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The Basics of Motivational Interviewing

July 2, 2014
Clinical Education, Motivational Interviewing
9 Comments

Motivational Interviewing Change or No Change

 

 

 

 

 

 

Motivational interviewing is a form of collaborative conversation for strengthening a person’s own motivation and commitment to change.

 

In a recent workshop I presented on Motivational Interviewing (originated by Dr. William Miller and Dr. Stephen Rollnick), the audience of interprofessional clinical practitioners came with varying degrees of familiarity with this well-established and evidence-based practice model. Below is a short summary of the essentials, with links for further reading, exploration and video examples. Start with this short interview with Dr. Miller, offering an overview of the background and basics of Motivational Interviewing.

 

The Righting Reflex

 

The “righting reflex” happens when we are triggered to want to “fix it” for the person…and tends to evoke a “Yes, but…” response from the person we are trying to motivate. As soon as we hear a person respond “Yes, but…”, that is feedback that we have likely slipped into the righting reflex.

 

Motivational Interviewing Spirit

 

Motivational Interviewing Spirit

 

 

 

 

 

 

 

The spirit of Motivational Interviewing (compassion, acceptance, partnership, evocation) is even more important than the specific skills (Open questions, Affirmations, Reflective listening, Summary statements – OARS). The ‘spirit’ is the essential foundation from which we practice.

 

Four Motivational Interviewing Processes

 

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There are Four Processes in Motivational Interviewing. They are not all necessarily sequential or linear, and we may need to jump backwards and forwards depending on where the person is at.

 

1. The process starts with engaging: without engagement there can be nothing

2. Motivational Interviewing is directional (as opposed to directive), with a trajectory toward a common goal (with engagement comes the process of focusing)

3. Once we identify and agree on a goal with the person, we move to the process of evoking change talk to enhance motivation for change

4. Commitment language signals a person’s readiness for the process of planning key strategies and supports to mobilize change

Note that these processes are not linear – we are continuously moving between processes as we stay alongside the person we are working with.

 

Foundation Skills of Motivational Interviewing: OARS

There are four foundation skills in Motivational Interviewing. The OARS skills are used in different ways throughout the processes of Motivational Interviewing. Caution: these skills are simple but not easy!

1. Open questions help us to get to know the whole person – closed questions gather focused information

2. Affirmations offer a neutral observation of a person’s strengths, resources, efforts, values – and statements of affirmation are more motivational than praise

3. Reflective listening communicates understanding and attention. Complex reflections aren’t complicated – shorter can be better!

4. Summary statements offer an opportunity to gather together diverse aspects of a problem, issue or conversational journey, and can also link back to previous material or ideas, and/or further exploration and dialogue.

 

Here are some of my favourite “Motivational Interviewing Axioms”:

 

“People are most able to change when they feel free not to” (affirm autonomy)

 

“You have two ears and one mouth. Use them in that ratio” (listen to understand)

 

“People only change when the pain of change is less than the pain of staying the same” (working with ambivalence)

 

“I learn what I believe as I hear myself speak” (evoke change talk)

 

 

Guilford Press offers the definitive series of Motivational Interviewing ‘textbooks’ across a range of clinical practice populations, disciplines and target areas.

 

 

Motivational Interviewing Tip Sheet

 

 

 

 

 

 

Click here for a one-page Motivational Interviewing Tip Sheet

 

Click here for video examples of Motivational Interviewing

 

 

Reflective Listening 101

April 21, 2014
Clinical Education, Motivational Interviewing
4 Comments

reflection

Why is Reflective Listening so difficult? And so important to clinical practice?

We all want to be understood – that’s the major impetus for any form of communication. And the trouble is that there are so many ways that communication can go wrong. In Thomas Gordon’s model of Parent Effectiveness Training, it’s evident how easy it is to misunderstand the intent and/or the content of another’s communication as our messages are coded and decoded through a series of filters:

thomas gordon listening

Reflective listening, considered to be THE foundation skill of Motivational Interviewing, is like offering a hypothesis about how we perceive someone else’s meaning. Reflections are offered in the spirit of “I’m listening to understand (not to judge, persuade or correct)”. True, unadulterated listening is rare, refreshing and affirming. It communicates respect and builds relationships. It goes “below the surface” and articulates the underlying meaning – thoughts, feelings, ideas, hopes, values – that a person may be expressing.

