Learning MI
My Journey
BMI
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CPN in Alcohol Problems Service
Complex needs: higher end of drinking
Large caseload
Busy, often seeing lots of clients back-toback with little thinking time between
sessions
• Little prior experience of MI
• Thought I was reasonable at my job
• Managerial rather than clinical supervision
New Opportunity
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Support to attend MI supervision group
Very experienced trainer
Monthly meeting with peers
Session revolving round tape analysis with
transcription
• “This is a great opportunity”
• “I’ll really apply myself”
• Bought the book
The Reality
• Didn’t read the book
• “Too busy” to do any work between the
sessions
• Numbers reduced, recordings often didn’t
materialise
• Sense of going through the motions for all
of us: “ambivalent”
• No-one really improved
• High anxiety having to present work and
have it considered by others
Cognitive Dissonance and Resolution of
Ambivalence
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Particularly awful session:
no direction, no sense of purpose,
embarrassing
I had a sense of myself as someone who
took pride in their work and was
committed to helping others
Here was concrete evidence that this was
not the case
Something had to change
Making a Commitment
• Read the book
• Got the videos from the library and watched
most of them
• Read through the transcriptions
• Started really thinking about what I was
doing
• Things were going to be different
The Edinburgh Interview
• Client late and intoxicated
• Not feeling great: dreadful hay fever
• Client clear he did not want to stop drinking and
wanted to drink himself to death
• This client was simply not going to leave the room
without me giving it my best shot at MI
• Client’s life at stake
• My self-respect and belief in myself as an effective
helper
What Happened?
• Hard work to listen and think with everything he
was saying about the assault, his sense of
hopelessness, his diversionary tactics
• Determined to restrain myself, so many possible
roads to go down
• I had an incredible sense that something was
shifting
• Still had to work to stop myself being distracted by
my excitement that he was becoming more open
to considering change
• Transcribed session………………………………..
No Going Back
• A dramatic awakening of the power of MI
• But also disappointment that I had wasted
so much time
• Being nice isn’t enough
• A sense that I could be helpful if I went
about it a different way
• Interested in helping others see how they
could be more effective
The Next Instalment
• Terri Moyers MITI coding
• Jeff’s idea about using it as a training
resource
• Discussion with Steve
• Support to undergo MINT training
• Exposure of my practice
• Discombobulated!
AMI
• Strangers think they know me
• Delivering training mostly to clinicians in my
workplace
• Running coaching groups
• Developing an e-learning module in
partnership with NHS and NHS Education
Scotland (NES)
• The National Scottish MI Coach Group
National MI Coach Group
• Supported by NHS Education Scotland early
2011
• Aims:
- to support MI practice development
across all the Scottish regions
- to change culture and encourage service
managers to buy into coaching model
Establishing the Coach Group
• Initial selection process to assess level of
experience with MI
• Workshop offered by MINT trainers to support
development of coaching skills to more
experienced group
• Less experienced group invited to attend
workshop facilitated by the newly formed
coaching group
• Selection process to establish suitability to join
coaching group
National MI Coach Group
• Meeting every few months
• Establishing local forums
• Communication via shared space on NHS elibrary: support/local developments/teething
problems
• Winter school to launch coach group: Steve
Rollnick & Gillian Tober
Ongoing Issues
• How to expand the number of coaches
• How to increase the number of forums
available
• What part can the coach group play in
establishing consistent standards for MI
training and coaching across Scotland
NHS Lothian Coaching Forum
• Trial and error (the usual issues)
• Voluntary vs mandatory
• Part of PDP (evidence of
engagement/participation)
• 2-day workshop then extended training over a
year
• Structured
• Moving towards establishing coaching groups
NHS Lothian Coaching Forum
• Competences outlined by NTA
• MIA-STEP standards to guide practice
development
• THEME worksheets: self-rating of specific MI
skills and strategies (taping)
• Group discussion
• Practice exercises
• Relevant literature
What Have I Learned?
• Clinicians are ambivalent about this kind of
thing: just because they say they want this
kind of supervision doesn’t mean they will
actually engage/remain in the programme
• Some people find exposure of their practice
a terrifying experience: the higher up the
food chain, the more you stand to lose
What Have I Learned?
• We need to pay attention to and work with
ambivalence to help clinicians become more
comfortable about exposing what they do
• Individuals who form a coaching/learning
group need a lot of guidance and support
before they can be helpful to each other
• It takes a lot of work/patience/time to keep a
coaching group going
Questions
• How do we help clinicians resolve their
ambivalence about on-going coaching?
• How do we influence the culture within the
workplace in order that on-going coaching is
seen as a priority both at management and
at clinician level?
• Should this kind of thing be mandatory?