[Episode 84] Today's episode of the Social Work Podcast is nigh Motivational Interviewing, Third Edition. In today's episode I speak amongst Mary Velasquez, Ph.D., Centennial Professor inwards Leadership for Community, Professional together with Corporate Excellence together with Director of the Health Behavior Research together with Training Institute at the University of Texas at Austin. Dr. Velasquez is a trainer for the Motivational Interviewing Network of Trainers together with has been involved inwards inquiry that informed the changes to Motivational Interviewing, Third Edition. In today's interview Mary talks nigh how she became involved amongst Motivational Interviewing, what has changed together with stayed the same inwards the revised version of Motivational Interviewing, DARN CATS, the iv alter processes, together with how people tin experience Motivational Interviewing inwards less than fifteen minutes.
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(from UT-Austin School of Social Work faculty page) Dr. Mary Marden Velasquez is the Centennial Professor inwards Leadership for Community, Professional together with Corporate Excellence together with Director of the Health Behavior Research together with Training Institute at the University of Texas at Austin. Dr. Velasquez holds a master’s score inwards clinical psychology together with a Ph.D. inwards behavioral sciences from the University of Texas Health Science Center-School of Public Health. Her computer program of inquiry focuses on the evolution together with implementation of interventions using the Transtheoretical Model together with Motivational Interviewing. With over xx years of back upwards from the National Institutes of Health together with the Centers for Disease Control together with Prevention, Dr. Velasquez has developed together with studied behavioral interventions inwards the areas of integrated primary care, screening together with brief interventions, fetal alcohol spectrum disorder, alcohol together with other drug abuse, prenatal health, HIV prevention, together with smoking cessation. H5N1 recent emphasis has been on education graduate students together with wellness professionals to usage brief motivational interventions inwards medical settings. She is the writer of books, mag articles together with majority chapters on using brief interventions to facilitate handling adherence together with promote conduct alter for a diversity of wellness problems. Dr. Velasquez is an internationally recognized trainer inwards both Motivational Interviewing together with the Transtheoretical Model, together with is a founding fellow member of the Steering Committee for the International Motivational Interviewing Network of Trainers.
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Transcript
Introduction
Jonathan Singer: Hey at that spot podcast listeners. Do I receive got a care for for y'all today! Mary Velasquez is hither to speak amongst us nigh what has changed together with what has stayed the same inwards Motivational Interviewing, Third Edition. Dr. Velasquez is an educator, researcher, clinician, trainer-of-trainers, together with the Centennial Professor inwards Leadership for Community, Professional together with Corporate Excellence together with Director of the Health Behavior Research together with Training Institute at the University of Texas at Austin. Oh yeah. That’s a lot of titles. But the coolest matter nigh Mary? Nah, you’ll receive got to hear to the podcast for that one. Oh man, that’s therefore incorrect to travel out y'all hanging similar that. I’ll simply say that nosotros start our conversation amongst a story that blew my mind.
After that nosotros start talking nigh changes to MI3. Mary points out that i of the biggest changes is that Miller & Rollnick receive got moved away from thinking nigh alter every bit happening inwards the 5 discrete stages described inwards Prochaska & DiClemente’s Stages of Change Model. In MI3, alter is conceptualized every bit occurring inwards iv overlapping processes: Engaging, Focusing, Evoking, together with Planning. These iv processes are therefore fundamental to the agency that Miller & Rollnick think nigh Motivational Interviewing that they’ve organized the majority around them.
Now, long-time users of Motivational Interviewing know that MI loves acroynyms. The most well-known is the acronym OARS, which stands for Open-ended questions, Affirming, Reflective listening, together with Summarizing. The OARS are iv of 5 core skills, together with the ones most closely aligned amongst the humanistic, person-centered side of Motivational Interviewing. The OARS are bully skills to usage if y'all wishing to follow your client. But, every bit Mary points out, Motivational Interviewing takes the stance of guiding clients, which is to a greater extent than directive than the next stance of person-centered therapy, but non every bit directive every bit other treatments. The fifth core skill, “informing together with advising” is consistent amongst the stance of guiding, which she talks nigh when she describes the “eliciting-providing-eliciting” sequence inwards the Focusing process.
MI3 has added 2 novel acronyms DARN together with CATS. Rather than reflecting malice towards our feline friends, they reverberate a refinement of the concept of Change Talk that was introduced inwards the 2d edition of MI. MI3 divides Change Talk into preperatory alter speak (p. 160) together with mobilizing alter speak (p. 161). Mary points out that this distinction is i of the most obvious research-informed changes to the model. DARN stands for Desire, Ability, Reason, together with Need. When y'all hear people using this linguistic communication y'all know they are preparing for change, but are non making the change.
In contrast, when y'all hear CATs language: Committment, Activation, together with Taking Steps, y'all know that people are mobilized for change.
Mary ends amongst an exercise that gives people a quick gustatory modality of Motivational Interviewing.
