Fundamentals of MI book cover“What do I do when my client does…?”

“Can I do MI with patients who…?”

“How can MI help me with my most difficult cases?”

Pragmatic questions like these are what motivates most clinicians to seek training in Motivational Interviewing, and they form the heart of the new text Fundamentals of Motivational Interviewing.  After a thorough – yet highly readable – overview of the most current formulation of MI, the authors structure the main part of the book in terms of common clinical challenges.  They provide numerous case examples illustrating MI-consistent responses to clients who, for example, frequently fail to show up for treatment, make slow progress, or suffer from a range of psychiatric symptoms.  They also provide tips for doing MI with more than one person in the room, and for using MI strategies to help patients with whom you have a difficult working relationship more broadly.  This book would make an excellent companion or follow-up text to accompany a skill-building workshop.

Learn more about Fundamentals of Motivational Interviewing by Julie A. Schumacher and Michael B. Madson at Amazon.com

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    Writing my last post had me interested in finding out more about Motivational Interviewing in dentistry. Here are some resources.

    From the journal Evidence-Based Dentistry, a summary of 2 recent reviews covering a total of 26 randomized clinical trials. The authors note that the evidence for MI in promoting oral health behavior change is inconclusive, but that “three studies showed consistent positive effects of MI on clinical and behavioural outcomes and were the only three to be rated as good quality by both review papers.”

    A demonstration of MI for smoking cessation in the dental setting, produced by the University of Florida Department of Psychiatry
    And an accompanying “how not to do it” video.

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      To the best of my knowledge this is the first book on Motivational Interviewing in dentistry geared toward an audience of practicing dental professionals rather than an academic text. The author is a dentist and long-time proponent of a Rogerian person-centered approach to the relationship in dentistry. He sees Motivational Interviewing’s structure and emphasis on guiding as a way of making the person-centered or patient-centered approach more accessible to dental professionals.

      Contents are broken into six main parts.  The first outlines the history and philosophical assumptions and beliefs of the person-centered approach in dentistry, makes a case for the use of MI, identifies barriers to effective conversations about change, and outlines the processes of MI.  Each of the next four parts focus on the four processes of MI in order: Engaging, Focusing, Evoking, and Planning.  The sixth part describes Motivational Interviewing in everyday dental practice.  Finally, several appendices provide supplemental information and resources.

      I have only previewed the contents and first chapter of the book so I cannot vouch for how successfully the author brings MI concepts and skills to life or the extent to which he addresses the specific needs of dental team members.  I will update this review when I have more information; in the meantime, if you are familiar with this book, please let me know what you think.

      Learn more about Motivational Interviewing in Dentistry: Helping People Become Healthier by Lynn D. Carlisle at Amazon.com

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        Motivational Interviewing DVD coverThis 2-DVD set or streaming video package provides new information and demonstrations of Motivational Interviewing based on the 3rd edition of the Miller and Rollnick text.

        Part I includes 2 hours of discussion among Bill Miller, Steve Rollnick, and Terri Moyers outlining and clarifying key concepts and clinical nuances of the updated MI model.  The conversation – which truly complements the book – is broken into four sections, each of which has briefer sub-sections.  The contents of Part I include:

        1. What is Motivational Interviewing?
        2. How does Motivational Interviewing work?
        3. Clinical challenges in applying Motivational Interviewing
        4. Challenges in applying Motivational Interviewing

        Part II includes 4 hours of demonstration interviews by Bill Miller, Steve Rollnick, Terri Moyers, and Carolina Yahne.  All of the examples are unscripted roleplays with actors portraying clients/patients.  The 14 interviews include 6 new demonstrations of MI in a variety of contexts and levels of clinical complexity; 2 examples that contrast MI-consistent and inconsistent styles with the same client; 2 examples demonstrating common pitfalls in health behavior change consultations (overuse of directing and following); 2 of Miller’s previously unreleased original demonstrations of MI dating to 1989; and 2 of the “greatest hits” of the 1998 training video series (“Quiet Man” and “Rounder”).  Several of the case examples include debriefing interviews so we hear the client/patient perspective on the process.  The package also includes annotated transcripts.