Bonus tip:  Reflections can sound contrived when they are prefaced by “stock” phrases such as:

“What I hear you saying is…”

“So you are saying that…”

“I am hearing that…”

I think practitioners use these phrases to (a) buy time while we’re busy figuring out what exactly we’d like to reflect; and (b) because we’re concerned that we might be ‘putting words into the other person’s mouth’. However, when we offer reflective listening statements with a spirit of partnership, acceptance, compassion and collaboration, it’s OK if we’re a little off-target with respect to the other person’s meaning, affect or intent. Our reflections can still evoke further elaboration.

Also: it might seem counter-intuitive, but reflections are more genuine and engaging when we just come right out with a statement (not an question, and no ‘stock phrase’ preface):

“You wish that…”

“It’s frustrating because…”

“It would be nice if…”

“You’re not too happy that…”

Understanding is at the heart of effective communication. It’s also key to building trust, rapport and safety. The saying: “I learn what I believe as I hear myself speak” articulates the power of dialogue in fostering insight and enhancing motivation for change. Reflective listening holds up the mirror.

Related articles:

Reflective Listening: The Most Powerful Tool in the Tool-box?

Reflective Listening Reflections

Lost in Translation

March 29, 2014
Clinical Education, Motivational Interviewing
1 Comment

Neon sign retro party

 

 

 

 

 

 

 

 

 

When words (and worlds) collide

 

This week I facilitated a webinar on Motivational Interviewing for members of the Ontario Association of Social Workers. I like how webinars offer an opportunity for professional development in a distributed learning format from the comfort of home or office; and clinical social workers tuned in for our evening session from various regions, cities and towns. We had a fun and at times informal conversation in the chat bar, with some interesting discussion focused on my unintentional use of idiomatic expressions and vernacular language.

 

Idioms are culture-bound and can be confusing to diverse groups who may puzzle at their intended meaning. For example, when I talk about needing to keep my head above water in working with complex clinical scenarios. And one of my personal favorites is a skill or tool that’s as easy as pie. No doubt there was a time when pie-making was super-easy, but not anymore (at least for me anyway).

 

Expressions aren’t just culture-bound, they can also be generational in their meaning. In this week’s webinar I talked about the Coles Notes version of Motivational Interviewing in reference to a one-page “Motivational Interviewing Tip Sheet”. There was some light-hearted (another idiom!) text-chat in the sidebar about the generational divide among people who understand what Coles Notes actually refers to.

 

Last night I had a conversation with the teenager in my life about putting pen to paper. Her reply? “I don’t know what that means”.

 

Maybe I need to spend some time with urbandictionary.com.

 

Related:

Six Tips for Facilitating Webinars

 

 

How can we effectively motivate change?

March 10, 2014
Clinical Education, Motivational Interviewing
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robot cute

 

 

 

 

 

 

 

 

 

 

 

Reflections on motivation and why people change

 

How to motivate change is a big question for clinical educators and practitioners because someone else’s behaviour change is, in the end, wholly out of our hands. Over my 15 + years of practicing and teaching Motivational Interviewing, I still find myself getting stuck in the “righting reflex” when I see a person making (what I consider to be) unwise decisions.

It all comes down to individual motivation and commitment, and that’s a scary prospect when the stakes are high. We see someone following a risky trajectory and we want to grab the steering wheel. How bad do things have to get before an individual figures it out for him- or herself?

My own experience is that everyone has a particular “pain” threshold: biologically, psychologically and socially. In other words, a state of being that I might find totally unendurable physically, mentally or inter-personally may not be so bad for someone else. We each bring a singular standpoint and value-set to the decisions we make and how we live our lives. 

And here’s the thing:

People only change when the pain of change is less than the pain of staying the same.

 

In other words, motivation is tied to individual perception and experience of suffering. For example, from a teaching standpoint, it can be heartbreaking to see a promising student at risk of failing a course due to not attending class or completing assignments. But the important thing is…how does the student see it?

A “red flag” from a Motivational Interviewing perspective is when I am more invested in change than the person I’m working with (in this case, the student). I can better enhance motivation by stepping back, exploring possible reasons for change, and offering what I’m hearing about the pain of staying the same. Underlining a person’s perception of some of the costs of negative behaviours can open the door to a productive conversation about possible solutions.

 

As Andy Warhol put it:

When people are ready to, they change. They never do it before then, and sometimes they die before they get around to it. You can’t make them change if they don’t want to, just like when they do want to, you can’t stop them.

 

Related articles:

Reflective Listening: The most valuable tool in the tool box?

Reflective Listening Reflections

 

Who was your favourite teacher?