There is something really “meta” nigh the fact that Motivational Interviewing every bit a model is changing. Right? I uncovering some comfort inwards knowing that the people who receive got developed this agency of addressing ambivalence together with strengthening motivation to change, are themselves opened upwards to changing how they think nigh change. It would travel difficult to receive got much confidence inwards a model of alter that ever stayed the same. Ok. Enough pontificating. If you’re a longtime listener of the podcast you’ll know that I commonly enquire my guests for a listing of resources. I didn’t do that this fourth dimension because Motivational Interviewing, Third Edition is the best resources out there. Guilford Press has some costless resources that include includes a to a greater extent than comprehensive bibliography of Motivational Interviewing, 2 annotated instance examples, reflection questions for each chapter, the personal values carte sort, together with a glossary of Motivational Interviewing terms. The link is inwards the majority together with on the Social Work Podcast website. To acquire to a greater extent than nigh Mary Velasquez, uncovering links to related podcasts together with other resources, or read the transcript, delight travel to socialworkpocast.com. If y'all similar the podcast, delight consider leaving a positive review on iTunes. If y'all wishing to connect amongst thousands of other fans of the podcast, travel to our Facebook page at https://www.facebook.com/swpodcast. You tin follow the Social Work Podcast on Twitter at @socworkpodcast. If y'all similar to hear to the podcast on the go, consider using the Stitcher mobile app which allows y'all to flow the 10 latest episodes together with percentage them amongst your friends together with coworkers. Now, without farther ado, on to episode 84 of the Social Work Podcast, Motivational Interviewing, 3rd Edition: Interview amongst Mary Velasquez, Ph.D.
Interview
Jonathan Singer: Mary, cheers therefore much for beingness hither on the Social Work Podcast together with talking amongst us nigh motivational interviewing. My foremost query is, how did y'all acquire involved inwards motivational interviewing?Mary Velasquez: Well, it's a flake of an interesting together with variety of a roundabout story. When I was a immature mom, staying at dwelling amongst my kids, I was a smoker. Hate to acknowledge that these days, but I was. And I wasn't feeling good i day. Called my woman parent over together with asked her to aid me amongst the kids. And simply variety of i of those days where you're feeling goodness plenty to variety of travel knocking nigh the house, but non goodness plenty to travel doing your regular things. So I was looking at a newspaper, a lilliputian throw-away newspaper, together with constitute an promotion that said, "If you're a smoker together with y'all don't wishing to quit, telephone telephone this number." So just, truly simply for the heck of it I called the number together with agreed to participate inwards a inquiry study.
I stayed amongst that study. They followed me. I moved. The researchers kept calling me together with variety of hounding me. And my hubby would say, "Why are y'all doing this? Why are y'all staying amongst this study?" And I said, "You know, I'm non truly sure." But I liked the questions they're holler for me. There was never whatever variety of intervention or anything that I truly had to do. And I said, "But they pay me $8." And he said, "Well, I'll pay y'all $8 to quit this study, because you're spending a lot of fourth dimension on it."
Later on, I decided to travel dorsum together with complete my college degree. I would similar to travel to graduate school. And I remembered that the psychologist that had done this written report sent a lilliputian summary of the written report to the participants, together with I got it out together with at that spot was this matter nigh the stages of alter together with how people went nigh changing a behavior. It turned out the psychologist was Carlo DiClemente. And my professor said I truly should acquire to know him, together with maybe volunteer inwards his lab.
Jonathan Singer: So are y'all maxim that y'all were component of the classic smoking study, similar the i that the Stages of Change model was developed out of.
Mary Velasquez: Well, yes. I am. It was, yes, it was Carlo. It mightiness receive got fifty-fifty been his dissertation study. But it was Carlo DiClemente, together with he was working amongst Jim Prochaska, together with they had done, I think, some original work, but this was definitely i of the early on studies. So I got upwards my courage together with called this guy's office, together with offered to volunteer inwards his inquiry study, because I was really interested inwards going dorsum to school. And the inquiry assistant said, "Well, nosotros don't truly usage volunteers." And therefore a few minutes afterwards called back, together with this was dorsum before the days of institutional review boards, together with she said, "Dr. DiClemente wants to know if y'all were inwards i of his inquiry studies, because he recognized the name." I said, "Well, yes, inwards fact I was." And she said, "Yes, he'd honey for y'all to come upwards in." So I started working amongst him. He's simply an amazing colleague, researcher, simply a uncovering person.
And continued through my finishing school, my master's degree. Went on to run every bit a projection manager for him. And therefore at that spot was a large written report called Project Match that was an alcoholism handling matching study, i of the largest studies funded past times the National Institutes for Health, together with he asked me to travel the projection coordinator. So I worked amongst him on that. And correct around that fourth dimension he was working amongst Bill Miller, who was also a Project Match investigator, together with simply an amazing psychologist, truly doing some really goodness work. And I learned nigh motivational interviewing truly through those early on days of working amongst Bill together with Carlo. The transtheoretical model stages of change, together with the other constructs, processes of change, were beingness truly studied inwards a number of unlike settings.
And every bit nosotros thought nigh this pre-contemplation together with contemplation stage of alter together with how to motion people forward, it turned out that motivational interviewing looked similar simply the matter to do. And Bill worked amongst the other investigators to write what's called Motivational Enhancement Therapy, which is a therapy manual based on motivational interviewing. So I trained inwards i of the early, Bill started doing this motivational interviewing. It's forthwith called motivational interviewing network of trainers, but grooming inwards motivational interviewing, how to travel a trainer. And therefore I went to that, together with they, truly the Stages of Change Transtheoretical Model together with Motivational Interviewing are what Bill together with Carlo telephone telephone kissing cousins. They sort of grew upwards together.
So Bill together with Steve Rollnick were developing Motivational Interviewing truly correct around the time. They incorporated the stages of alter into their early on work. And it was simply a natural fit. So all of our research, I went on to...Carlo moved to the University of Maryland, together with nosotros continued to run together, together with therefore I continued to write grants, moved to medical schoolhouse every bit manager of inquiry inwards a theater unit of measurement medicine department. We continued to run together together with write grants, together with forthwith all of our grants incorporated motivational interviewing along amongst these stages of alter together with the relaxation of the transtheoretical model variables. And therefore stayed there, did inquiry there, together with therefore was recruited to the School of Social Work at the University of Texas at Austen. So that's variety of a...Told y'all it was a long story.
