Training Clinicians in Motivational Interviewing: One Size Does Not Fit All!

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January 18, 2016 by Nicholas Spence

one size fits allThe role of motivational interviewing in clinical practice for a variety of lifestyle changes is, without a doubt, well founded. Clinicians are the interface between evidence based treatments and clients. It is, therefore, critical to develop training protocols that are effective in arming clinicians with the skills and experiences required to optimize motivational interviewing. Common sense tells us that clinicians are a diverse group, possessing a wide variety of characteristics, which may play a major role in the design and effectiveness of motivational interviewing training interventions.

An article from 2012 that is still relevant today, by Carpenter and colleagues, appearing in the Journal of Consulting and Clinical Psychology entitled, ““Old Dogs” and New Skills: How Clinician Characteristics Relate to Motivational Interviewing Skills Before, During, and After Training” examined this issue.

Specifically, in a sample of 58, they sought to examine the relationship between addiction health care professional characteristics (education, occupation, and verbal-cognitive) and motivational interviewing counseling style (reflective listening skills and collaborative therapeutic stance promoting client’s autonomy and ideas about change), before (pre workshop), during (1 week post workshop), and after (8 & 20 weeks post workshop) a motivational interviewing training intervention.

There were two parts to the training intervention: a training workshop that took place over two full days that were one week apart, including a focus on the spirit of motivational interviewing, open questions, affirmations, reflections, and summary statements, using a combination of didactic instruction, experiential exercises and role playing; randomization to one of three post intervention supervision  programs, including live supervision via teleconferencing (TCS) using an ear phone during a simulated encounter, standard tape based supervision (Tape) during a simulated encounter, or workshop training alone. The Motivational Interviewing Treatment Integrity (MITI 2.0) was used to evaluate the skill of interviewers with clients at the three time points.

A number of interesting results were reported in the study. Three notable ones include the following:

  1. Prior counseling experience was associated with a stronger motivational interviewing spirit and greater reflective listening skills;
  2. Prior vocabulary skills were associated with a stronger motivational interviewing spirit and less confrontational counseling style;
  3. Clinicians without a graduate degree benefited most from supervision incorporating immediate feedback (TCS), while clinicians with a degree benefited most from feedback on previous sessions (Tape).

As we seek to translate the growing scientific body of evidence into clinical practice, it will be critical to ensure that we develop training protocols that are well suited to the variety of needs of clinicians given their different occupations, experiences, education/training, communication skills, and likely a variety of other salient factors. The take home message is that time spent focusing on pre-training, identifying the characteristics and skill sets of trainees, coupled with the use of appropriate training interventions, will lead to optimal results.  Indeed, a “one size fits all” approach to motivational interviewing training may greatly mitigate the power of motivational interviewing in clinical practice.

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