September 06 MI News Ethics and MI
MOTIVATION NEWS
Published by Cathy Cole, MSSW, LCSW Motivational Interviewing Network of Trainers
September 06 http://www.cathycoletraining.com \"What People Need is a Good Listening To\" Mary Lou Casey
NEWSLETTER FEATURE ARTICLE The Ethical Use of Motivational Interviewing
IF YOU DO NOT SEE TRAINING THAT WILL FIT YOUR NEEDS, PLEASE EMAIL ME AT cathy@cathycoletraining.com IN ORDER TO DISCUSS HOW I CAN PROVIDE TRAINING TAILORED TO YOUR NEEDS. I FREQUENTLY TRAVEL TO AGENCIES OR CONFERENCES TO PROVIDE MI TRAINING.
ONSITE TRAINING OPPORTUNITIES
INTRODUCTION TO MOTIVATIONAL INTERVIEWING Introduction to Motivational Interviewing--November 13-15, 2006
A 3 day workshop at the Friday Center, Chapel Hill, NC Monday, Tuesday and Wednesday,November 13-15, 2006 Limited to 15 participants $650, 19 hours CE; CE Provider * 886383517 For details, visit http://www.cathycoletraining.com under Onsite Training
DISTANCE LEARNING TRAINING
FALL TELECLASS--An 8 hour distance learning course as an Introduction to MI; lecture, demonstration and active practice. 8 hours of CE. CE Provider * 886383517 Course will meet Mondays from 7-8PM ET September 18 through November 6, 2006 $440 early registration; $460 after August 28, 2006. See http://www.cathycoletraining.com for details under Distance Learning future
ONSITE TRAINING DATES 2007 LOCATION: CHAPEL HILL, NORTH CAROLINA
Select the dates and training that works for you.
INTRODUCTION TO MOTIVATIONAL INTERVIEWING March 19-21, 2007 October 8-10. 2007 A Three day workshop covering the basics with ample opportunity for coached practice
ADVANCED MI TRAINING April 31-May 2, 2007 November 5-7 A 2 1/2 day workshop with an emphasis on coached practice
MI COACHING--TAKE ADVANTAGE OF ONGOING SUPERVISION OF YOUR MI PROGRESS VIA COACHING For individuals and agencies with previous MI training either with me or another MI trainer, I offer ongoing coaching/supervision in the application of MI. Generally, this coaching takes place by phone. You can arrange for individual or group coaching. Please email me at cathy@cathycoletraining for more information.
ABOUT MY WORKSHOPS: I have provided MI training since 1995, following my training with Drs. Miller and Rollnick. My teaching approach is very pragmatic, focusing on the core concepts of MI and allowing the learning to progress from direct practice.
I have elected to limit the size of my workshops in order to maximize the opportunity to provide learning that can both address the concepts and practice of Motivational Interviewing while at the same time assist in the application of MI to each participants work setting.
I offer all participants the opportunity to submit a 15-minute audio-tape of an interview using the MI approach before and after each workshop. This will allow for you to have feedback on your progress in learning.
Onsite training is limited to 15 participants, both in Advanced and Introductory MI; Distance Learning classes are limited to 10.
This letter may be forwarded to anyone you feel could benefit as long as it is forwarded in its entirety. Past newsletters available via web site http://www.cathycoletraining.com
Welcome to Motivation News, a newsletter devoted to clinical information on the use of a Motivational Interviewing (MI) approach to change. The authors of this approach, William Miller, PhD and Stephen Rollnick, PhD define MI as a 'client centered, directive method for enhancing an intrinsic motivation for change by exploring and resolving ambivalence\". This collaborative approach to working with clients has wide application in coaching, mental health, addictions, health care and health education. Information in this newsletter is taken from various source material from the Motivational Interviewing Network of Trainers and specifically from the book Motivational Interviewing, Preparing People for Change; Miller and Rollnick, 2nd edition, 2002, Guilford Press.
The Ethical Use of Motivational INterviewing
In the text, Motivational Interviewing, Preparing People for Change, Guilford
Press, 2002,Miller and Rollnick devote chapter 12 to Ethical Considerations.
As I think about the ethical use of MI, I am guided by the three components
of the Spirit of MI: collaboration, evocation, and autonomy.
In collaboration, we are working to foster a relationship based on each person contributing to some discussion and consideration of how to address a particular behavior issue. The role of the interviewer is to assist the client in reviewing all aspects of what it would mean to make a behavior change. The interviewer may offer, with permission,feedback and information to clarify and provide direction around making change, should the client elect.
It is the process of evocation, eliciting ideas around change, that allows the client to carefully consider desire, ability, reasons, and need for change, decide on whetherto make a commitment to change and begin taking steps. It remains the decision of the client whether to move forward in making change or not.
The client's ability to decide is what is governed by autonomy. Despite the point of view of the interviewer or what the interviewer might think is best, in the end only the client can and should decide.
Remaining ethical via the use of the spirit of MI means we do not resort to coercion, ordering, telling, directing, or seeming to allow for choice when we clearly do not plan to offer choice. Any way that we imply to the client that personal choice and control is available when it clearly is not is an unethical use of MI. Using MI to attempt to manipulate the client to our point of view is not ethical.
Some of my MINT colleagues even raise the issue of whether we should inform clientsthat we employ the MI approach, essentially being very direct in letting the client know we are actively interacting with them in a therapeutic manner designed to resolveambivalence for change. I have not quite resolved that dilemma for myself.
But let's consider one situation: John Smith is hospitalized on an inpatient psychiatry unit. He has not done well living independently and the team has decided that he should live in a community halfway house. Here are two approaches, the first not ethical, the second ethical. (I) is for Interviewer, (C) is for client.
I: John, you are going to be discharged next week. Where do you plan to live?
C: I want to go back to my old apartment. I like it there.
I: Hmmm, are you sure? Don't you think living some place where you would be around others, get your medications, meals and some activities would be better for you?
C: No, I don't like those places, been there before...crowded,dirty, no fun.
I: Why don't we look at the pros and cons of living in halfway house?
C: No! I am going home. That's it.
For me what makes this encounter unethical, outside of the MI non adherent interactions, is the team's agenda not being made clear.
And now this way that is ethical and consistent with MI.
I: John, you are going to be discharged next week and the team has some concerns about you returning to your apartment. I'd like to talk with you about your plans. (providing feedback, setting the agenda)
C: I want to go back to my apartment; I like it there.
I: I realize that, and the decision of where you go will be yours. If you are willing, I would at least like to express our concerns over you living on your own in the apartment.
C: I'll hear what you have to say, but I won't change my mind.
I: Fair enough. You told us when you were admitted that you often stay in your place, in bed, not taking your medications, eating, or seeing anyone for several days. When this happens, you begin to hallucinate againand either come to ask to be admitted or get brought in. This has happened three times this year already.
C: Well, that is true; but I don't think living in one of those houses is for me.
I: Maybe we shouldn't get stuck on that part; maybe we should first talk about your goals about staying out of the hospital or not. I don't want to assume anything.
In this example, clear feedback and point of view was expressed without imposition; client choice was reinforced, and the interviewer was moving toward satisfying 'expressing empathy' by eliciting goals from the client.
As we work to implement MI in everyday interactions with clients, there will be many times when we do have a point of view, do think one choice is better than another; remaining ethical means that we disclose this to the client if this is justified/required, but note it as just what it is: our point of view, backed with pertinent feedback to support it. Many clients are quite happy to hear this, take it into account. From my view, this allows the client to progress in examining ambivalence around change.
Keep practicing!
For more information on MI training and Cathy Cole visit http://www.cathycoletraining.com
Additional Educational/Coaching Offerings: Use of the MITI (Motivational Interviewing Treatment Integrity Code) for feedback on taped interviews.
Onsite workshops: one to three day training in MI for agencies or educational consortiums
Onsite consultation: Preparing your agency for MI. Combining this with specific training for agency staff increases the effectiveness of implementing MI.
Additional Advanced MI training: Telephone conferencing for active case supervision and focus on MI skills or on site training for staff groups already trained in MI; feedback on tapes using the MITI.
MI Coaching: assessment of a taped client session with phone supervisory consultation; feedback on tapes using the MITI.
For information on any of these MI trainings, send email to cathy@cathycoletraining.com
Cathy Cole, MSSW, LCSW is an educator and clinician.
She received her Masters of Science in Social Work from
the University of Tennessee and has maintained a varied clinical and
education practice throughout her career. Since her training in
Motivational Interviewing in 1995, she has provided extensive training.
For more information on Cathy visit http://www.cathycoletraining.com
To contact Cathy, use cathy@cathycoletraining.com
cathycoletraining Mission: to provide excellent education and coaching with a specific focus on the use of Motivational Interviewing for exploring and resolving the natural ambivalence for change. Training in the use of Motivational Interviewing is offered on site or via teleconference. Contact Cathy at cathy@cathycoletraining.com for more information or visit http://www.cathycoletraining.com
For more information on Motivational Interviewing, visit the web site http://www.motivationalinterview.org
(919) 967-9653 — 
cathy@cathycoletraining.com© 2009 Cathy Cole Training, Inc.