Jonathan Singer: What a bully story. You'd never think that a sore pharynx could Pb to something similar that.
Mary Velasquez: And I did quit smoking along the way. I did, simply because of all those questions they were holler for me, I think. And truly I think it, that's component of what inquiry does is raises people's awareness.
Jonathan Singer: So the tertiary edition of Motivational Interviewing has simply come upwards out. I sympathise there's some pretty large changes that are inwards the novel edition, including a novel Definition of what motivational interviewing is. Could y'all tell us how it's changed?
Mary Velasquez: Sure. I think that i of the things that has made motivational interviewing every bit pop every bit it is, is that Bill Miller together with Steve Rollnick receive got done an first-class task of keeping it alive, of growing along amongst their...As nosotros acquire to a greater extent than nigh motivational interviewing they revise the book. The do the inquiry that truly informs the field, together with therefore they accept the results of that inquiry together with apply it inwards novel ways. So motivational interviewing today may hold off different. Fundamentally it's non different. But at that spot were a lot of things that are evolving.
And therefore i of the things that is, I think, i of the biggest changes is that instead of having i laid definition, they truly sort of built these 3 definitions. One is sort of a lay person's definition, which I similar the best. But it's really, it's nigh conversations nigh change. So basically they're truly defining it every bit that. So the Definition that I similar is that motivational interviewing is the collaborative conversational vogue for strengthening a person's ain motivation for together with commitment to change. So basically it's a conversational style. So it's y'all together with I are having a conversation. And a lot of what we've learned nigh motivational interviewing of belatedly is that it has to do amongst language.
So every bit nosotros speak nigh change, together with every bit a truly skillful person, or a truly aware provider, colleague, physician, counselor, social worker talks nigh change, they're truly paying attending to the client's language, together with therefore it's a conversation. In motivational interviewing, they are looking at sort of a continuum. They speak nigh i agency of working amongst a soul is directing them. We tell people what to do, together with that's been really mutual inwards handling programs, especially inwards addictions. We tell people what to do, together with nosotros tell them how they should do it. So that's i style.
Another vogue at the other destination of the continuum is following. So nosotros simply variety of follow behind the person, letting them do whatever they want, travel where they wishing to go, together with nosotros follow. But inwards betwixt the directing vogue together with the next vogue is truly a vogue that's to a greater extent than nigh guiding. And y'all think nigh a goodness guide. Perhaps you're climbing Kilimanjaro. H5N1 guide is going to travel there, maybe offering advice, but non tell the soul what to do, really, but sort of travel at that spot simply to guide them together with to aid them. So a goodness motivational interviewing counselor, provider, is going to travel to a greater extent than of a guide. And therefore inwards motivational interviewing it's non necessarily a province of affairs where i person's the expert, together with the other soul is learning something. In fact, it's simply the opposite, because it's the customer that's the expert, or the soul who's the practiced nigh their ain life.
And I'm talking about, because this is the Social Work Podcast, I'm using the term customer together with counselor or social worker. But it truly is inwards all kinds, y'all know, these kinds of conversations hap every day, together with nosotros recognize inwards motivational interviewing that it's whatever conversation nigh change, really, where the soul is listening together with eliciting from the customer their ain ideas, maybe reflecting dorsum to them, helping them motion frontwards toward change. That's goodness motivational interviewing. And y'all don't receive got to travel necessarily a practitioner of some sort. You tin benefit motivational interviewing. It's a skill. It's non tardily to learn, necessarily, but it's learnable, together with lots of people do it inwards all kinds of professions, together with tin do it well. H5N1 goodness pastor ofttimes tin do motivational interviewing. Physicians usage it quite effectively. So I think that's the beauty of it, together with I think that's why it's acquire therefore pop together with therefore important.
Jonathan Singer: I think it's interesting y'all said that it's non easy. I think that i of the things that I've heard from students, or folks that don't know nigh motivational interviewing is, it doesn't hold off similar their doing anything. Right? I'm watching this person, together with it simply seems similar they're having a conversation, together with where's the therapy. Where is the actual technique?
Mary Velasquez: That's a goodness question, because it ofttimes looks similar a conversation, ofttimes looks effortless, when inwards fact, goodness motivational interviewing, there's a lot going on. The counselor, or the therapist, or the provider, is truly thinking on their feet, listing for the customer language. And they're listening from the person, i time again linguistic communication nigh change. The recent run inwards motivational interviewing over the past, maybe the past times decade, has identified what nosotros telephone telephone alter talk. H5N1 lot of the run past times Dr. Terry Moyers at the University of New Mexico, she's done a fabulous task of trying to figure out if motivational interviewing is therefore effective, together with it is. Researcher is showing it's a really effective style. What is it nigh motivational interviewing? What's happening inwards that session?
And allow me simply digress for simply a 2d here. There's some existent problems amongst the agency people typically "deliver" counseling. I think for many, many years, nosotros trained, I'll travel back, speak nigh social run students here. You know, nosotros develop people, together with nosotros tell them, "You know, when y'all travel in, here's how y'all open." My students say, "We know how to opened upwards a session. We know how to terminate. We're taught how to terminate a session. But what do y'all truly do when you're at that spot inwards the room amongst a client?" What Terry together with Bill together with Steve together with others did, was hold off at successful clients, together with they listened to therapy tapes of those sessions, together with truly tried to identity what was happening. They worked amongst a guy named Paul Amerhein, a psycholinguist, to sort of figure out what the customer was saying, together with what the therapist was maxim to the customer that truly helped the soul motion forward.
