Archive

Motivational Interviewing

DSC_0041

Honesty is the best poetry

I’ve written elsewhere about “PowerPoint Best Practices” and why slide design can make the world a happier place. Images are like poems: their economy is such that they immediately engage our affective (versus cognitive) domain – and affect is hugely influential in learning and knowledge retention. I was briefly obsessed with imagist poetry as a teenager: “that which presents an intellectual and emotional complex in an instant of time”.  (It left its mark.)

The same disciplined simplicity is at the heart of the best and most effective use of beautiful/disturbing/thought-provoking/unexpected visuals accompanying a presentation. (PS: Check out this anthology if you want to learn more about imagism)

“Sounds good, but how can I visually translate MY ideas?”  (especially an image that is compelling, novel and adds value)

It’s a fair question. Most academics are trained to frame our ideas and concepts in words, not pictures. Yet words and pictures are both just symbols. For example, this slide deck for a full day workshop on advanced practice in Motivational Interviewing is approximately 80% images – used as placeholders for each of the practice-based activities I facilitated throughout the day.

In short: think about how you would define or translate the one key idea behind what you are trying to communicate. It is more than an excercise in finding pretty pictures – ruthless simplification forces us to reflect on the essential. That which we intend to be most memorable. This can only be a good thing for both presenter and audience!

Major Caveat: Visual communication is especially critical in relation to numeric data. Twenty years ago I never thought of data visualization as a career path, yet these modern-day dowsers are crucial to our understanding of the digital ocean. And that’s a whole other conversation: check out Big Data Science on Twitter. I am a rank amateur compared to what these people do.

If I were presenting this article to you, here is my slide:

DSC_0028

(Honesty is the best poetry, Queen St West, Toronto, Canada )

little green flying insect

It’s the practice itself that really matters

I found this on Twitter the other day, and it got me thinking about the art of listening…

While someone else is speaking, how often am I busy framing a reply? And if I’m focused on thinking about what I’m going to say next, that’s not actually listening. And then, I started thinking about how many conversations occur where both parties are more engaged in their own internal dialogues rather than a real, authentic, “I’m listening to you” dialogue.

Through this lens, silence isn’t just not speaking while someone else has the floor. Silence is a way of being, an inner stillness. In addition to silencing my “outside voice” (i.e., not interrupting), listening includes silencing my “inside voice” (see above) … and paying complete attention: with ears, eyes, undivided attention and heart.

I’ve been delivering training on Motivational Interviewing for about the last 15 years, and have spent much of that time focusing on the skill of reflective listening in clinical practice. In fairness, I also endeavor to “walk the walk” in everyday life. But something about that tweet caught my attention and made me pay attention.

Every conversation is an opportunity to simply practice listening. And like any discipline, it’s the practice itself that really matters.

DSC_0135

 

Always the beautiful answer who asks a more beautiful question.” – e. e. cummings

 

I’ve been thinking about how our questions define who we are today, and who we will become.

At a conference last week, I attended a session focused on questions. Not scientific questions or the questions we ask others in clinical practice – the focus was on questions that we ask ourselves. This inspired me to think about some of the big questions I should be asking.

Here are three of my top questions for 2015-16:

  1. What do I want more of in my life?
  2. How can I better contribute?
  3. Where do I need to work harder, and where can I scale it back?

 

To paraphrase Voltaire:

“Judge a person by their questions rather than by their answers”.

 

DSC_0068

 

 

Educating the heart

 

It’s the end of another academic year, and summer stretches tantalizingly forward. A good opportunity to reflect on the past year’s teaching practice, what went well, and what can be improved.

Here is a wise metric to guide reflective practice on teaching and learning:

 

“Educating the mind without educating the heart is no education at all.”

                                                                                                                         – Aristotle

 

Well-written learning objectives tend to be concrete and measurable, guided by what students should be able to do at the end of a course. But it’s equally important that we not lose sight of supporting students’ learning how to be.

Compassion might just be the most important course learning objective, regardless of our discipline or field of practice…and the most important life learning objective?

This summer, I will be thinking about how to more intentionally integrate compassion as an overarching and foundational objective in my own teaching – and learning.

 

 

 

DSC_0089

 

Begin with the ending, end with the beginning

 

The best presentations are structured like a really good story, with a clear beginning, middle and end. Dale Carnegie’s famous axiom offers a skeleton how-to: “Tell the audience what you’re going to say, say it; then tell them what you’ve said.” But starting your talk with “Today I am going to share with you…”  is not the most dynamic or compelling way to capture an audience’s attention. On the other hand, people want a road map – it’s important to orient the group to what they are about to learn and experience.

 

Begin with the ending

So, what does “beginning with the ending” look like in practice? For me, the ending doesn’t reference the conclusion of my presentation. Rather, the real ending – the whole purpose and intent of my presentation – are the implications for attitudinal, behavioural and/or practice change. In other words, I like to start with where I want the audience to end up – not me!

For example, when I offer clinical workshops on Motivational Interviewing, I begin by asking the group to reflect on specific clients that they find challenging: “Imagine it’s Monday morning, and you get to work, look at your calendar, and see that the first three clients you’re scheduled to see are the most difficult individuals that you’re working with. How are you feeling?” Common responses include “stressed”, “anxious”, “hopeless”, “frustrated” , “annoyed with the person who scheduled these clients!”. Then I say: “Now imagine that you’ve finished this workshop, you get to work tomorrow morning, and you see these same three clients booked into your calendar – and you actually look forward to your morning because you get to try out the skills and strategies that we are going to learn today!”

This brief thought experiment gets people involved right away because it establishes not only the relevance of the content, but its application beyond the workshop.