January 14, 2014
Motivational Interviewing, Post-secondary Education
3 Comments

http://www.flickr.com/photos/gabbymarcuzzi/7125458745/

 

 

 

 

 

 

 

 

Take a moment and consider…who was your absolute favourite teacher?

 

What was it about him or her that had such an impact? What was so memorable about this person’s qualities and behaviours?

 

Chances are that a name and a face came to your mind immediately. Even after more years than I care to say, I still remember Mr. Bolland, my high school English teacher. His sense of humour, his love of literature, his patience in the classroom and respect for students made me keen to come to class. He was inspiring. Chances are, these are some of the qualities that you also recall so vividly.

 

I’ve used this activity, contributed by Dr. Carolina Yahne as a resource for the Motivational Interviewing Network of Trainers (MINT), in my own clinical courses and workshops as a way to evoke the “spirit” of Motivational Interviewing. This includes the principles of partnership, unconditional acceptance, accurate empathy, autonomy support and compassion.

 

The fact that people experience the “favourite teacher” exercise so universally and so similarly underlines the impact that educators (and others!) can have on a someone’s life. People remember most of how we make them feel (as opposed to what we say), and I like to remind myself that each and every student represents an opportunity to make a positive difference.

 

Reflective Listening Reflections

November 30, 2013
Clinical Education, Motivational Interviewing
5 Comments

latte drakehotel

 

 

 

 

 

 

 

 

The latte factor in Motivational Interviewing

 

Reflective listening, as it’s used in Motivational Interviewing, can include both simple (content-focused) and complex (beneath-the-surface) reflections. I like to use the analogy of an iceberg to illustrate the difference between simple and complex reflections (link to article); but the iceberg image doesn’t quite to do justice to the richness of what’s “below the waterline”.

 

At a recent professional development workshop I attended, the facilitator used the image of a café latte to illustrate listening for varying verbal and non-verbal content. This got me thinking: a better (and better-tasting) analogy for reflective listening might well be a macchiato versus an iceberg:

The top layer of foam represents the spoken content that the person offers.

The middle (espresso) layer represents the person’s thoughts and feelings.

The bottom layer – the foundation, as it were – represents the person’s values and beliefs.

 

 

Accurate empathy (that is, listening with ears, eyes, undivided attention, and compassion/heart) is needed to hear and reflect a person’s unspoken emotions as well as underlying values.

 

Here’s a quick example:

 

Client: “It is way too stressful right now for me to make this change.”

 

Now you have three choices:

Reflect the spoken content (simple reflection)

Reflect your sense of what the person might be thinking or feeling (complex reflection)

Go for the underlying values/beliiefs as you understand them (complex relfection)

 

It goes without saying that this is offered in the spirit of Motivational Interviewing: Partnership, acceptance, compassion and evocation. You might be on target or not quite accurate, but in the end your reflective response – especially complex reflections – will forward the conversation (and exploration) in an affirming and supportive way.

 

 

Presentation Secrets (2)

October 2, 2013
Motivational Interviewing, Presentation Skills
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Girl Crying Girl

 

 

 

 

 

 

 

 

 

Where does it hurt? That’s the key diagnostic question whether you’re a presenter or a clinician

 

A common clinical dilemma in counselling practice is when the practitioner is more invested in change than the client. This is manifested in clinicians working harder than their clients and caring more than they do about change. How and why does this happen?

 

I think this disproportionate effort stems from two things:

  1. Practitioners are trained to identify issues of concern and have a heightened awareness of the long-term implications and consequences of negative health behaviours.
  2. Because of their training and awareness, practitioners often feel that they know what is best for their clients.

The first point is helpful; the second…not so much.

 

It’s like the quotation:

“Advice is what we ask for when we already know the answer but wish we didn’t.”  In other words, people are the experts in their own lives.

 

So what does all this have to do with presentation secrets?

In a teaching context, the instructor – just like the clinician – is expert in his or her specific knowledge domain and strategies for internalizing and enacting knowledge and skills. It’s when we take the stance of “I know best” that we run into trouble in the classroom. All people (whether patients or students) are in charge of their own lives and actions; learning is volitional and learners will always be self-determining in what and how much is learned.

 

Here’s the secret:

Always start with the problem that the learner identifies as relevant and pressing. Affirm autonomy. Offer solutions in the spirit of collaborative problem-solving. Tailor the content to the real-world needs of the individuals with whom you are engaged.

How do you know if you’re doing it right? Hearing “Yes, but…” is the clue that you’ve gone off track. Figure out the pain point and offer ways to make it better. Then leave it up to the real experts: the people you are entrusted to serve.

 

 

Presentation Secrets (1)

September 10, 2013
Clinical Education, Motivational Interviewing
1 Comment

 

DSC_0084

 

A small investment that can add big value to your training or workshop

 

People attend courses and workshops for a variety of reasons: some are there to learn, some are forced to attend, and others are curious-but-skeptical. Yet whatever the reason, how can we add value in the form of creating a compelling and memorable experience? An experience that effectively reaches beyond the workshop into the “real world” inhabited by our learners?

An obvious way to help bridge the learning-practice gap is to offer a package of professional, relevant and well-designed handouts. We trainers reassure ourselves that this invaluable resource will serve as an oft-consulted reference for learners post-session. Yet, how many of these things have you unearthed and pitched out in an office-purge years later? It’s a natural tendency to “file it and forget about it”. So…What else is needed?

I have attended two recent faculty development sessions where the speakers employed an ingenious and appealing strategy. So brilliant, so obvious, why have I never done this before? I am decided that I will now incorporate this into every single workshop:

Give each and every participant a small, meaningful token – a symbol – of the underlying meaning or “spirit” of your session.

Don’t tell them ahead of time. Do it near the end of your workshop or talk. Involve them in an activity demonstrating how they might use it.

 

Example:

In the Motivational Interviewing workshops that I facilitate, we talk about the skill of affirming as one of four foundation skills in this counselling approach. Last week at a session I gave for Queen’s University Health, Counselling and Disability Services clinicians, I handed out “saphires” (plastic, from a discount store) to each participant, and asked them to consider an affirmation that they could offer to a challenging student they are working with. Long after the workshop, that “jewel” on a practioner’s desk is a tangible reminder of mindful practice, and more evocative (and concise) than the 40 page handout I provided! (Or even the one page ” MI Tips ” for that matter).

Learners give their time, attention and wisdom to us when we co-construct learning communities. In the spirit of reciprocity, I have decided that going forward, a symbolic token to take away represents a significant value-add for learners and a reminder of what we have collectively shared.

 

Motivating Your Audience

August 9, 2013
Clinical Education, Motivational Interviewing, Presentation Skills
1 Comment

ocean fish

 

 

 

 

 

 

 

 

 

Every audience comes with varying levels of motivation to learn: What can you do to engage them?

 

A recurring challenge in facilitating continuing professional education workshops is how to respond to participants who do not see a value in attending. This isn’t uncommon, given that training is often mandated by management and the topic or content of your session doesn’t necessarily align with their individual learning goals or perceived needs. It’s easy to get focused on (or distracted by) these less-than-enthusiastic folks, but people participate along a diverse spectrum. A strong facilitator reaches out to everyone in the room.

So, you might wonder, how is an individualized, motivational approach possible with more than just a handful of participants? In my experience over 15 years of leading professional courses and workshops, I have found that groups of all sizes generally coalesce into five sub-groups:

  1. “Keeners”: It doesn’t matter whether they came voluntarily or because their manager made them attend. They are hungry for any and every opportunity for learning: 100% intrinsically motivated.
  2. “On the Fence”: These folks aren’t unhappy to take time off work for your session and are open to learning, but they are looking for a practical demonstration of how and why the topic/content is relevant before they will engage.
  3. “Open-minded Skeptics”: They are generally seasoned and respected experts in the group who are provisionally willing to give you a chance. However, because of their super-strong skill-set they have lots of experience sitting in courses with not much to show for it, and this can impact their motivation for learning in your course.
  4. “Convince Me”: These individuals can be hard core for even the most experienced trainer. They are not happy campers from the get-go, and they are not afraid to show it openly and repeatedly.
  5. “Multi-taskers”: This sub-group has other things on the go besides your training. Often arriving late, leaving early, on their mobile, or otherwise occupied, they are polite and willing to participate when present, but your workshop is not necessarily a high priority.

 

How can we best respond to and motivate these diverse groups, all at the same time, over a course that might range from an hour, or a day, through to multiple days? Let’s look at some quick tips for each:

The “Keeners” are on your side. You really need to mess up in order to alienate them. You will know who these individuals are right away because they are quick to raise their hands, offer insights and opinions, and generally smooth your path. Make sure to explicitly thank and encourage them.

Those who are “On the Fence” can (by definition) go either way. It’s important to prepare a strong start to the session by engaging the group in a conversation – or for a large audience, a demonstration –  of the practical value of the topic/course. A quick “Turn to the person next to you and identify the most important take-away”, or a video demonstration, case example or personal story can accomplish this. The key is to spark peoples’ interest and invite them in.

The “Open-minded Skeptics” can be your best friend or your worst enemy. Adult education affirms that learners come with pre-existing knowledge and skills, and that is never truer than for this group. Because they are, themselves, experts, it’s essential to explicitly acknowledge and invite their and others’ contributions to the content you have prepared. These folks often ask specific, technical questions, and they will know if you try to fake it. Probably everyone else will know too. My own approach is to be up front with the group, respectfully affirm where others’ knowledge and skills exceeds mine, and encourage a collaborative learning environment where everyone – regardless of months, years or decades of experience – has something of value to contribute (check out this link for a nice way to establish this climate from the start: First, empty your cup). In addition, I make a point of naming and reinforcing participants who demonstrate their skills and effectiveness – they are a resource to the whole group.

Now let’s consider those who come across as somewhat difficult, or even openly antagonistic: “Convince Me”. I don’t see these individuals in every workshop, but it’s happened often enough to be worth coming prepared. This is where skills in group facilitation and knowledge of group dynamics are essential. I need a large chunk of the group to be “with” me, in order to help manage what can become a facilitation disaster (I am not exaggerating). If the majority of participants are engaged, enjoying themselves, and find value in the material, it is hard for one or two naysayers to sabotage. On the other hand, if the group as a whole are “On the Fence”, the “Convince Me” contingent can bring it all down. If you do run into problems, here is a tried-and true strategy for How to TAME difficult, skeptical, hostile or challenging participants.

Last but not least, “Multi-taskers” should not be ignored. Artful facilitation can help them shift to “Open-minded Skeptics” or even “Keeners”. The thing is, you may never know because they aren’t totally present (literally). But that doesn’t mean your workshop didn’t make an impression – these individuals are often opinion leaders and influencers with large professional networks (that’s why they’re so busy). Articulating everyone’s right to participate however they choose is a win-win. They will do it anyway, and affirming personal choice and control communicates respect and positive regard.

One caveat: The real world is messy and disorganized, and slotting people into categories is perilous at best. Individuals and groups are dynamic, organic and open to complex reciprocal influences from you, one another and the environment. Thus, my most important tip? Don’t stand in the middle of the stream; go with the flow.

 

Check out more learner engagement strategies:

Classroom Management 101

Five Things About Teaching

That’s just how we roll

Perceived versus Actual Practice in Motivational Interviewing (MI)

August 3, 2013
Clinical Education, Education Research, Motivational Interviewing
1 Comment

ideas lightbulbs

 

 

 

 

 

 

 

 

 

 

 

“What I don’t know I don’t know” – That’s the most essential learning

 

In nearly every course or workshop I teach on Motivational Interviewing (MI), there are nearly always practitioners who express some variation of “I already do MI naturally”. In other words, why spend time “learning” about something that I already know how to do? A reasonable response, if accurate.

I say ‘if accurate’ because research on MI practice suggests a disconnect between what practitioners say they do versus the MI skills they can actually demonstrate. We’re talking video recordings of actual client sessions, coded by skilled clinicians trained in the use of a standardized instrument. So while there may be a small proportion of therapists who really are “MI naturals”, it’s likely that most practitioners, whether they know it or not, can not or do not demonstrate the skills of MI without training, coaching, practice, coaching, and practice.

 

Motivational interviewing is essentially a way of being with a client (Dr. William Miller, the originator of MI, calls this “MI Spirit”), comprised of partnership, acceptance, compassion and evocation. It seems intuitive, but the “Righting Reflex” is hard to resist. Additionally the processes of MI – engaging, focusing, evoking and planning – are accompanied by a range of skills and strategies. Integrating both spirit and skills demands artful practice, and integrating MI with other approaches (for example Cognitive Behavioural Therapy, CBT) involves even greater therapeutic sophistication.

No practitioner ever reaches the apex of clinical perfection – it doesn’t exist! Just like the clients we serve, practitioners are engaged in an ongoing process of development. And it’s the basics (reflective listening is a good example) that can be the most challenging.

 

People come to a learning environment with four general categories capturing both pre-exisiting knowledge and knowledge deficits:

  1. What I know that I know: Everyone comes in with something of value
  2. What I know that I don’t know: Everyone has areas they can identify as avenues for further learning
  3. What I don’t know that I know: Everyone has knowledge and skills of which they aren’t aware
  4. What I don’t know that I don’t know: We all have a blind spot when it comes to what we still need to learn. When we can shine a light on it, that’s the “aha” moment! 

A Patient’s Perspective on Interprofessional Collaboration (IPC)

July 11, 2013
Clinical Education
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leaf detail

 

 

 

 

 

 

 

 

Patient safety includes patients’ subjective feelings of safety

I have participated in and taught about interprofessional collaboration (IPC) for many years, but last week I experienced it firsthand from a new perspective… as a patient.

Here’s a quick replay:

It is 6:15 AM. No coffee. Emerging from the changing room in a hospital gown and disposable slippers I re-enter the Admitting waiting area with others similarly attired, accompanied by our respective escorts. The only exuberance is among a group of three teenage girls, whose noisy laughter and nonchalance exudes the indestructibility of youth.

From Admitting, on to the Pre-Op waiting area. One by one patients are called, and then it’s my turn. Past the swinging double doors, down a wide corridor, more people in surgical scrubs, into the Operating Room. It’s kind of freaky being the one with the IV: “Just hop up here onto the operating table.”  A narrow bed in the centre of that big room, with really bright lights just like on TV. Ummm…sure. Too late to back out now.

Have you noticed how right away you can feel a room’s atmosphere (positive or negative)? Well in that moment of total vulnerability, I sensed the camaraderie of a super-high-functioning team. I felt respect, cooperation, kindness and compassion. Not just toward me but to each other. More than anything anyone actually said or did, the underlying atmosphere was like a warm blanket of reassurance and comfort.

Health and counselling practitioners universally affirm the importance of positive regard, mutual respect, trust and acceptance in relation to our patients or clients. Last week was a good lesson about how profoundly our interprofessional relationships – those same elements of positive regard, mutual respect, trust and acceptance – are visible, impactful and meaningful. Just like kids know when their parents are fighting (even in the absence of verbal cues), patients know when there is discord in the team.

As I discovered firsthand, IPC is not just about patient safety, it’s also about patients’ subjective feelings of safety. A skillful surgeon is key. An outstanding team takes it to the next level.

 

P.S. The biopsy was negative.

The good, bad and ugly of PowerPoint

June 22, 2013
Presentation Skills
1 Comment

nest blue eggs

 

 

 

 

 

 

 

 

 

 

 

Slideware 101: Tips and Resources

 

We’ve all been there: the uncomfortable chairs, the slightly darkened room, and slide after slide after slide. Each one identically bullet-ed, punctuated by the occasional graph and the speaker stating, “I know that you can’t read this, but…”.

 

The almost ubiquitous use of slideware has rigidified knowledge communication, and the sad part is that somewhere buried in the bullet points and boredom is someone’s singular message, lost. Not only that, sometimes the consequences of information presented poorly can be devastating.

 

Edward Tufte, a Yale University Professor Emeritus and visionary in information design and data visualization, wrote an influential essay – posted online – pointing to the use of PowerPoint slide decks in NASA engineering briefings as a contributing factor in the 2003 Columbia space shuttle disaster. In their report, the Columbia Accident Investigation Board concluded that “the distinct cognitive style of PowerPoint reinforced the hierarchical filtering and biases of the NASA bureaucracy during the crucial period when the Columbia was injured but still alive”. The take-away? Templates that structure information into bullet points can obscure nuance and interrelationships within and between knowledge domains.

 

The way I see it, it’s not slideware that’s the problem, it’s how it is used. Done well, visuals (whether video or static images) can add impact and interest to a presentation. But the design tools and templates of PowerPoint et al. are generally used by folks who have never learned design. Thus we end up with…

 

PC World Article: Worst PPT Presentations

 

 

 

 

 

 

 

 

 

PC World: Worst PPT Presentations

 

 

 

 

 

 

 

 

 

You can check out the full article with more examples here.

 

I too have been guilty of multitudinous slideware sins, and found redemption in Garr Reynolds’ Presentation Zen, and accompanying resources and slide decks. I especially like the PowerPoint “Before and After” demos to illustrate how good design can transform our visual communication.

 

In a nutshell: 

Simplicity is key to good design. Images trump words. Fewer words are better than a lot of words.

 

Here a couple of my own PowerPoint makeovers, inspired by Reynolds’ work.