So they identified these iv areas of what nosotros telephone telephone alter talk. The foremost is the wishing to change. So the soul is thinking about, I truly wishing to do this. I wishing to change. The 2d is ability. I tin do this. How mightiness I travel nigh it? Because unless a soul truly feels similar they tin do it, they receive got the confidence they tin do it, they're non probable to change. The tertiary is reasons. What are the reasons for a soul to change? And therefore the demand for change. So they usage the acronym DARN. And therefore they speak nigh this alter talk, this alter language.
So that's what's happening inwards this session. H5N1 goodness motivational interviewing provider is listening for that alter talk. And they're also listening for what nosotros telephone telephone sustain talk, therefore if a soul is talking nigh the reasons for staying the same. So you're hearing ambivalence going on inwards that session. The person's talking nigh all the reasons, for example, that they shouldn't accept their medication, or all the reasons that they are going to travel on to smoke, or to drink. And therefore on the other hand, the desire, ability, reasons, together with demand for change. So every bit a skillful MI provider is listening to that, they laid out to reverberate the alter talk, non ignoring this sustain talk, but reflecting the alter talk. And every bit the person, every bit nosotros hear to a greater extent than together with to a greater extent than alter talk, nosotros also therefore laid out to hear some commitment linguistic communication from the client. So again, skillfully reflecting the alter talk, leading upwards to commitment language, together with that's truly to a greater extent than of, I'm going to change. I'm going to do this. I hope I'll do it. I volition do it.
So that's what's happening inwards that session. And the therapist, or the counselor is keeping track, truly tracking what the client's saying, using unlike levels of reflection, maybe really uncomplicated reflection. Maybe simply repeating what the client's saying, or changing the words slightly. And therefore to a greater extent than complex reflections, maybe some metaphors, truly continuing the conversation together with advancing, helping the soul motion toward change, but i time again using the client's ain ideas nigh change. So there's a lot going on inwards that session, together with a truly goodness together with truly skillful soul who's doing motivational interviewing is keeping upwards amongst all of that, together with resisting the urge, what nosotros telephone telephone the riding reflex, where nosotros ofttimes wishing to give advice. We all wishing to tell the soul what to do. We say, "Oh, I'm truly good trained. I know how to aid y'all do that." And therefore as, i time again going dorsum to the social run example, that's the matter when y'all say, ofttimes y'all hear people say, "What's truly going on there? It simply seems similar it's a conversation."
Our students, what I do inwards my score is, the foremost component of it is truly education them to listen, how to usage goodness nonverbal behaviors, how to non usage this riding reflex, together with to receive got the students acquire that they receive got to pose aside, oftentimes, their ain ideas nigh the client's change. H5N1 steep learning curve, sometimes, for us to undo those behaviors of wanting to create people.
Jonathan Singer: So what are some examples of linguistic communication that people mightiness usage to dot that they're inwards those unlike places?
Mary Velasquez: Well, if y'all think nigh what nosotros telephone telephone sustain talk, that's basically when a soul is staying sane. So "I receive got a lot of stress inwards my life, together with if I were to quit smoking, I would simply travel anxious all the time. I'm just, I'm non laid upwards to do that." So that's sustain talk. Identifying alter talk, nosotros usage that acronym DARN, together with y'all tin position it by, tin y'all hear someone say, "I know I could do this." Or " Actually I think I can. I receive got a argue to do this. I wishing to." So that's that alter talk. And the commitment linguistic communication is truly when someone says, "I volition do this. I hope to do this. I am going to do this. I'm certain that I'll do this." And therefore there's some other lilliputian slice that's simply variety of taking steps, therefore when the soul is truly therefore commencement accept action. So the acronym that's ofttimes used is DARN, together with therefore DARN CATS. And inwards motivational interviewing, nosotros usage a lot of acronyms to aid us recollect things. So the DARN slice is that alter talk, together with therefore the CAT slice the commitment, together with therefore the taking steps, or taking action.
Jonathan Singer: So this tertiary edition is coming out amongst some changes. Could y'all speak a lilliputian flake nigh motivational interviewing the agency that nosotros receive got thought nigh it, together with therefore simply contrast it.
Mary Velasquez: Sure. Yeah. I think i of the bigger changes is that inwards the foremost Motivational Interviewing, the foremost 2 editions, nosotros talked about, or nosotros read nigh stage i together with stage 2 of motivational interviewing. The instance I recollect that ever stuck amongst me is that Bill together with Steve talked nigh walking upwards a loma inwards snowshoes, together with therefore you're helping the customer truly develop motivation every bit y'all walk upwards that hill. And therefore they acquire to the travel past times together with they variety of ski downwards the other side, together with that component is easy. And inwards the latest edition, the tertiary edition of Motivational Interviewing, they're truly focusing non entirely on that edifice motivation, but what do y'all do when y'all acquire to the travel past times of that hill. How do y'all aid a customer conception farther change, together with how do y'all elicit from their ideas nigh change, but therefore truly aid them think nigh how to motion forward, together with how to accept action.
Jonathan Singer: And is that because providers were saying, "Okay, I'm truly pretty goodness at getting people upwards the hill, but therefore when they acquire at that spot I variety of lose them," or at that spot seem to travel things that don't work, or maybe it's non quite every bit tardily to ski downwards the loma every bit it seems. Is that why the changes happened?