 

End with the beginning

I agree that it’s useful to offer a summary of what I’ve covered as I wrap up a presentation or workshop (“tell them what you told them”), but that’s not the end. After summarizing, I make a point of explicitly circling back to the beginning by inviting participants to reflect on where they were when we started our collective learning journey, where they are now…and where they want to go. Bridging the knowledge-practice gap is a challenge, yet therein lies the value of the whole experience. Setting concrete implementation objectives and a plan for follow-up is key.

I also point to the ending as a beginning, and to our continuing development as an ongoing series of new beginnings. We are always still beginning, each time from a different place.

Finally, ending with a great quotation is always a nice touch. Here’s one of my favourite quotes on motivation and change:

Andy warhol quote

 

So…what will you try out in your next presentation?

 

 

 

DSC_0004

 

It’s not our problem – it’s the group’s problem!

 

Last week I had the pleasure of working with a number of seasoned group therapists around advancing their practice in group facilitation. It is a rare opportunity (and luxury) to all get together and explore what is frequently a solitary job. Busy clinics can leave little time for practitioners to reflect on and process what they do. But it is more a necessity than a luxury to reflect in and on practice (in the words of Donald Schön).

We kicked things off talking about two questions relating to group facilitation:

 

2 Adv Groups 2015 FINAL 2 Adv Groups 2015 FINAL 1

 

In other words, what are areas where things are going well, and where are you (individually and collectively) struggling or feeling challenged?

That second question in particular evoked lots of conversation, and I started to make a list. Here are some of the things that people came up with: participants who talk too much or not at all; disruptive behaviour; group engagement (lack thereof); lateness, attendance and drop-out; peoples’ diverse needs, expectations and abilities.

Then something interesting happened. The conversation started to shift to challenges like: balancing group content with process; agenda-setting; fostering trust and cohesion; appropriate disclosure; boundary-setting. The dialogue moved from focusing on participant behaviour to facilitator behaviour.

This is common in clinical supervision teams – it is so much easier to look at others’ behaviour – yet the most productive troubleshooting stems from identifying what we, ourselves, can do differently. The energy in the room changes too. Focusing on difficult client behaviour feels frustrating, hopeless and stressful. Focusing on new strategies that we can experiment with and implement feels productive and inspiring.

One of the biggest “aha” moments was how we group facilitators tend to take on all of the participants’ behavioural issues or concerns as our problem to solve. It’s kind of like the song “The Weight” by legendary roots rock group The Band: “Take a load off Fanny, take a load for free. Take a load off Fanny, and you put the load right on me!”

Addressing and dealing with stuff that comes up is really the whole group’s responsibility (and problem!). Of course, we are part of the group, but so are the participants. Asking open-ended questions and offering complex reflections about group process (not content) tends to be more productive than asserting our authority and directing traffic. In short, it’s not our job to single-handedly solve every problem that arises. It is our job to facilitate collective problem-solving and dialogue in a supportive and respectful space.

 

I’m thinking how closely this all maps onto classroom teaching. We’re not doing therapy in the classroom (although sometimes it can feel that way). The best teachers – like the best group therapists – demonstrate agility in creating shared accountability for positive norms and behaviours, and do so with authenticity, compassion, partnership, humour and deep acceptance.

 

Related

Reflective listening 101

 

 

 

trying

 

The spirit and skills of Motivational Interviewing (MI) can transform even the most delicate email conversations

 

Responding to email can be tricky at the best of times, and when emotions run high email is downright perilous. We’re all aware of the email best practice to “sleep on it” before hitting send, and/or to just pick up the phone and step out of the email conversation altogether. But what if we have to respond the same day? And what if we can’t reach the person by phone or want to document our response?

Enter Motivational Interviewing (MI) as a guide and model of good practice in email communication.

In responding to delicate or difficult emails, I try to employ the four core MI strategies (remember them with the acronym O A R S):

 

Motivational Interviewing OARS

 

In addition, we know that the skills of MI fall flat in the absence of MI “spirit::

 

MI Spirit

What does it look like in practice?

Say you receive an email in which the writer is clearly frustrated, and the tone is somewhat hostile and accusatory. Start with a modified affirmation/ reflection:

“I appreciate that you have been trying hard to get results, and it sounds like this has been a very frustrating process.”

Just the act of affirming the person’s efforts and accurately reflecting the feelings or experience helps the person to feel heard and acknowledged. This, in and of itself, can help to de-escalate the situation and starts to move the conversation in a positive trajectory. It sounds simple, but it’s not always easy when we want to reflexively put forward our response/justification/rejoinder.

Open questions can be used to evoke a constructive response and generate collaborative solutions:

“You raise an important – and difficult – issue, and it would be great to hear your thoughts about how we can best resolve this. What might be some ideal next steps?”

Of course, it might be appropriate to provide information and suggested solutions proactively, but my past experience is that when we jump to solutions too quickly, without first really hearing and acknowledging the person and evoking their preferred outcomes, our tone via email can come across as defensive or even abrupt (the “righting reflex”). If you do want or need to offer suggestions/solutions, an MI adaptation is to preface these with a caveat that affirms the individual’s autonomy:

“I’m not sure if this is the solution that you are looking for, but we could try…”

“I’d like to suggest some ideas, and I’m eager to hear your thoughts as to whether they are in line with what you are hoping to achieve…”

“This may not fit with what you have in mind, but is it worth exploring…”

 

Hmmm…sounds good (you say) but who has the time?! It’s true that thoughtfully responding to email with compassion and unconditional acceptance, and using the foundation skills of MI, might slow us down in the short-term. But in the big picture it actually ends up saving us time. Adopting an “MI approach to email” fosters good will, communicates mutual respect, and preserves the relationship.

 

%d bloggers like this: