Tell me again, what is the point of Motivational Interviewing (MI)?

Podcast: Play in new window | Download (Duration: 30:00 — 54.9MB) | Embed

Subscribe: Email | RSS | More

Welcome to today’s episode of The Communication Solution podcast with Casey Jackson, John Gilbert and Danielle Cantin. We love talking about Motivational Interviewing, and improving outcomes for individuals, organizations, and the communities that they serve. 

Today we are talking about Motivational Interviewing. We revisited the point of MI, dialed back, and started from the beginning. Where did it come from? What does it even mean?

About This Episode

• What is MI?  
• Casey and John explain their history and experiences with MI
• Not a common language or a common way of thinking about things
• A method of communication that affects behavior change
• Impact on behavior change in the most effective and efficient way possible.
• The thought processes, research and experiences of Dr. William Miller and Stephen Rollnick
• Identifying motivations, thoughts and behaviors
• MI and healthcare perspectives
• Addiction and substance use world
• Acceptance and Compassion
• A different Mindset
• Ambivalence and finding peace
• And so much more!

You don’t want to miss this one! Make sure to rate us or share this podcast. It would mean so much to us!

Thank you for listening to the communication solution. This podcast is all about you. If you have questions, thoughts, topic suggestions, or ideas, please send them our way at casey@ifioc.com. For more resources, feel free to check out ifioc.com. 

Want to see the video podcast?

Want a transcript? See below!

Hello and welcome to the Communication Solution Podcast with Casey Jackson and John Gilbert. I’m your host Danielle Canton. We love to talk about communication. We love to talk about solutions, and we love to talk about providing measurable results for individuals, organizations, and the communities they serve.

Welcome to the communication solution that will change your world. Hi. Welcome to this episode of The Communication Solution with Casey Jackson and John Gilbert. I’m Danielle Canton, your host, and we are so excited today to jump into a topic. It’s like, guys, tell me what is it like? What is the point of MI?

Let’s just start from the basics. I’m so curious to kind of dial back and kind of start from the. You know, Danielle, I think what’s what’s helpful about this conversation is, you know, I’ve been training on motivational w for around 20 years now, and I was just doing a train the trainer this week, and one of the things we got into, and John and I have talked about this quite a bit in curriculum development.

You know, John and I have been working together for, you know, over 10 years now, 11, 12 years now. The hardest part for curriculum development is really understanding how do you teach to a naive brain when your brain’s been immersed in the research and the practice of MI for over 20 years. And I think, and I’m gonna jump in and just kinda laugh cuz I just kind of opened it with like, tell me again what’s the point of MI because it’s like, we literally call it MI Yes.

And there’s some people out there. What’s, what is ? It’s Michigan. I’m from Michigan. Or you know, originally I’m like, if you’re in the healthcare field, it’s my, the basically, there you go. Yeah. So lots of different people use different acronyms, motivational interviewing, and I, I, I think. I think that’s how we get so used to just talking about these things.

So second nature, and especially because it is, it literally is our full-time job is teaching and training people on motivational interviewing. So I think the more you get so oriented to it and used to it. , you think it is a common language like any other industry, and then you realize it’s not a common language and it’s not a common way of thinking about things.

So I mean, the simple way of when we say, you know, what is the point of motivational interviewing, it’s if you’re trying to affect behavior change, it’s a method of communication. And then you can keep it simple from there, or you can get extremely complex from there. And that’s, I think this kind of revisiting what is the point?

And the point is, I think originally, if I’m gonna break it down, I always think it’s effective communication, but that’s, that’s not what MI really is. It’s not what motivation really is. It really is effective communication, but specifically the intention of it is to have an impact on behavior change in the most effective and efficient way possible.

That’s why I think people get confused even with the term motivational interviewing, like where did it come from? What does that even mean? And it basically, if you look at where Dr. William Miller kind of constructed the thought from is that people have a lot going on in their lives. They struggle with a lot of decision making, with ambivalence, with stuckness.

And if you get them the chance to get some of their thoughts outta their head, it, it can help people get unstuck. Especially if you bring in. What their values are, which is what John and I have really leaned into more. But specifically around a target behavior. So, you know, this came out of the addiction world.

So people were thinking about, you know, quitting their alcohol use, cutting down their alcohol use or their substance use, smoking. And when you think about just behavior change, you can see how quickly that’s going to spread into mental health and behavioral health and. Because of diabetes, heart disease, and all these behavior changes.

And so that’s kind of where the, the construct came from is how can we be more effective in working with people. And, and part of what Miller, I think when he kind of titled it motivational interviewing, I know part of his intention was to break away from doing things to people. So he wanted to get away from it being a therapy or a technique.

And he was really just looking at the research, his own experiences anecdotally, and then researching it about when you interview people, when you just listen to them like a Barbara Walters or a Diane Sawyer, like the old school interviews, people were not defensive because you had somebody leaning in Oprah Winfrey.

They just lean in and listen. And if people are gonna lean in and listen, people are gonna talk and, but if you’re gonna shake your finger at them and tell them all the things they’re gonna do wrong, then they’re gonna get. . So instead let’s just, let’s talk to people and find out what, why would they wanna change in their life?

What would be their motive to change in their life? That’s so interesting cuz that was one of my biggest questions coming in not knowing anything about MI or motivational interviewing and just taking the name alone. I was like, motivational interviewing. So you wanna motivate somebody to do something you want.

Exactly. That’s that’s not what it is at all. It’s helping identify their motivations. Right, exactly. It. . And that’s part of the confusion too, because it’s why, you know, one of John’s lines that he started using that really helped me just get even clear about the terminology is we’re really listening for people as far as what is their motive.

 So we’re not trying to motivate them. It’s listening more deeply into what is their motive for change and, and not listening to what they wanna change per se, but what is their motive for. Yeah, that’s really interesting and I think it helps to know. Dr. William Miller was the co-founder of this approach, this communication approach.

How many years ago? Oh, a, well, the first publication, or the first research was in 80, I think it’s kind of attributed to early eighties. 84 was the first original, research project, and he, you know, he, he’s attributed being the co-founder. The reality is, is it was kind of his brainchild. . And when Stephen Rollnick , Dr.

Miller said, the only person that read the journal article was Stephen Rollnick. And so they started talking when they ran at each other to conference. And that’s where the, that’s where it became the co-founder perspective. But the original construct of it was just with Dr. Miller and his own practice as an addiction specialist and as a lecturer and as a, you know, an on faculty.

It just, these ponderings and musings that he started writing down in terms of, you know, what we do in the addiction world doesn’t. But it seems like when I do these things, it does work better. And as you started kind of noting those things and drafting some stuff up, other people are going, wow, that really makes sense.

And that’s when Steven Rok dove in and, and they just started teasing it out together. It makes sense too as a social worker. You, you as a social worker. The more I meet people, now, today, the more I’m seeing, oh, social workers are familiar with this. It’s actually built into their curriculum. Yes. Where they’re all aware of motivational interviewing, which I think is, is fascinating.

It’s like this whole language, you all. What you know, and what’s interesting about it is I tend to find that in John’s field, like in the healthcare field, in the dietician field, it’s almost more common to use that type of language out loud as a coach or as health coaches, than I even see it in social work.

So social workers think of it still as a technique. But I think there’s other industries that came on later onboard later with motivational interview. That are more into what the intention of it is from a coaching perspective and not as much from this therapy medical intervention technique. That’s still, so we use that language in social work quite a bit.

But it’s ironic that the field that was born from the addiction world, substance use world, it’s, they’re not as skilled at it across the nation as you would think, since it was the field that it was born. Because it’s still seen as more of a technique and they’ll put it on their website. You know? Yes, we use motivation as one of our primary methodologies, but when you go to measure it, they’re actually not particularly skilled in it.

Per Fidelity. It’s a, it’s a fascinating concept, how many people want to be associated with it, but then don’t, don’t actually know the technique from a Fidelity perspective. I am curious, John, how did you kind of fall in love with MI in, you know, as a nutrition expert? Can you talk a little bit about your history and introduction into it?

Yeah, I’ll definitely give a sense of how I got into it. I would like to get out of my head all the strings of thought that have been going on, that answer the question you originally started with, and then I can end with that to take that in whatever direction. But the first part of that is Dr.

William Miller would talk about, it’s a conversation about change now. Then Casey was getting at, well, what’s the intent behind having the conversation? And it’s likely going to affect some kind of change in their life. And that’s where in recent years, it was moving from it having to be necessarily a behavior change.

To a change more generally could be a shift of mindset or something like that. Could, you know, it’s always been involved relatively for a long time with mental health, but I say that just because a conversation about change is a really simple way to start thinking about it. Casey, you had mentioned you’re sitting down and you’re interviewing someone.

Maybe you’re not sitting down, but you’re interviewing someone about their motivations. And the reason I wanna bring that up is talking with Dr. Miller and where this all comes from. . There’s also a place that you were picking up Danielle, which is that we’re there to accept the whole person and that they’re a whole person with, as we’re treating them, some sort of self-determination and that they can do whatever they want to do, and you’re there to interview them about their motives and not get them to change, but be curious about change in their life, and ideally as Casey, you are alluding.

Operate from their worldview as you do that, which sometimes we think we’re doing, and we’re not including myself a lot of the time . So, that is just one way to start framing is a conversation about change. You’re interviewing someone about your motives. You’re not trying to get them to change.

You’re seeing, if you’re curious about. Motives and thoughts and ideas and so that’s a lot of like the basics. And then there’s also something about helping them, case you were saying, values align their behaviors with their top priorities, with their values, their things that really matter to that person, that would be happier and healthier for them.

And we tend to blame outside ourself when our behaviors aren’t doing that versus. . If you’re having a conversation with someone and you’re not defensive, it’s that Barbara Walters feel, as Casey was saying, then you are gonna be more open to talk about change and then potentially consider changing your behavior to align with your version of happier, healthier, and your values.

And so I just wanted to lay that out. That it can be simpler, it can get more and more complex. We can talk about it. We got lots of other podcasts, but I got into this through the research of the efficacy. Casey was using that word of being effective, and that’s how I got into it, is a simple aspect of it.

Danielle, I have fallen in love with the compassion and the acceptance and what that means in the world of how we treat each other. That’s what I’ve fallen in love with and that this is a way. Embody a lot of people’s beliefs in the world, that aren’t just talking about it, but it’s being about it.

And, and so that’s what I’ve fallen in love with. But what got me interested was the healthcare perspective of this is just the best practice and it’s the best thing we got. So let’s dive into it then. And that’s what led me to meeting Casey and all sorts of stuff from there that I think we’ve talked about in other podcasts.

But yeah, so Casey, I don’t know, there’s a lot of different layers to that if you wanted to riff or if that answered your question, Danielle. But those are just a few thoughts I had while I was listening. Yeah. I wanna highlight one thing real quick. Casey is not just talking about it, but being about it.

Yes. I love that. I love that. Sorry, go ahead. Well, you know, and, and that’s when we get into that and there’s so many things we can talk about it that the way of being about it. What’s so fascinating about the ongoing evolution of motivation, because it is so research driven. , like it’s so data driven and so it keeps evolving based on new research.

 What so much of it has to do with as well is what we even measure, like the tool that we worked on, the motivation being competency assessment or the other, you know, extremely well known coaching tool for professionals is the motivation being treatment integrity, scale, all these scales. Part of what we look at, aside from basic technique is almost this like for ours, the mindset or the intention.

And for others it’s like kind of your global. Like how are you showing up and how do you measure that in people and professionals and give them feedback of are they showing up in the way that, that being with people, what do we know is the most effective way to be with people and how can you get feedback on that?

