camera lens

 

Focusing means strategic centering with a collaborative goal

 

In a previous article, we looked at Motivational Interviewing (MI) as having four key processes: Engaging, Focusing, Evoking and Planning.

Motivational Interviewing is directional – not directive. There is a horizon, something that we and the client are committed to working toward. However, finding and collaboratively agreeing on goals can be a challenge! This week’s intentional practice looks at the process of working with your client to jointly identify an agreed-upon goal. Below are two brief case scenarios. With a partner, you will each take a turn with one of the scenarios as a departure point for a follow-up session with a client with the intention of setting an agenda for change. The skills for intentional practice in this activity are to:

Practice a focusing conversation using the skills of MI – with special attention to those noted above. How can you practice these skills to guide the client toward focusing on a meaningful and collaborative goal? Take five minutes and then switch roles. After you have both had an opportunity to practice, take five minutes to debrief and share feedback with your learning buddy.

 

Case Example 1:

You are meeting with your client, Akilesh, for a follow-up appointment. In your initial session, you learned that he has been under a great deal of stress due to impending lay-offs at his work place. To make matters worse, his wife is in her first month of maternity leave with a reduced income. His mother’s health is failing, and his older son has been acting out at school: hitting and spitting at other children in his class, and on one occasion, his teacher. Finally, at the end of your first session, Akilesh “came clean” with you and acknowledged that he smokes 10-15 cigarettes per day.

 

Case Example 2:

You are meeting with your client, Elina, for a follow-up appointment. At the end of your initial session, Elina reluctantly agreed to come back and see you again. You suspect that in addition to appeasing her cardiologist by attending the referral appointment with you last time, she is now coming back for this second appointment because she wants to appease you. In the previous session, Elina acknowledged that she would probably be healthier if she quit smoking, but stated that smoking is a profound pleasure for her. She shared that she has already made so many changes, she just can’t see herself giving up her cigarettes.

 

Reflective practice questions:

Was your “righting reflex” triggered by anything in the case example, or by any of the client responses in your role play? To what extent were you able to maintain MI Spirit throughout the conversation?

 

1 engaging

 

Engaging is the Relational Foundation

 

In their 2012 edition of the Motivational Interviewing “textbook”, Miller and Rollnick outline four recursive processes of MI. My colleague Wayne Skinner and I summarized these in a recent book chapter on MI:

Engaging: Client engagement is essential to the helping relationship. Without engagement, it is not possible to proceed, as the client makes a decision about whether to join with the practitioner and actively participate in treatment. The skills of engagement must also continue throughout all stages in the helping relationship.

Focusing: This “strategic centering” process hones in, with the client as equal partner, on the possible target(s) or direction(s) for change. At all times, client autonomy is respected – it is for the client to determine what he or she would like to address or work towards in treatment. Periodic “re-focusing” may be needed as goals evolve or change over time.

Evoking: Once the client is engaged in treatment, and client and practitioner have agreed on areas of focus, it is the practitioner’s task to evoke from the client his or her ambivalence about changing, reasons for change and strategies for change. In this stage the skills of MI become strategic in guiding the person in the direction of change by paying special attention to evoking change talk.

Planning: The process of planning can occur when (and only when) the client is ready to make a commitment to change. The skills of evoking commitment language, as well as the client’s strategies and ideas for change are key in this process.

Note that these processes follow a logical sequence, as each builds on the one before. However, practitioners may circle back to previous processes throughout the helping relationship.

 

Advancing Practice

Advancing our clinical practice takes practice. People often ask how they can access further training in Motivational Interviewing (MI), and there are lots of options available, but the most effective way is to just practice the skills! Peer practice is a good approach especially for those new to MI. I like case-based simulation as a teaching tool in MI to support integrated practice.

 

Case-based Learning

This exercise challenges you to intentionally practice the spirit and skills of Motivational Interviewing as they relate to engaging with our clients. The first few minutes of the very first session are powerful: this time communicates a wealth of information to your client about who you are as a person and a practitioner, as well as how you regard them. As you practice, consider how you can optimize the spirit and skills of MI as a powerful and impactful entry into engagement.

Below are two brief case scenarios. With a partner, you will each take a turn with one of the scenarios as a departure point for the first five minutes of your consultation. Remember that your purpose in this activity is to:

  • Intentionally embody the spirit of MI: partnership, acceptance, compassion and evocation
  • Beware the “righting reflex” – your task is to engage, not to fix it!
  • Practice reflective listening – incorporate at least three reflective responses in your practice.

Take five minutes and then switch roles. After you have both had an opportunity to practice, take five minutes to debrief and share feedback with your learning buddy.