 

This slide attempts to summarize (via text) the information and context that should be delivered in a narrative elaboration of the simplified (after) slide

Motivational Interviewing Processes: Before

 

 

 

 

 

 

 

 

 

Motivational Interviewing Processes: After

 

 

 

 

 

 

 

 

 

 

This was from a slide deck on presentation skills, and offers a good example of how slides and handouts should be two different things

Presentation Skills: Before

 

 

 

 

 

 

 

 

 

Presentation Skills: After

 

 

 

 

 

 

 

 

 

 

I was quite proud of this next slide, which had lots of text animations (shudder). The second slide conveys the “ACE” acronym via the image

Motivational Interviewing "Spirit": Before

 

 

 

 

 

 

 

 

 

Motivational Interviewing "Spirit": After

 

 

 

 

 

 

 

 

 

 

 

Follow this link for more examples of PowerPoint Makeovers.

 

 

The most challenging class ever

March 16, 2013
Clinical Education, Education Research, Motivational Interviewing, Post-secondary Education
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Toronto-20140510-00694

 

 

 

 

 

 

 

 

Here’s what the ultimate teaching challenge might look like…and in the future it may be the rule rather than the exception

A new book, Motivational Interviewing in Groups (Wagner and Ingersoll) outlines motivational approaches and strategies in group facilitation. While the book’s emphasis is on clinical practice, the principles and applications are also relevant to education settings.

The book’s authors present a table illustrating different types of group format, structure, composition, size, length and admission arranged along a continuum of difficulty (for facilitators) from easier to harder:

Slide1

 

 

 

 

 

 

 

 

 

 

This looks different for educational groups, but the essentials still apply. Here is my modification of Wagner and Ingersoll’s framework calibrated for teaching and learning:

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In other words:

Elective courses are easier to teach than mandatory courses. Students generally take electives out of interest, as opposed to being forced to take mandatory courses. Teaching students content that someone else thinks they ought to know is tougher than content in which they’re already interested.

Instructor-led courses presuppose a “script” (i.e. lesson plan), versus collaborative or student-led curricula. Paragogical approaches posit peer-to-peer learning and individual autonomy, and demand a proportionately higher level of finesse and facilitation.

Classes where students share more similarities than differences can be easier to work with than heterogeneous class compositions. For example, students who differ widely in age, ability or pre-existing knowledge and skills present more of a challenge in ensuring that all learning needs are met, and establishing an inclusive, cohesive and positive community of learning. Of course diversity, including culture, sex, gender and lived experience, enriches everyone’s learning exponentially – but demands artful facilitation on our part.

Student engagement and interactivity are more straightforward in classes of 25 or less. As class size increases so does the challenge of promoting opportunities for practice and integration of knowledge and skills.

It’s easier to keep peoples’ interest and attention for a single class of 2 or 3 hours than it is for a whole day or for multiple days. The latter demands both a varied menu of instructional strategies as well as formidable stamina (on the part of the instructor and the students).

Strict and highly competitive admission criteria can yield the “cream of the crop” of high-achieving and highly motivated learners. On the other hand, classes where admission is unrestricted means addressing the needs of the best and the brightest alongside those with academic struggles and other challenges.

Like any framework, this conceptualization tends to oversimplify and blur the many complexities and nuances of artful classroom teaching. Real life is always messier than the manual (if there even is a manual). But in general, teaching a mandatory class using a student-led curriculum, among a highly diverse cohort of 100 students or more, over a multi-day course that is freely open to all could well represent the ultimate teaching challenge.

We haven’t added the layer of classroom-based versus online teaching and learning, but does this scenario represent what may well be future of higher education…MOOC 2.0?

 

Classroom Management 101

February 17, 2013
Clinical Education, Motivational Interviewing, Post-secondary Education
2 Comments

cat paw

 

 

 

 

 

 

 

Why it’s less about managing the class than joining with the group

Recently overheard in a high school classroom: “F#*%  you…sir!”    Wow: Did I just witness respect + disrespect expressed simultaneously? How does that work exactly?

Teaching is a tough job whatever the age group. Adults may be less “out there” than teenagers, but the group dynamics are the same. Groups tend to behave like unitary entities: they can be your best friend or your worst enemy. But if they fall into the latter category they are a many-headed hydra who cannot be vanquished.

Here’s how I see it: If you have to actually “manage” the class that is not a good sign. Now I am not talking about classroom management in terms of providing guidance or direction with respect to learning content or processes. Every group needs a guide to stay on track. What I mean is that if students act out, tune out or walk out, things have already gone bad. At that point it’s likely not so much a student issue as a group issue.

Here are a few tips to help get things off to a good start, and to keep it that way:

1. Mutual respect is an essential precondition for ANY relationship. If it’s lacking there’s no relating. Regularly affirm your respect for each student and for the class as a whole (the “two clients”: the individual and the group).

2. Make it interesting. Easy to say, but how? Three words: make it relevant. OK, but how? The group will tell you if you ask. What do they care about? Why are they there in the first place? What do they want from you and from each-other?

3. But… what if I am teaching a mandatory course that no one cares about? Here’s the thing: There is no such thing as a topic that’s inherently interesting (have you ever gone to a talk that intrigued you only to be bored out of your mind?). And, conversely, there is no such thing as a topic that’s inherently boring (have you ever gone to a talk you were dreading only to be pleasantly surprised?). Why is the course mandatory? What’s the larger narrative? Why is this essential knowledge and learning? These are the primary questions to address as part of an ongoing group dialogue.

4. Show that you care. Not just about what you’re teaching, and not just about your students as people, but about their experience in the here-and-now. Who’s tired? Who’s bored? How comfortable is the room? What else is happening in the world and how does that impact the tasks at hand? This in-the-moment reflection continuously reestablishes the connection between facilitator and class. In clinical practice it’s called therapeutic use of self – tune in to your own experience to help you tune in to the group.

5. Be generous. Generous with your humour, your time, your interest, yourself. I think of generosity as comprised of curiosity, authenticity, empathy and joy. It’s less a focus on how the group sees you than on who is in the group and what you see in them. And be generous with people when they’re having a bad day. It happens to all of us.

Over the last two days I facilitated a mandatory training for a diverse group of health and social service professionals in Halifax, Nova Scotia. What a pleasure – even if some learners started off the day with ambivalence, we all ended on a high note. And just to add…if you ever find yourself in that beautiful city, be sure to check out Cabin Coffee on Hollis Street for a latte and a killer cinnamon bun!

Reflective Listening: The most powerful tool in the tool-box?

January 25, 2013
Clinical Education, Motivational Interviewing
9 Comments

 TO LISTEN

Ears + Eyes + Undivided Attention + Heart

Zen rocks lake

Group facilitation is more about listening than speaking

Facilitating groups is a delicate art: groups progress through certain well-defined stages of development, and our style as facilitators needs to be pitched to where the group is at. Furthermore, facilitators need to respond to the “two clients” – the individual, and the group – and attend to both content and process. This multilayered complexity, whether in education or clinical contexts, is a big part of what makes groups so energizing and exciting.

What is reflective listening?

In its simplest form, it’s a response that paraphrases or mirrors the spoken content of a person’s statement. Reflective listening is a way to check back and make sure that we’ve understood what someone else tells us. This type of response is also a good alternative to the “Righting Reflex”!

Done artfully, the skill of reflective listening looks easy but is far from it (at least in my own experience). Really impactful reflective listening goes further than paraphrasing, and mirrors back the implied meaning beneath a person’s words; exploring the emotions, assumptions, ideas, hopes, concerns or wishes. These types of complex reflections demand our full listening attention and focus on the other. We all want to feel understood, and reflective listening helps bridge the communication gap in a respectful and validating way.

Here’s an analogy: simple reflections are like the tip of an iceberg – the content “above the waterline” – while complex reflections go deeper.

This video example of an angry client demonstrates how the practitioner uses lots of reflective listening to establish understanding and build rapport.

Reflective Listening in Groups

Reflective listening in groups ups the ante because of their interpersonal complexity. But, looked at another way, groups give us even more options and opportunities to use this important skill. I’ve come up with three general categories for practicing reflective listening in groups (and I’m sure that there are more):

1. Simple versus complex reflections

2. Reflecting an individual’s comments versus content taken from the group’s overall contributions

3. Reflecting group content versus group process.

Note that a facilitator might decide to use any one of these approaches (and within each category are a myriad of alternate ways of responding)…that’s the artful strategy part!

Here’s an illustrative example of a hypothetical client who is coming to the first session of a support group for people living with heart disease. The facilitator has asked group members to share their goals for attending, and the last client to speak says:

“I’m only coming to group today because my doctor and my wife are both pressuring me.”

Reflect 1

Reflect 2

Reflect 3

Notice how each reflective strategy builds on the next – but they aren’t sequential (or prescriptive for that matter). Just some pretty powerful tools that are appropriate across a spectrum of clinical, educational, professional and other kinds of groups. Because in the end, the best facilitation is more about listening than talking.

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