Mary Velasquez: I think so. And I think that at that spot were also some studies, including some of our own, that are showing that using the motivational interviewing strategies that nosotros know to appointment tin travel really effective if you're helping a soul who's non laid upwards to change. And every bit they acquire closer to that change, if nosotros travel on to usage those same motivational interviewing strategies, y'all know, we're variety of looking at decisional residue together with truly continuing to speak nigh reasons for alter together with why they should alter together with helping them run into that, but they're ready, they're truly laid upwards to accept activeness together with nosotros don't focus on that, therefore nosotros tin stall them. So truly using other strategies, fifty-fifty some cognitive behavioral strategies, I think that has a lot to do amongst it.
Certainly inwards our ain work, we've seen, we've done some research, for example, on groups, grouping motivational interviewing inwards groups, which is some other interesting area. But inwards that work, people who came into the group, who were non laid upwards to change, did really good inwards a motivational interviewing group. But those people who came inwards who were already laid upwards to change, using the stages of alter linguistic communication that people inwards preparation perhaps, didn't do therefore good amongst motivational interviewing. And inwards fact, the people who were less ready, when nosotros looked at them a twelvemonth later, they had truly done improve using the motivational interviewing approach than those people who came inwards laid upwards to change.
So I think that's i of the things that Bill together with Steve truly receive got done a bully task of focusing on, how do y'all truly position where the soul is, together with therefore usage the strategies that are really appropriate for. They don't ever usage the linguistic communication of states of change, but using strategies that are appropriate to where that soul is on a continuum. You think nigh what they called a readiness ruler, on a scale of 0 to 10, how laid upwards is that soul to change, together with therefore truly tailoring to where they are.
Jonathan Singer: So it sounds similar maybe at that spot are non therefore many changes to the motivational interviewing concepts around working amongst people inwards pre-contemplation together with contemplation together with maybe preparation, but it's to a greater extent than the activeness together with maintenance that some of the changes are happening?
Mary Velasquez: Well, sort of. They're really, I think, refining their language. So they don't usage the stages of alter terminology inwards Mi3, but truly they explicate what they telephone telephone these processes. So at that spot are iv of them. And the foremost i is engaging, where you're truly developing the human relationship amongst the client, listening, helping the customer experience comfortable amongst you, developing that rapport, together with therefore truly calling that the foremost procedure inwards motivational interviewing, that engaging piece, paying a lot of attending to that.
And therefore the adjacent slice is the focusing part. How do y'all aid the customer position the actual conduct change? It could be, for someone who's diabetic, for example. They may travel smoking. They may travel eating unhealthfully. They may travel non exercising. But how do y'all aid them position the area, speak nigh the i they're most laid upwards to change, or maybe the i that is causing them the most problems. If you're a wellness aid provider, how do y'all focus. Oftentimes, that's where our students inwards social run acquire really lost. They follow the, they wishing to enquire the customer nigh their childhood, or they wishing to position their depression or anxiety. They acquire all...It's i of the biggest things that nosotros attempt to learn the students, when nosotros learn them motivational interviewing, is how do y'all focus that session, together with how do y'all focus it inwards a agency that's most helpful to the client. And it's nigh where the customer wants to go, but also an informed guiding process. So that's the 2d piece.
Jonathan Singer: So similar if somebody comes inwards together with they're diabetic, fifty-fifty though y'all mightiness travel truly interested inwards their childhood together with how they learned nigh nutrient together with their theater unit of measurement history, that that mightiness non necessarily travel focusing the conversation on a conduct that they would change. Is that right?
Mary Velasquez: Yeah. It's just right. And nosotros learn our students that typically y'all wishing to, every bit rapidly every bit y'all can, position a target behavior. And that doesn't hateful that that won't alter every bit y'all travel through the session. And some behaviors are to a greater extent than amenable to that, of course, inwards a wellness aid setting. And to a greater extent than together with to a greater extent than of our students are becoming integrated wellness conduct specialists. And inwards that case, the students, y'all truly wishing for them to identify, if they receive got xx minutes amongst someone, what conduct should they focus on.
So ofttimes I'll say, for example, I learn them to usage a strategy that Steve Rollnick explains inwards his Health Behavior Change book, where y'all pull several circles on a paper, together with y'all say, it's called agenda setting. "Mr. Smith, amongst your wellness issues, ofttimes times unlike behaviors tin Pb to beingness diabetic, tin contribute to diabetes. One mightiness travel smoking together with i mightiness travel exercise. One mightiness travel diet. Let's write them inwards these lilliputian circles. And therefore what else mightiness at that spot be. You tin run into that some of these circles are blank. How would y'all fill upwards this in? Now let's speak nigh these unlike behaviors. Which i of these mightiness travel most of import to you? Or which i of these would y'all similar to run on today?" Or, "As your counselor, it seems to me that this is an expanse that is causing the biggest concern. Would it travel all correct if nosotros focus on this today?" So there's real, there's an holler for permission. There's getting the client's concerns correct at that spot inwards front end of you, therefore that's the focusing piece.
Jonathan Singer: Okay. So the foremost i is this engaging. And therefore the adjacent i is the focusing. And that instance that y'all simply gave of the circles on the page. I hateful it seems really concrete together with collaborative together with similar a bully agency to laid an agenda amongst somebody who mightiness non travel coming upwards amongst it.
Mary Velasquez: That's right.
Jonathan Singer: And therefore y'all said there's a tertiary together with a quaternary thing?