Case Example 1:

Akilesh has been referred to your clinic because he has just been diagnosed with Type 2 diabetes. He is not overly concerned, as he was told that his condition at this time is not severe and can be controlled with diet. He is hoping for some clear guidelines and advice about foods to stay away from, and how to adapt his eating patterns. His chart states that he does not drink alcohol and that he is an “occasional smoker”. When he comes into your office, you notice that he smells strongly of tobacco smoke.

Case Example 2:

Elina is attending her appointment to appease her cardiologist, who is very concerned because of her continuing heavy tobacco use following her heart attack nine months ago. Elena is polite but clear that she does not intend to quit smoking. She has started an exercise program and is now eating a healthier diet, and feels that there is a limit to what changes she is willing to make in order to maintain her “quality of life”.

Reflective practice questions:

Was your “righting reflex” triggered by anything in the case example, or by any of the client responses in your role play? To what extent were you able to maintain MI Spirit throughout the conversation?

everything has beauty

 

Learn how to see

 

I was reading an article suggesting that in the future, 47% of today’s jobs will be automated. The robots are coming?

Increasingly, adaptive systems, pervasive computing and big data are supplanting many services or functions currently delivered by actual humans. In this reality, education shifts from knowledge transfer to… incubating creativity, fostering entrepreneurship and enabling critical reflection, judgement and decision-making.

“In a roboticized economy, colleges will have to pivot to building students’ capacity for coming up with original ideas”

This isn’t new. Transformative learning experiences have always meant seeing the world in new ways. Time spent in the “classroom” (wherever or whatever that looks like) is so precious and limited. I want to create learning spaces that illuminate possibilities and unleash students’ potential.

Learning to see beauty means creating it. Creating the possible is beautiful.

 

 

street art basketball

 

 

Nothing is possible without engagement

In any interpersonal interaction, nothing is possible unless there is engagement. This is true whether it’s a one-to-one counselling session, a classroom full of students, or a company team meeting. Engagement is the foundation of relationship, collaboration and change.

Enter Motivational Interviewing: A collaborative conversation for exploring and resolving ambivalence about change.

It seems like no matter how many years I have spent as a Motivational Interviewing trainer and practitioner, I still find nuances and insights in this model of practice decribed as ‘simple, but not easy‘. Lately I have been thinking about engagement as the essential underlying process in Motivational Interviewing, and mulling over how we can translate the clinical skills of establishing engagement with clients to our everyday skills in educational and work place settings to foster student and employee engagement.

 

Engagement is less about skill than it is about the spirit in which we practice – as clinicians, educators and leaders

What would our conversations, classrooms and meetings look, sound and feel like if we were able to deeply and consistently enact the four components of MI Spirit?
  1. We come to the relationship from a stance of respectful partnership, where all individuals bring valued and equal expertise
  2. We unconditionally accept others’ autonomy, worth and capacity – even when their intentions or actions don’t align with what we think best
  3. We are deeply committed to the highest interests of the other, rather than advancing our own agenda: compassion
  4. We are as eager to hear others’ stories, perspectives, beliefs, wisdom and values as we are to share our own: evocation as opposed to installation or education.

First and foremost, the spirit of Motivational Interviewing is more important than the skills.

Simple but not easy

When we like what we see, hear and feel, it’s relatively straightforward to respect what others bring to the table (partnership), to affirm their absolute autonomy (acceptance), to act with their best interests at heart (compassion), and to create a space in which their voice is heard and affirmed (evocation). The going gets tough when we don’t like what we’re seeing, hearing or feeling. That’s where our real work begins, and where we are most tested as clinicans, educators and leaders.

Authority is the enemy of engagement

Engagement isn’t the whole story, but it’s the essential beginning. Nothing substantive happens without it.
And when we have it, all things become possible.
compassion motivational interviewing quote

ocean paper boat water cropped

The evolution of teaching and learning

Whether implicit or explicit, we all have a theory of teaching and learning. This gets expressed and enacted in how we engage with our students, the tools we use (or don’t use), and even where we stand in the classroom (F2F or virtually). Traditional theoretical frameworks can be broadly grouped into four domains: instructivism, critical theory, constructivist approaches and andragogy (or adult learning). But the rise of many-to-many, decentred and non-linear networking and communication channels have given rise to corresponding advances in frameworks for teaching and learning in the global classroom.

The 1.0 Classroom

education 1_0

Instructivism as a standard approach to teaching emerged from positivist and post-positivist paradigms. Characterized by the traditional “chalk and talk” style, instructivist pedagogy is premised on a transmission model of learning. Learning outcomes and curricula are pre-determined and delivered in a primarily didactic fashion. The same information is provided to all learners regardless of their pre-existing knowledge and skills.

 

 

Teaching 2.0

education 2_0Constructivism marked a shift from teacher-centred to student-centred learning, deemphasizing informing (memorizing facts) in favour of transforming: locating, critiquing and synthesizing knowledge in a culture of collaboration and sharing. Curriculum development is based on student query, which acknowledges that students learn more by asking questions than by answering them. In this model, students critically engage with course material by posing questions that further group reflection and debate. Adult learning (andragogy) and critical approaches extend and complement contructivist learning models.

