Common Questions in Motivational Interviewing

               “Is Motivational Interviewing a good fit for my organization?” This might be the question that you are asking if you are visiting this site. If you’re here, you’ve taken some of the first steps to understand Motivational Interviewing: just being curious about it. With that in mind, I’ve generated a list of common questions. If you have any of these questions, then you’re in luck. If you have other questions, ask and we can answer them in future blog posts.

Is Motivational Interviewing just a clinical therapy intervention?

               MI appeals to people from all kinds of backgrounds. Doctors might be drawn to it as a way of increasing patient fidelity to change plans to improve medical outcomes, such as exercise for weight loss or smoking cessation. Social workers might want Motivational Interviewing in order to partner with families in family reunification plans. The counselors in the clinical practice, assumed to be MI’s stereotypical environment, use it to have a client-driven counseling approach, centered on listening and reflection, because that’s what feels right. And in giving these examples, we’ve answered one of the common questions: is Motivational Interviewing just a clinical therapy intervention?
               Well, no. Motivational Interviewing can be utilized by professionals inside and outside of clinical settings, and even by paraprofessionals who might not have formal education in fields like social work or psychology. It also sees use across fields, such as by individuals in health professions like nursing and medicine. It can also be used by individuals in caregiving occupations and roles like contact tracing in response to COVID. Anywhere helping someone change their behaviors for their overall well-being is a place that Motivational Interviewing might be a good fit. Because of that, it is important that we decouple MI from its reputation as a clinical practice. Motivational interviewing is an especially nice fit in community-based services where providers reach out to clients in their homes or other community spaces.

Can Motivational Interviewing work in case management?

               We’ve talked about how Motivational Interviewing can benefit case managers who need to support families with family reunification plans. This indirectly addresses another question: can MI work in case management, specifically? The answer is that it can, but it requires adopting Motivational Interviewing to its new environment. Case managers think, somewhat fairly, that the environments they work in are not conducive to the practice of Motivational Interviewing because they are often making brief visits that are focused on referrals and service monitoring. Often in child welfare positions, the emphasis is on directing the client to what they have to do to maintain child safety – and workers may mistakenly take on this mission without listening to the clients, and without letting them drive their own change process. Case managment also frequently involves a lot of paperwork that is needed in a time-limited environment, which may lead to an attitude of “just fill out this form,” and “This is what you need to do” – guiding them in navigating bureaucracy without taking the time for the engagement process, which includes open-ended questions, affirmations, reflections or summaries. So to be clear, does MI in child welfare settings look like Motivational Interviewing In clinical practice? Not entirely. The steps being taken are the same, the time and place as well as the time afforded to it is not.  Given that worker engagement is one of the primary drivers of parents’ active participation in their case plans, slowing down to make time for these tasks are important. We focus on coupling this important work with trauma-informed care that recognizes the good reasons clients may be hesitant to cooperate with service providers, and how to listen better and create better plans.

Does Motivational Interviewing take a long time?

             This answers another question that you might be having about MI: doesn’t doing an Motivational Interviewing-driven conversation take a long time? The answer: It doesn’t have to. Each and every one of the steps is important, but you can move through each stage of an interview process quickly if you’re focused and word yourself carefully. It takes some skill to use MI efficiently, but it’s still possible to do. This is something that we here at Sage Consulting demonstrate and teach how to do in our classes. The important thing to know is that the engagement stage may take a little bit longer, but it will save time in the long run when you’re working alongside, instead of in resistance to, your clients.

You can practice this yourself if you simply keep in mind every step you should be following, use OARS, pay attention to the four processes (engagement, focusing, evoking, planning) and track where the client is in the Stages of Change process between precontemplation, contemplation, preparation, action, and maintenance.

Does Motivational Interviewing require a clinical license?

               With all of this said there’s another question that comes up a lot that’s been indirectly answered: do you need a clinical license to practice Motivational Interviewing? The answer is no. In fact, some of the settings that could benefit from Motivational Interviewing the most are not staffed by clinical therapeutic professionals. Doctors, caregivers, child welfare workers, housing case managers, community health providers, nutritionists, and other similar positions are all people who might want to use MI. What’s important is the knowledge, and we demonstrate regularly that this can be distilled for your use no matter where you are in your professional development.

Is Motivational Interviewing just another strength-based technique?

               If you’ve seen MI in action, it might make Motivational Interviewing look easy, like it’s just a strength-based conversation. That’s another misnomer that is held by people we run into. Doing Motivational Interviewing right requires rigorously following the steps in a mindful fashion. There are professional standards on what it should look like (we call this fidelity), and it’s been increasingly accepted as an evidence-based practice in various settings because it produces outcomes reliably when its used methodically. We teach MI over the course of weeks for this reason, iand ask people to follow up with coaching groups, n order to make sure that our students can actually apply the skills. It is hard to accomplish use of MI after a two-day workshop.

How do I know if I’m using Motivational Interviewing correctly?

               And now your personal pendulum might swing in the other direction: how will I know if I’m applying Motivational Interviewing correctly? Motivational Interviewing is about following the steps, honoring the spirit of it, and watching to see if you’re getting the outcomes that accord with the process. A key takeaway is that MI is not a set of tools, it is a way of being with people. The best way to know for sure is to get coaching from someone very experienced in Motivational Interviewing.  We offer coaching in Motivational Interviewing to help people improve their skills.  Tools are available to rate one’s basic proficiency with Motivational Interviewing, and a Motivational Interviewing instructor can listen to a recorded tape and rate your skill and help you target your skill development. Motivational Interviewing training uses “real plays”- practice with real situations- to help with skill development.  It’s not easy, but it is learnable! Once you’ve been taught how to do it, your practice, interest, and diligence will get you the rest of the way there.