Mary Velasquez: There are. The tertiary is truly to a greater extent than of an evoking or eliciting process. That's where the alter speak that I was talking nigh earlier, that's where that comes in. So we're eliciting the client's ain ideas nigh change. Oftentimes nosotros use, i instance is a strategy called elicit-provide-elicit. So y'all enquire the soul what they know. So, "Mr. Jones, what do y'all know?" Or Mr. Smith, I think it was, "What do y'all know nigh diabetes together with what contributes to diabetes." And therefore learning from the customer what they know nigh the behavior. And then, "Would it travel all right? I receive got a few other pieces of information. Would it travel okay if I speak amongst y'all nigh that?" And therefore coming dorsum at the end. So that's the render piece. And therefore coming dorsum at the destination together with holler for an opened upwards question. "What do y'all brand of that?" Or, "What mightiness y'all do now?"
So truly eliciting, providing data advice inwards a agency that the customer is truly component of the conversation. And therefore again, holler for an opened upwards query at the end. Always listening for alter talk. Always reflecting the alter speak when y'all hear it. So that agency the client, nosotros hear it several times. You enquire an opened upwards question. The client's response is ofttimes alter talk. The counselor reflects that alter talk. And therefore at the destination of the session, inwards goodness motivational interviewing, they usage summaries, together with therefore you're summarizing, picking, Bill talks nigh it almost every bit edifice a bouquet, putting together a bouquet, therefore picking flowers, those alter statements nigh alter are the flowers that sort of shape this bouquet, together with therefore a summary. And therefore the customer is hearing it i time again during that summary. So that's the eliciting piece. And that's a slice that truly takes a lot of skill.
And inwards these studies nigh language, i time again what they hear is that the to a greater extent than alter talk, the to a greater extent than ofttimes the customer makes statements nigh change, there's an increased probability that the soul volition truly change. It's the alter talk, but therefore also the commitment language. So it's the type of alter speak every bit well. They simply maintain talking nigh change, that's good. But if y'all tin aid a customer motion frontwards into that commitment linguistic communication piece, that's what's most predictive of long-term change.
Jonathan Singer: Yeah, I honey the visual of the bouquet, inwards damage of a summary, truly picking out those beautiful parts. That's nice.
Mary Velasquez: I did some grooming amongst some sheriffs from South Texas once, together with they weren't quite every bit enamored amongst the bouquet [laughing].
Jonathan Singer: That sort of picking out the best mag clip.
Mary Velasquez: I'm afraid so. And they were doing Motivational Interviewing together with learning it, together with truly doing it very, really well.
Jonathan Singer: That's interesting. So was that the fourth?
Mary Velasquez: No, that was the third?
Jonathan Singer: That was the third. Okay.
Mary Velasquez: And the quaternary is truly planning, therefore helping the soul think nigh what they'll do. "If y'all brand this change, when y'all brand this change, who tin aid y'all do it? How volition y'all know that it's working for you? What are some steps, really specific steps that y'all tin take? How tin y'all position those resources? Are at that spot people inwards your environment? Are at that spot programs?" So truly helping the soul travel really specific nigh what mightiness travel helpful to them.
Jonathan Singer: And therefore these iv processes, would they occur inwards a unmarried session, over multiple sessions? Is this something that, is at that spot a fourth dimension frame for it, or is it...I'll allow y'all reply the question.
Mary Velasquez: Yeah, that's a really goodness question. And it varies depending on the client. In some cases, the customer comes inwards truly sort of laid upwards for change. And rather than spending a lot of fourth dimension inwards the session building, it's truly helping the soul to plan. And I think ever that engagement slice sometimes, y'all ever wishing to do that. You ever wishing to develop the rapport amongst the client. You ever wishing to elicit their ain ideas nigh change. But some people are truly laid upwards to acquire downwards to the planning piece. So again, it depends on the client. If nosotros don't pay attending to where the customer is inwards the whole procedure of change, we're going to lose them pretty quickly. And a lot of times, the customer volition tell y'all you're doing a bully job, together with give cheers y'all really much, but they're non going to change.
And i of, I think, again, a forcefulness of motivational interviewing, is non entirely tin nosotros position together with hear together with hear these things happening inwards a session, but we're able to code them. So nosotros tin hear to a tape of a motivational interviewing session together with identify, what is a what nosotros telephone telephone MI-adherent behavior. You know, the therapist is beingness supportive, holler for permission. And non-adherent, therefore directing, telling the soul what to do. So nosotros truly score that. Open questions. Open questions are questions that can't travel answered amongst a yes or a no, together with truly lead, aid a soul to think nigh all aspects of change, every bit opposed to a unopen question. It's non ever bad to enquire a unopen question, but nosotros attempt to receive got many to a greater extent than opened upwards questions than closed.
So y'all tin tape that, the opened upwards to unopen query ratio. You tin banking concern complaint that during a session. You tin hear for alter talk. How much sustain speak did y'all hear where the soul wasn't going to change, together with therefore how much alter speak did y'all hear? So y'all tin tape all that. You tin rails it. You tin give feedback every bit a supervisor using what's called the Motivational Interviewing Treatment Integrity Coding System. I think that's the whole holler of it. They telephone telephone it the MITI. And therefore there's some other really goodness coding systems every bit well. But that is, it truly looks like, according to the research, that y'all tin tape that alter talk, together with therefore y'all tin truly predict how good a person's going to do.
Jonathan Singer: So y'all talked nigh DARN CATS. And y'all talked nigh these iv phases: engaging, focusing.
Mary Velasquez: Evoking.
Jonathan Singer: Evoking, together with therefore planning. And truly the agency that you're talking nigh it truly answers that foremost query that I had truly beautifully, which is, are they doing anything? I mean, clearly at that spot is therefore much to do together with therefore much to focus on, together with to do it inwards a agency that sounds similar variety of a natural conversation I could run into would travel really, truly require a lot of skill, a lot of training. Now i of the things we've talked nigh is wellness behaviors together with things similar that. Is at that spot a house for motivational interviewing where there's non a concrete objective behavior, or fifty-fifty wellness behavior. What nigh similar a social skill?
Mary Velasquez: That's i of the changes, again, inwards the Mi3 book. There's quite a flake written nigh when at that spot is non a specific conduct change, how y'all would travel nigh working inwards that situation. There's also a term that I truly like. It's called equipoise. How y'all every bit a counselor maintain a residue when y'all receive got an view nigh this client. So this kid, for example, y'all may receive got some thoughts nigh how this kid is behaving. What happens when it's a moral decision? So maybe this kid's parents, maybe y'all think this kid should travel taken out of the dwelling situation.
And every bit a social worker, I think y'all truly receive got to travel aware of, at that spot are cases inwards which at that spot is a favored outcome, together with an of import outcome, where y'all receive got an opinion. But inwards other cases, maybe non therefore much. Say a soul is going to get, thinking nigh an abortion. Right? So tin y'all maintain your equipoise inwards that situation? When is at that spot a fourth dimension that y'all may non wishing to usage motivational interviewing. Maybe it's inappropriate depending on your thoughts together with your feelings, together with truly simply knowing whether y'all tin travel inwards that province of affairs every bit a social worker, using motivational interviewing, but using it well, together with i time again keeping that what nosotros telephone telephone equipoise. There's a really prissy subdivision on that inwards the novel majority every bit well.
Jonathan Singer: So motivational interviewing has changed, it sounds like, inwards response to inquiry together with maybe therapists' feedback. I'm wondering. Are at that spot concepts that nosotros think of every bit beingness classic motivational interviewing that are maybe non emphasized therefore much anymore? They're ideas that are on the outs, or non emphasized? Because you've talked nigh some of the things that are beingness introduced, beingness emphasized.
Mary Velasquez: Yeah. Well, i expanse is the stages of change, for example. Early on I think people got variety of confused betwixt the stages of alter together with motivational interviewing. They sort of saw that every bit beingness the same thing. And inwards Mi3, there's much less of an emphasis on the stages, together with to a greater extent than of an emphasis on alter sort of beingness on a continuum. Another instance is decisional balance. We typically think of that every bit every motivational interviewing session should receive got looking at the pros together with looking at the cons. And inwards the novel conceptualization, there's truly less emphasis on the sustained talk, on looking at the pros of the electrical flow behavior. Certainly y'all wouldn't do away amongst that, but much to a greater extent than of an emphasis on looking at the alter every bit opposed to doing an equal decisional balance.
Jonathan Singer: And why is that?
Mary Velasquez: Well, I think at that spot has been, i time again they're doing a truly goodness task of relying on the research. And when I say "they," I hateful Bill together with Steve, the originators of the model. I hateful Terry Moyers, who has done, again, a lot of the research, together with all of us inwards the motivational interviewing network of trainers. Many of us receive got inquiry studies. We've published the findings, together with they truly paid attending to that. It's a changing. Your Mi3 is going to hold off somewhat unlike from the original Motivational Interviewing. Again, the spirit is really important, focusing on the client's autonomy, together with the collaborative aspect of it, the evoking piece. That's all nevertheless there. There's null that's truly gone from motivational interviewing, together with I wouldn't say anything's truly fifty-fifty on the outs. But it's developing.
I think some other matter that's been exciting is an emphasis on groups, motivational interviewing inwards groups. There's some novel work. Chris Wagner together with Karen Ingersoll lately published a majority on MI inwards groups, together with how do y'all accept these concepts together with do...Motivational interviewing tin travel tough amongst i person. Think nigh doing it amongst 8 or nine or 10. Linda Sebelle talks nigh it every bit conducting a symphony. Mark together with Linda Sebelle receive got done some tremendous run on combining motivational interviewing amongst cognitive behavioral therapy. They receive got a new, really prissy handling manual out. So a lot of those things receive got been developing. The original researchers, I think, receive got done a prissy task of paying attending to those things every bit they've come upwards along.
Jonathan Singer: It's exciting, because I know that i of the things that I speak nigh amongst my students, together with i of the things truly that Joe Walsh said inwards an interview amongst him on theories for clinical practice, is that students, they read nigh theories, clinical practise theories, together with they think, "This is how it is." And they don't think, "I could render feedback on whether or non this truly fits my client's situation. It should, according to the theorist, or the author. But when I apply it, it doesn't truly fit." And what you're maxim is that Miller together with Rollnick, together with the relaxation of y'all who were involved inwards this every bit researchers, truly are saying, "Yes, feedback is good. And if it's non working, let's alter it." Which I think is amazing.
Mary Velasquez: Yeah. One of my favorite lines from Carrie is, "You know, nosotros simply made this materials up." We are learning every bit nosotros go. On a personal note, I receive got to say, these folks are goodness people who hear together with wishing to aid people improve their lives. And they don't accept themselves every bit good seriously. Other people may accept them really seriously, together with they do bully work. But they're non afraid to say, "Oh, y'all know, good maybe our thinking nigh that needs to shift a lilliputian bit." Steve Rollnick oftentimes gets frustrated amongst us every bit specialists. Sometimes nosotros Americans wishing answers to everything pretty quickly. I think that it's evolving, together with that's the beauty of the motivational interviewing approach, is it continues to evolve, continues to grow, together with sometimes those ideas that nosotros thought were therefore clever inwards the commencement together with therefore correct on rails are moved aside inwards favor of novel ideas.
Jonathan Singer: So we've talked a lot nigh motivational interviewing, the changes inwards Mi3, a lot of the concepts. If at that spot was entirely similar fifteen minutes to give an instance of what motivational interviewing looks like, what would y'all say? What would y'all do?
Mary Velasquez: Well, Bill Miller uses an instance that I truly like. He calls it "taste of Mi." So he'll enquire a group, he'll enquire them to purpose play. And foremost he'll receive got them attempt to convince a soul to change, together with give them all the reasons that they demand to change. Of course, that's the non-motivational interviewing style. And therefore his gustatory modality of motivational interviewing, he simply has people enquire the next questions: Why would y'all wishing to brand this change? How mightiness y'all do this to succeed? What are your 3 best reasons for doing this? How of import is it to you? And forthwith what do y'all think you'll do? That gustatory modality of MI truly gives people a stark contrast betwixt that foremost approach, that is the convincing, telling, advising, together with therefore the 2d i that is motivational interviewing. There's much to a greater extent than to it than that, but clearly that gives, if y'all had 15-20 minutes, that's the matter I would do.
Jonathan Singer: That's great. Mary, give cheers y'all therefore much for taking the fourth dimension to speak amongst us nigh motivational interviewing, together with to percentage your deep, deep experience on this. Especially because, every bit of this recording, the tertiary edition of MI simply came out. So really, truly appreciate y'all doing this.
Mary Velasquez: Thanks, Jonathan. I truly enjoyed it. It was fun.
Jonathan Singer: Hey, it's me again. I know, you're waiting for the klezmer music. Just a duo of things, together with therefore I'll pose it dorsum on for you. So if you're a long-time listener of the podcast, you'll know that I commonly enquire my guests for a listing of resources. And you'll also notice that I didn't enquire Mary. Because, Motivational Interviewing, 3rd Edition, is the best resources out there. Now, Guilford Press has some costless resources that include a to a greater extent than comprehensive bibliography of Motivational Interviewing, 2 annotated instance examples, reflection questions for each chapter, the personal values carte sort, (I don't truly know what that is) together with a glossary of motivational interviewing terms. And the link to those costless resources is inwards the Motivational Interviewing book, together with it's also on the Social Work Podcast website.
Now if y'all wishing to acquire to a greater extent than nigh Mary, or to uncovering links to related podcasts together with other resources, or read the transcript, y'all tin travel to SocialWorkPodcast.com. If y'all similar the podcast, delight consider leaving a positive review on iTunes. The to a greater extent than positive reviews, the easier it is for folks to uncovering it. And if y'all wishing to connect amongst the thousands of other fans of the podcast, y'all tin travel to our Facebook page, at Facebook.com/swpodcast. You tin follow the Social Work Podcast on Twitter @socworkpodcast. And if y'all similar to hear to the podcast on the go, y'all could consider downloading the Stitcher mobile app, which allows y'all to flow the 10 latest episodes together with percentage them amongst your friends together with coworkers.
Okay. You've been truly patient. Here's your klezmer music.
[outro] I'm Jonathan Singer, together with cheers for beingness amongst me today for some other episode of the Social Work Podcast. If y'all missed an episode, or receive got suggestions for time to come episodes, delight see SocialWorkPodcast.com. If you'd similar to back upwards the podcast, delight see our online shop at CafePress.com/swpodcast. To all the social workers out there, maintain upwards the goodness work. We'll run into y'all adjacent fourth dimension at the Social Work Podcast.
Transcription service provided past times Rev.com
References together with Resources
- Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing, Third Edition: Helping People Change. New York, NY: Guilford Press.
- Motivational Interviewing (3rd Edition) Companion Website: Includes a to a greater extent than comprehensive bibliography of Motivational Interviewing, 2 annotated instance examples, reflection questions for each chapter, the personal values carte sort, together with a glossary of Motivational Interviewing terms.
- Singer, J. B. (Producer). (2009, Oct 10). Prochaska together with DiClemente's Stages of Change Model for Social Workers [Episode 53]. Social Work Podcast [Audio podcast]. Retrieved from /search?q=prochaska-and-diclementes-stages-of
- Singer, J. B. (Producer). (2007, Feb 12). Person-centered therapy [Episode 8]. Social Work Podcast [Audio podcast]. Retrieved from /search?q=prochaska-and-diclementes-stages-of
- Velasquez, M. M. (2001). Group handling for pith abuse: H5N1 stages-of-change therapy manual. New York: Guilford Press.
- Velasquez, M. M., Ingersoll, K. S., Sobell, M. B., Floyd, R. L., Sobell, L. C., & von Sternberg, K. (2010). H5N1 dual-focus motivational intervention to cut down the endangerment of alcohol-exposed pregnancy. Cognitive together with Behavioral Practice, 17(2), 203–212. doi: 10.1016/j.cbpra.2009.02.004
- Velasquez, M. M., von Sternberg, K., & Parrish, D. E. (2013). CHOICES: An integrated behavioral intervention to foreclose alcohol-exposed pregnancies amidst high-risk women inwards community settings. Social Work inwards Public Health, 28(3-4), 224–233. doi: 10.1080/19371918.2013.759011
APA (6th ed) citation for this podcast:
Singer, J. B. (Producer). (2013, September 11). #84 - Motivational Interviewing, 3rd Edition: Interview amongst Mary Velasquez, Ph.D. [Audio Podcast]. Social Work Podcast. Retrieved from /search?q=prochaska-and-diclementes-stages-of
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