issue across disciplines in my MI workshops and so I highly recommend a read, no matter your scope of practice. Staying on topic with clients can be appreciated from many different angles and this article provides an excellent exploration of the possibilities for skillful practice.
At the close of every MI 2 workshop attendees are asked to write a 'thank you note' to MI, as if they had just met MI in the street, like a favourite old teacher. I have collected over 120 notes again this year again and have featured in this issue, some of the most impactful letters of gratitude. This editorial was so well received in the end of year issue for 2017, I thought I'd make this a new Pavestone tradition. I hope you find the sentiments expressed inspiring and encouraging of your growing MI practice.
The interest in MI as a central (not 'specialist' or 'fringe') skill for health practitioners is growing fast. I was recently approached by Allied Magazine to pen a brief article on MI in progressive allied health practice. What evolved from this invitation is reproduced and extended in this issue featuring Five Pearls for you MI practice. I do hope you find it a supportive recap of many of the explorations in your MI learning so far, or a stimulating intro for those of you coming along new to these concepts.
In this issue I am extending on the beautiful Parker Palmer poem shared in Issue 48. If you missed it or would like a refresh you can take a peep in the blog listing below. In this 'poem' Palmer encourages us to work with presence rather than intervention, to be truly helpful when someone is stuck or struggling. This encouragement is deeply resonant with the spirit of MI and in this issue I thought it may be useful to bring this encouragement to life and offer a sample of what this may actually sound like in session with a client. This sample dialogue feature a practitioner working within the HAES ® approach to health. Read on for more.......
For this issue of Practice Pavestones I am sharing a beautiful piece of writing from activist, author and teacher Parker Palmer, for our reflective practice. Palmer invites us to consider the option of 'letting go' as practitioners when we may typically experience the urge to grasp tightly and push for more in search of an outcome for the clients we work with. I do hope you enjoy it.
When working in an MI framework we are actively steering a conversation towards the strengthening of a client's own motivations for change .....from within them. Rather than instilling motivation via our knowledge and enthusiasm, we are evoking it or drawing it out of the client. One way we can do this is by listening for and responding to change talk. In recent issues we have looked at responding to change talk by inviting our clients to 'say more please' by elaborating or giving examples (more in Issue 46). This issue will feature a quick look at responding to change talk by affirming it. When practicing affirming, rather than looking for problems and finding solutions we are 'looking for the good' and handing it back to the client - after all it is their resource!
An expression amongst MI practitioners, that some of you may have heard at a Pavestone training, goes something like this: 'When you hear change talk don't just sit there! DO SOMETHING!'. This is an evidence informed call to action for the practitioner. How WE respond to what we hear our clients say about change directly influences the appearance of more change talk, the strength of it and what a client may then do after session in the direction of change. It is amazing how often we miss opportunities to dig deeper and draw forth from the client. In this issue I will be introducing a fine tuning of the elaborative 'tell me more' question: asking your client for examples that may build towards the direction of change. Taking the time to do this can be a very efficient investment.
I've planned a fun edition this issue, the last for 2017. It's all about saying thank you - such an important expression of this festive season. At the end of every MI 2 workshop, attendees are invited to write a thank you note to MI 'as if they met MI in the street, like an old friend'. It is a playful way to round off the days learning and always heart warming. For this issue I have selected some letter highlights to affirm and encourage your own work towards continuing to develop in a client centred direction. I really hope you enjoy it.
This Issue is taking time out from our current exploration of the methodology or 'mind-set' of Motivational Interviewing. Inspired by recent discussions with colleagues in Ireland, this editorial offers some thoughts about the 'heart-set' of MI. In particular our practice of acceptance of our client's autonomy: why respecting this is vital and challenging and what it can feel like when we lose our way with embodying this attribute. I hope you find this month's editorial supportive and thought provoking.
Over recent issues (41 and 42) we have been exploring conversation options available to us within Motivational Interviewing when assisting clients expressing low confidence in their ability to change. In this issue we will be looking more closely at the challenge we may face if confidence building work is outside of our scope of practice. This may be particularly true when the behaviors our clients are trying to change are functional. In this challenge, our MI Spirit and framework can be a wonderful asset. Finding our client's own reason for attending therapy through a respectful, values based conversation can help a sometimes risky discussion flow with empathy and connection. Read on for more about understating functional behaviours in a super soundtrack for this month.
Motivational Interviewing invites us as practitioners to have a deep belief in our client’s capacity to do well in their lives, if they so choose. In MI the therapist will put this belief into action and to go looking, with the client, for their resources and beliefs that would be an asset for the difficult task of behaviour change. This aspect of MI practice is highly relevant to our current exploration of the importance of confidence in our client's ability to change and the role we play as practitioners in optimising its development. Last Issue 41 we took a look at skillful conversational options available to us when a client expresses low confidence in their ability to change. In this issue, I will be introducing a beautiful practice written by Bill Miller which you may find useful when helping your clients to develop confidence in their own ability to get some traction with important self-care behaviours.
Read on for more....
If you have been reading in sequence from Issue 39 you will be familiar with the skill of using scaling questions in MI to identify our clients' own thoughts about the importance of change in their lives and confidence for making that change. In Issue 40 we focused particularly on working with low importance for change. The challenge this issue's editorial will feature is: how do we work effectively with our client who believes strongly it is important to change but they are held back by a lack of confidence? Read on to explore some ideas of what MI might encourage us to do (and NOT do!) when this challenging scenario presents.