 So I think that’s the thing that’s the, so fascinating about it when we break down to some of the basic concepts as well. You know, John, as you were talking about, What I was thinking about in reading, Dr. Miller’s one of his books, you know, on second thought, it’s just when you, when you break it down to what is motivational interviewing, it’s, it’s just approaching something that’s existed for, since the Dawn of Man, which is ambivalence on any given day, just think how many choices do you make on any given day, like how many, and especially in this day and age, I mean, as a, you know, as a prehistoric man. You know, there wasn’t tons of choices. , there we’re mostly based off survival mode. You know, your choice is to eat or be eaten. So they’re pretty basic choices on any given day. And now in this technology world, we have so much ambivalence and you know, people tend not to be long-term satisfied in relationships the way they used to be because there’s just so many choice and the more choices people. The more ambivalence they wrestle with. And that, for me is amazing. So those are the pieces of it that I think are, are amazing is you’re just breaking down the very basics of human behavior to the fact that we all have choices to make every day. And we can feel two ways about the choices, or we can get stuck in the choices and we can have multiple choices we can make and motivational interviewing is how do you help people make choices that are gonna get them to where they want to go and not get. in all the narratives that can keep people stuck in their lives, or stagnant. Or rotting in ways that they don’t want to be stuck or stagnant or rotting. How do, how do you get people unstuck from that?

Which means we’re not jumping in to fix it, which is what we want to do, which is our fixing reflex or our writing reflex, which we do podcasts about. It’s more a matter of how do you help people work through their, their stuckness or their choices in a way that align with who they are, not who everybody else wants them.

 So those are, that’s like when you’re peeling back all the nuances in minutia and motivational interviewing, it really is coming down to these basic concepts that John’s talking about with, you know, how do, how do we accept people for where they’re at, which helps them relax and then look at their, where their ambivalence is, and, and where the choices come from within that.

So, and what we know is with the more complex behaviors, especially if you stick to a target behavior, Motivational being has a very specific structure to it. If you want to quit smoking, if you wanna manage your heart disease more effectively, if you want to get to the gym more often, if you wanna lose that last five pounds, those are very specific target behaviors that depending on how you make choices in your life and how you resolve ambivalence can be done very efficiently and effectively, or you can dwell on it and perseverate on it for days or weeks or months or years.

So motivation kind of cuts through all that in a very efficient and effective. And add additionally to it related to that, there is this level of are we walking in to learn something, to get this person to do something different? And I would just want to bring it back to that, that so many people can learn so many components of MI, but then their intention, when you ask them, say, coaching with the Micah or something, you ask, so what was your intent when you were, you know, going about this part of the session? And they say, well, I was just trying to get them to get them to see, get them to say, get them to do. And it’s just normal to use language like that.

It’s normal to think how do I get buy-in, and how do I kind of sell ’em on this idea? It’s just, it’s missing this underlying point that people likely have ambivalent somewhere inside of them. Like you were talking about, Casey, about some kind of change related to the environment you are in with them, a healthcare practitioner, social work, maybe addiction or mental health.

They likely care about something happier and healthier and if you have acceptance, which does not mean you agree with them, and it can be harder to. Then look away as we went through that activity at the conference, the Mint Motivational Interviewing Network of Trainers Conference in Chicago. Casey, you and I, we accept the situation.

We accept the person and we know that this is their life, their choice, and treat them from that place and from why are we there? Then, while we’re there, because we’re in some sort of professional. To help and, and provide. Well, how do we do that? We could do that through unsolicited advice and fixing and treating them as broken and lacking, or we could try to do it, and by it I mean express compassion and be helpful and contribute to this person’s life.

How could we do that in a way that is been shown to be helpful for the long run with something like MI and that you could measure different component. And that you still get to express compassion and do it in an ethically influential way. There’s nothing else I’m aware of that can bring all those things together that can even measure the difference between being problem centered, person-centered, or this way of being centered, motivational interviewing, and it’s just, there’s nothing else I’m aware in the world that can really embody all of this all at.

Which is why I think the other books that Dr. Bill Miller has written are amazing too, like Loving Kindness, that book, how to Listen Well, I think if I’m getting that one right. And then the on second thought, Casey, that one’s a mindblower that will probably have a whole other podcast on, but there’s just so much richness to it, but it’s so basic in its tenets of how it’s trying to treat other human beings well, and I, I think part of the profound aspect of motivational learning is, It is in some ways, I don’t wanna say an antidote to a Western medical model, but the Western medical model is so prevalent across all of these different fields because what we get credibility for is being an expert.