        Motivational Interviewing: Helping People Change 2 DVD set or streaming video (2013) from the Change Companies

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          This is one of my new favorite videos.  The first vignette in particular demonstrates the four processes of Motivational Interviewing outlined in the third edition of the Miller and Rollnick text – Engaging, Focusing, Evoking, and Planning – as they unfold over the course of about 15 minutes in realistic, unscripted roleplay.

          UC Davis: Motivational Interviewing in Child Welfare Services video - free, online

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            Influence: Science and Practice book cover
            Why am I featuring what has become a classic sales text among my Motivational Interviewing resources?  Most of the time when practicing MI, we have what Steve Rollnick refers to as ABC’s – aspirations for behavior change – for the patient/client.  In other words, we are attempting to influence our interviewee.  Or, in the case of MI in equipoise, we are aware that the potential for influence exists, and we are making deliberate efforts not to exercise that influence.  In fact, the ethical practice of MI includes determining whether it is appropriate to exercise influence toward the other person in that particular context or relationship.


            Once we start thinking about MI in terms of influencing another person, I think it is both generally informative as well as helpful for ethical practice to be aware of the principles relevant to what the author, psychologist Robert B. Cialdini, refers to as “compliance.”  Some of them, such as commitment and consistency, social proof, and the sort of psychological reactance associated with perceived scarcity, will be familiar to MI practitioners.  This highly readable book includes numerous examples from everyday life as well as strategies to protect yourself against each of the strategies presented.  I enjoyed reading it together with Thinking, Fast and Slow by Daniel Kahnemanto get a review and update on the cognitive psychological underpinnings of the principles outlined in Influence.

            Learn more about Influence: Science and Practice (5th Edition) by Robert B. Cialdini at Amazon.com.

            Learn more about Thinking, Fast and Slow by Daniel Kahneman at Amazon.com

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              The challenge that lay ahead of us was to help each other adjust the angles of our respective lenses so that our visions could come into common focus. Otherwise, we’d slip into futile haranguing.

              I don’t know if this physician has ever learned MI, but she clearly practices in the spirit of MI.  A great example of what it looks like in the real world – asking, listening, informing, negotiating *with* the patient toward better health.

              Doctor Priorities vs. Patient Priorities – NYTimes.com.

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                This workbook is designed to help the beginning MI practitioner learn MI skills step-by-step, aided by clear explanations of key concepts, ample case examples, and worksheets for use in sessions with service users. Published in 2008, the Toolkit is based on the first 2 editions of the Miller and Rollnick MI text, but the content remains quite relevant to the practitioner. The authors, who have extensive experience in corrections and who wrote the first edition of the Toolkit for the UK Probation Service, also add some additional material borne out of real-world experience. For example, the authors add to the familiar 4 principles of MI a fifth principle of “Clarify Contracts” – a skill especially relevant to doing MI in settings where the service user, referral source, and agency providing the service may not share the same agenda and priorities.

                Relative to Rosengren’s Building Motivational Interviewing Skills, A Toolkit of Motivational Skills provides somewhat simpler explanations, more basic instruction in the basic counseling skills underlying MI, and more practical tools (as suggested by the title) for structuring behavior change discussions. It may be of particular interest to those who have not had prior training in counseling skills or who work outside of what are typically considered “counseling” settings.

                Learn more about A Toolkit of Motivational Skills at Amazon.com

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                  “…choosing to endure rather than desist is a choice that must be effortfully sustained over time…”

                  Traditionally, Motivational Interviewing has focused on helping people prepare for and commit to behavior change as if it were a one-time event, but anyone who has ever made a New Year’s resolution knows that’s not the case! Research on the personality trait of perseverance, or “grit,” gives insight into the kinds of motivational and volitional processes we need to evoke in order to help our clients commit to lasting change. It also provides some insight on when it might be appropriate to switch or hand-off from MI to action- and maintenance-stage approaches.

                  Big Questions Online: Can Perseverance Be Taught?

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                    …So I have come to believe that the right answer to the question, “If this were your mother, doctor…” is: “Tell me more about your mother.”

                    No mention, or probably even thought, of MI – just a beautiful example of a health care conversation in the spirit of compassion, acceptance, collaboration and evocation. Maybe a model of MI in equipoise?

                    Well: “If this were your mother, Doctor…”

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