In this issue we will be extending on our exploration of Scaling Questions introduced last newsletter. These questions can be powerful invitations for our clients to connect more clearly to why change matters to them and where they are in the change process. So here's a wrinkle: what happens when our clients share with us that change is NOT that important to them? Read on to explore some ideas of what MI might encourage us to do (and NOT do!) when this challenging scenario presents.
Regular readers will be following the thread of discussions on the Evoking process of Motivational Interviewing over the past few newsletters. In this editorial I am going to be featuring a style of open questioning featuring 'change rulers' which can be powerful invitations for our clients to connect more clearly to why change matters to them and where they are in the change process.
These questions, also referred to as Scaling Questions, are particularly oriented towards evoking from the client their own perspective on the importance of change and their confidence for making change. They can be powerful questions for evoking more change talk from the client. They can also serve as excellent indicators of where the client is at in their change process to enable us to 'dance in sync' with their stage of change.
To read more download away!
What a challenge this common conundrum is - when a client insists that you 'just tell me what to do!'. When it comes to engaging in a sound Evoking process - this is a surefire derailment.
Given the evidence is clear about the unhelpfulness of advising ambivalent clients, how do we skilfully reply?
In this issue we will be spending some time exploring how Motivational Interviewing may encourage us to respond to this request in a manner most likely to open a more fruitful discussion for our client's benefit.
Read on to colour in some context to this question, learn about when giving information is good work and what we might do when it is NOT such good work.
February's Issue 36 introduced the concept of 'change language' and the first steps in working with this important aspect of dialogue with clients. Readers were encouraged to start by simply identifying Change Talk in their client's speech and to simply reflect it and ask for elaboration. This vital aspect of client perspective is at the core of the third process of Motivational Interviewing: Evoking. In this issue we will be exploring more about getting Change Talk alive and kicking in session. It is so obvious it seems too simple........just ASK FOR IT!
If you are feeling stuck with a client who is clinging to the status quo in their dialogue with you – it may prove fruitful to have a look at what you are asking for.
In January's Issue 35 we explored the Righting Reflex - the part of us that wants 'good things' for our client and the paradoxical impact this desire may have on promoting unhelpful behaviours for our ambivalent clients.
We can manage our Righting Reflex by many skillful means. One such means is being able to attend to the 'change language' of our client. In this issue we are going to take a toe dip into what we mean by change language to equip you with some starting points if you are practising implementing MI into your counselling skill repertoire. Read on for more...
This editorial will be picking up the thread from Issue 33 in October which was the last newsletter to be exploring Focusing - the second process in Motivational Interviewing.
Once you have found a useful direction for a session with a client, what follows next? I am going to be exploring how things can quickly derail from this point, even though we have the very best intentions. In fact, maybe because of our best intentions! Puzzled? Read on for more.
This issue is our last for 2016. Keeping with tradition of 2014 & 2015 this edition collates a synopsis of the year's issues with handy links to each issue's full editorial and completes with a CPD Quiz. You can buy the quiz to test your knowledge and for APDs - convert your dedicated reading of Practice Pavestones into assessed CPD hours for your APD renewal.....just around the corner.
But I have some sad news folks..............this will be the last year that the CPD Quiz will be published for subscribers unless there is a big increase in uptake. Do you have APD mates who are struggling to fill their assessed CPD hours for 2016? At $9.95 the 2016 Pavestones Quiz would have to be the most affordable assessed CPD on the market - not to mention fun, useful and super practical.
Please support Pavestones by sending on to APD colleagues who may be looking for great value assessed self-study in this vital area of clinical practice.
Read on to get a great summary of the years content and link to the Quiz...
This is the last issue exploring the second process in Motivational Interviewing: Focusing. I will be presenting two different styles for finding a meaningful session direction with your client.....and a soundtrack featuring a canine friend who just can't seem to find one! You can play with some focusing templates available as downloads in the editorial. What's your Focusing style? Tick a Box or Free Fall? or something unique to you?
In any modality of behaviour change counselling we need a direction, something to focus on with our client in order to be producitve. What is particularly emphasised in Motivational Interviewing is the HOW and the WHY of finding a focus.
In the HOW, MI encourages that it is very important that we find direction collaboratively with the client. Asking the client what matters to them and what they would appreciate help with is central to demonstrating the spirit of Motivational Interviewing.
The HOW of Focusing may sound pretty straight forward. Something has brought your client into your office and so we may assume they have something they want to focus on with us. Well, as they say: 'It ain't necessarily so!'.
Last week I received a fabulous question from a subscriber which brought a possible Focusing challenge to life. With her permission I will share her question here:
Could you please direct me to a past issue of Pavestones that might look at how to move forward with client who says they are 'doing everything but not getting results' but who I suspect isn't [doing everything]?
How on earth do we stay along side our client and find something to work on when they present as 'all good' and we have well founded concerns things are not going so well? Read on to find out more.
Once we have joined with our client in a strong engagement it's time to do something directional. This issue we are going to be exploring how to shift gears from the process of Engagement to the process of Focusing without crunching the gear box and bunny hopping through a session.
Download this issue to found out what the clutch sounds like and for a few more cheesy metaphors!
For those of you that are just joining the conversation, we are currently exploring the first process in the Four Processes of MI introduced back in Issue 28. This important starting point for MI is referred to as Engagement and we completed an introduction to what this really means and what helps it to happen last issue. Engagement is much much more than a friendly warm greeting.
Have you ever considered that your 'job' may get in the way of you doing good work? In this issue we are looking at how some of our workplace requirements and role expectations can really limit our effectiveness in facilitating behaviour change by blocking client engagement. While taking a look at these challenges I will be exploring some alternative ideas and options to consider. Read on to learn more and have a laugh at Christopher Pyne....