You know, and so when I, in trainings, what I tell people often is that I want a medical professional if I broken my arm, I don’t care if they’re skilled in motivational interviewing. Where it gets complicated is if I’m dealing with heart disease. The outcomes around heart disease and people change a behavior are very poor when you take a healthcare approach, when you take a Western medical model approach.

So you’ve got this way of being with people and communicating that’s very measurable. It’s very specific in how you use motivational. I. That improves outcomes, but it’s almost the antithesis of the way you’re trained in a Western medical model and behavioral health, mental health addiction, substance use.

 All aspects of healthcare, John, that you work within, those are all driven by Western Medical model. We are the experts. We’ve studied this. We have degrees after our name, and if you do what we tell you to do, you’re gonna get better. And if you don’t, then we’re gonna add another diagnosis to you. So when you’re talking about that broken, Mindset.

It’s just a completely different, truly a different mindset than a how do I start from their own struggle and help engage their brain. This is why I do the whole training on motivational and trauma informed. It’s like with a stressed and pressured brain, how do we, how do we mindfully as a professional?

Engage their executive functioning and that prefrontal cortex so that we’re strengthening their sense of personal agencies, that they’re solving their own problems without us. That’s when we get into another podcast around empowerment and what does that really mean? So. Then this is where I think it gets into the whole MI geek thing versus the naive brain thing.

Because then we start getting complex, even talking these concepts. Because what you break it down to is if somebody’s wanting to change a behavior, we can communicate with them in a way that their behavior will change in a way that aligns with their values. Well, and I wanna jump in there, Casey, cuz there’s so many concepts.

 As we’re, we’re nearing the end here that we could go off on so many levels. But one of those deals with us walking in with a. , whether we’re conscious of it or not, it is gonna be multiple bias. You know, those that are listening MIght have heard of implicit biases. There’s also conscious biases. You know, Daniel Kahneman is kind of a living legend in that world of bias.

And so we all have it. So how do we walk in and try to as best we can, get that out of the way and try to be helpful for this person? MI is one way to do that. And you know, that also means. Bias. They’re gonna have bias. And how, how biased are we against their bias? And the reason, I’m not trying to make it heady, but I’m trying to say we’re not there to change people’s belief systems.

We have our own belief systems coming in and EMI is a way of treating this person. And then as you practice it more at least, what some of the anthropological sort of perspective they’ve done on MI so far. There’s a, a few people that are working. They’re finding that people feel different. The more you use this as a way of treating people, of seeing people, and the more you go into the motivational interviewing network of trainers, people anecdotally talk about how MI changes you.

It changes them. It changes us, and it, I don’t know how much that is becoming a belief system or not. I’m, I’m, I don’t know, but there’s something to be said about allowing. Through you and change you and somehow be this way that just treating people of how I see you. and I’m, I’m with you in a different way.

Okay. So you were saying, mindset and Bill Miller would also talk about mindset, a heart, if I’m not mistaken, he, we have a quote in our tool talking about having the music with just the lyrics or just the harmony or a clash of harmony, , where there’s resistance or discord or just the technique with the, the words.

And so many people in all the years of training with. . We fundamentally believe we have this heart, and then some people fundamentally believe they have the mindset and bringing it all together. It’s just when you bring it all together, there’s particular things to seek feedback on that. Unless you’ve really immersed yourself in MI, it’s unlikely you’re doing all these things at once, even if you have a huge big heart and a really good mindset.

I just wanted to wrap that in relation to what you were saying, Casey. This is a way of treating people, but it’s also a measurable thing. That’s not a script that’s very dynamic, but that most people don’t seek feedback on with fidelity because they believe in what we’re talking about. But Danielle, you were saying the difference between being about it versus talking about it.

I feel like we could talk about it all day, but it’s not until any one of us that try it out and seek. That’s the vulnerable stuff, but that’s also where the rubber hits the road to really see are we doing this? And I just wanted to end with that, for a place to guide people if you do want to embody this stuff, that seek feedback from your colleagues or however, and and practice.