 

Education 3.0

Over the last decade, two models have emerged to challege our existing paradigms: heutagogy (Blaschke, 2012, Hase and Kenyon, 2000) and paragogy (Corneli and Danoff, 2011). These extend constructivist, critical and adult learning theories offering models of learning that are (1) self-determined, (2) peer-led,
education 3_0 (3) decentred and (4) non-linear. These characteristics map onto social media applications and the democratization of knowledge and information. Heutagogical and paragogical approaches also extend traditional andragogical and adult learning frameworks by emphasizing meta learning, or learning how to learn.

 

Andragogy, Heutagogy and Social Media

Andragogy (Self-directed) Heutagogy (Self-determined) Parallels with Social Media
Competency development Capability development Knowledge curators
Linear design of curricula Non-linearity in curricula Hyper-learners
Instructor/learner directed Learner directed Autonomous digital communities
Content focus (what is learned) Process focus (meta learning, learning how to learn) Online collaboration, sharing, crowd-sourcing

 

This shift is radical in challenging the implicit notion that we (educators) know best what students need to learn. As Morris (2013) puts it, the issue of how to modify or reinvent teaching in higher education “can create anxiety, uncertainty, and even resentment toward a shift in the culture of learning that we’ve had little control over, that’s come at us from outside our own domain; for others, this new landscape appears inviting, exciting, and full of possibility”.

Radically self-determined and networked learning approaches (like heutagogy and paragogy) affirm individuals as the experts in their lives and learning trajectories. Nothing less than what has always been.

 

 

Note: Images depicting Education 1.0, 2.0 and 3.0 were adapted from a blog post by Jackie Gerstein: Experiences in Self-Determined Learning: Moving from Education 1.0 Through Education 2.0 Towards Education 3.0

This post was adapted from a previous article.

 

 

 

 

 

 

 

 

 

A year in pictures – Happy 2016!

 

 

The turning of the calendar is a place in-between. A perspective both backwards and forwards. This year in pictures represents gratitude for what has been, and eager welcome of what is yet to come.

 

take time to enjoy small delights

take time to enjoy small delights

 

be the change

be the change

 

even when it's really bad, get your hands dirty and try to make repairs

even when it’s really bad, get your hands dirty and try to make repairs

 

appreciate the beauty that surrounds us

appreciate the beauty that surrounds us

 

focus on what really matters

focus on what really matters

 

follow new paths

follow new paths

 

don't be afraid to shine

don’t be afraid to shine

 

spread the love

spread the love

 

take time with family and friends

take time with family and friends

 

be happy

be happy

 

bake a cake

bake a cake

 

Celebrate! (Happy 2016)

Celebrate!
(Happy 2016)

 

 

 

 

 

 

perfect present

Lovely things

 

 

Curated just for you by educateria

 

 

1. A guide to understanding your lived experience and yourself

The newly-relmetaphysical dictionaryeased Metaphysical Dictionary by Svetlana Lilova is profound, whimsical and wise, delightfully illustrated by Graham Falk. At her recent book launch at Centennial College, the author described how, newly-arrived in Canada and never having heard spoken English, she traversed the city with a dictionary in hand. Fast-forward many years, and Lilova offers us a compass, a roadmap, a mirror and a prism through which we can distill our lived experience and inner selves in this small, elegant volume.

Order here.

 

 

 

 

 

 

2. A constant reminder

Inspirational sayings and quotations are always welcome, particularly expressed in everyday items. We are continuously exposed to a deluge of unsolicited and counter-productive messaging, and these are a welcome antidote.

moment is your notebook

 

“This Moment is Yours” notebook available here. It has to be in turquoise.

 

 

 

 

 

 

 

i can and i will

 

An heroic affirmation of determination and ability! This zippered pouch is perfect for everyday essentials. Available here.

 

 

 

 

 

 

 

 

3. Your very own power source

Your phone is at 2% power and no outlet in sight…and you’re scheduled to join a conference call in five minutes. Enter the charging block. Until nearly every surface integrates device charging, this is what we need circa 2016. Available here.

power block

 

4. Stories to remind us we are all connected

hony-stories-2

 

 

 

 

 

 

I am a big fan of HONY. The latest book by photographic census-taker Brandon Stanton reminds us that the singular is universal. Ordering information here.

 

 

 

 

 

5. Fall asleep under the stars

 

star map projector dome

 

 

The Star Map Projector Dome (available in your choice of southern or northern hemispheres) evokes the magic and mystery of laying on a dock at night and looking up at the sky. Not very practical in December, so this is the next best thing. Check it out.

 

 

 

 

 

 

 

 

May your days be merry and bright!

mock up poster frame in hipster interior background,christamas decoration,

 

 

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