Yeah. And I think what I wanna do is bring it down from that high up in the clouds and also bring it down to the concrete is that you don’t have to be that level of embody in it to be effective with it. And I think that’s when I go back to the question of what is motivational interviewing? It’s a way of communicating to be effective and you don’t, we, I think that’s the balance we talk about.

And we’re, you know, another podcast I know that’s coming up for us is just the difference between what’s MIand what’s the difference between a naive brain and a geek brain. John just shared the Geek Brain . And the, the naive brain is that, well, can I learn this? Like, that’s a whole life study. And with motivational, it doesn’t have to be a life study.

You can go through really, really good solid training and motivational and be able to influence outcomes after a really good, solid training and motivational with some practice, that you’ll notice a difference. So that’s what I love about this is what is motivational. It’s a way of communicating with people to affect change.

It’s a very mindful way of communicating with. That most human beings don’t know how to do and have it practiced. That’s the other thing that research is really clear about is there’s components of it that people are good at. But like John was saying, when you’re looking at the the wholeness of motivational interviewing, it’s way more complex if you wanna get really highly skilled at it than people think it is.

And then on the flip side, it’s learnable, it’s teachable, and people can see changes in conversation even after an initial training as well too. I mean, we, again, we could go on forever, but this is, I think that’s just a great kind of synopsis of, you know, at least from my perspective and John’s perspective, what MI is.

That’s so awesome. And I think, you know, from a, from a naive brain for sure, coming into MI. and just being introduced at a very high level at a keynote that you had given at a conference. Casey, I walked away. A changed person. So, you know, from the naive brain perspective, I can say, wow, this can really dramatically, influence your life.

Change your life for the better and open up your world to, something really beautiful. when you guys are talking and, and you do come from a very professional, you know, mental health, arena. And I come from the business world where I’m like, oh my God, every human on this planet needs to at least some level.

At some level. The point of MI my God, is how can we treat each other better? How can we live each other up? Yes. And it’s. , every single person on the planet, the person who’s making the New Year’s resolution that I wanna go to the gym and my God, why can’t I? What is it? Yes. It’s like the ambivalence we face every day.

 This is the solution. Yes, this is the solution for the individual struggling with quitting smoking, going to the gym, whatever it is, the 20 million. I’m gonna look up that data point. How many decisions does the average person make in a day? It’s exhausting Exhaust. And to have a guide, an expert guide, which is you guys, you’re experts at this, an expert guide to teach you how do you walk through that ambivalence so that you can find peace?

Cuz at the end of the day, I’m like, the point of MI. Yeah, it’s change. But I’ll take it even a step further and say, my God, it’s peace. It’s the peace you get when you, you’re like, oh my God, I’ve, I’ve made my choice. Found my day. I can feel my, I can feel my brain is working and it’s, it’s helping me be who I want to be instead of my brain working to make me feel more stuck and struggled and depressed and stressed.

You know, using your brain in an effective way is exactly what it’s about for me. So when you say that, it’s just like, wow, that’s, that’s MI It’s helping people resolve around ambivalence. So the behavior lines with their values, and they just feel like my brain’s working again. After all this stress and pressure of covid, my brain is actually starting to work on my behalf instead of against me.

Yeah. So, I mean, I know we’re wrapping up. I just wanna thank you guys cuz you are experts in this field. You’re out there, thank training. Training, thank organizations, training individuals every day on this. Yes. Beautiful, beautiful form of communication. So I’m grateful to be in your world. So excited for future podcasts. Let’s keep going. This is awesome. Awesome. Thank you, Danielle. Thank you. Nice job.

Thank you for listening to the Communication Solution Podcast with Casey Jackson and John Gilbert. As always, this podcast is about empowering you on your journey to change the world. So if you have questions, suggestions, or ideas, send them our way at Casey@ifioc.com. That’s C A S E Y I F I O C.com. For more information or to schedule a training visit i f ioc.com Until our next Communication Solution podcast, keep changing the world.