Why You Should Stop Trying to Convince Clients to Change, An Interview with Hillary Bolter, LCSW
An interview with Hillary Bolter, LCSW, on Motivational Interviewing. Curt and Katie chat with Hillary about what MI really is, what therapists often get wrong when supporting clients in making changes, and the importance of how therapists show up for this evidence-based model.
It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
Click here to scroll to the podcast transcript.Transcript
Interview with Hillary Bolter, MSW, LCSW, LCAS
Hillary is one of those folks that inherently thinks they have great ideas and solutions for people upon first encounter (Enneagram 1!). She’s ready to jump in and FIX! When she began her MI learning process, she realized just how essential MI was going to be for her energy, effectiveness, and longevity in the helping profession!
She has been a member of the Motivational Interviewing Network of Trainers (MINT) since 2011. She is a Licensed Clinical Social Worker & Addiction Therapist and absolutely delights in helping individuals, groups, and organizations learn the essential skills of Motivational Interviewing. She has worked as a helping professional for 20 years, ranging from working in wilderness therapy to community mental health, providing in home & school-based services, as a therapist with specialties including working with anxiety, trauma, addiction, and veterans.
In this episode we talk about motivational interviewing:
- Motivational Interviewing (MI) is simple but not easy
- The righting reflex – the tendency for therapists to try to persuade toward change
“When we are using motivational interviewing, we are staying out of that righting reflex… So rather than imparting that information about change, or persuasion to change, we’re evoking their motivation for change.” – Hillary Bolter, LCSW
- The differences between MI and the stages of change
- What does “using MI” really mean?
- The spirit of MI – the attitude we bring to our clients – empathy, collaboration, evocation, acceptance and compassion
- OARS skills: open-ended questions, affirmations, reflections, and summaries
“The OARS skills are essentially the micro skills of motivational interviewing. They are the how we get there. We get we guide conversation by asking more open ended questions than closed, by providing affirmations that highlight strengths and abilities and efforts that we see our clients making. We do a lot of reflections, reflective listening. And we provide summaries that help consolidate and guide the conversation.” -Hillary Bolter, LCSW
- Change talk – the more people talk about change, the more likely they are to change
- Focusing on why people would like to change
- When we focus on why TO change, clients may argue against change (voicing the ambivalence)
“When somebody’s truly ambivalent and we start to argue for change, their tendency is to argue against change.” — Hillary Bolter, LCSW⠀
- How therapists may want to navigate changes that feel urgent (unsafe behaviors, for example)
- Three styles of communication: following, guiding, directing
- The ways to move from directing or educating back into a more collaborative stance
- Why MI isn’t more widely used
- The ways that MI skills could intermingle with other theoretical orientation
- The idea around walking with your clients
- Looking at the myth that motivational interviewing is manipulative
- How to assess whether the change is in the client’s best interest
- The focusing process as a way to ensure client participation
- Motivational Interviewing is a communication technique
“Such a central piece of the spirit of MI [motivational interviewing]…is the compassion. The best interest of the client. Not the best interest of my wallet, or the best interest of my organization numbers, or the best interests of my spiritual beliefs, but the best interest of the client.” -Hillary Bolter, LCSW
- Distinguishing between the motivations that drive the change – focusing on the best interest of the client is the only one that really is MI
- The importance of experiential training for MI
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Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Hillary’s website: bolterconsulting.com
- Special offer: use “MTSG” for 10% off a foundations of MI course
Instagram: https://www.instagram.com/hillarybolter/
Motivational Interviewing Network of Trainers (MINT)
Relevant Episodes of MTSG Podcast:
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
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Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:15
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast about all things therapists and things that we do, things that we don’t do, the things that we try to do. And today we are… Katie’s looking at me like this is the meandering…
Katie Vernoy 0:37
What are you talking about?
Curt Widhalm 0:38
Sometimes I have really good intros to episodes. And sometimes this is where we sit. So…
Katie Vernoy 0:45
There we go.
Curt Widhalm 0:46
And maybe in the spirit of this episode, how ready are we for this to be our greatest episode ever? After the very phenomenal intro that we had. We’re here talking about motivational interviewing with one of our Therapy Reimagined 2021 speakers, Hillary Bolter, thank you so much for joining us today.
Hillary Bolter 1:09
Absolutely. And you’re modeling what it is that you’re supporting listeners in which is being your real self and being okay with that.
Katie Vernoy 1:20
We’ll take it, we’ll take that. Yes, that is exactly what we’re doing. So the first thing that we always ask our guests, who are you and what are you putting out into the world?
Hillary Bolter 1:31
My name is Hilary Bolter. I’m a licensed clinical social worker, and I’m a trainer in motivational interviewing. So essentially, I believe that I help cultivate effective helping professionals through motivational interviewing.
Curt Widhalm 1:45
So we were talking right before we started recording, and Hilary asked us, you know, what our experience with motivational interviewing is, and I’ll be honest, that I’ve done a number of courses on motivational interviewing and seen a lot of very thick books on motivational interviewing in both teaching, back when I was writing licensing test questions, and a lot of my reaction to this has just been, this just makes sense. Why is this so complex when this this could really be done in just a couple of pages. But…
Katie Vernoy 2:24
So, you are saying people are writing too much.
Curt Widhalm 2:26
I am saying that this is something where I, I think very naturally fall into a lot of the principles and aspects of this. And I don’t understand why it’s so complicated to so many other people all the time. But apparently, people make some mistakes in this. I probably do too. But what kinds of mistakes do you see people making with motivational interviewing? Or potentially what am I bypassing by not reading those very thick books that are things that can help our listeners, maybe not make those same mistakes?
Hillary Bolter 3:00
Right, and your experience is really similar? For many people, they will say, hey, this motivational interviewing stuff, it makes sense, it feels intuitive. There is like this level of recognizing the essence of MI, and how, yeah, we want to be doing that, or I am doing that, right. So there is that resonance that people feel. Motivational interviewing is simple, but not easy. So in that simple way, the essence is pretty simple. And I can describe it more and kind of define it for you. However, practitioners, we find it really hard to actually implement the full kind of gamut of what motivational interviewing has to offer us. Such as withholding that righting reflex that is really hard for people to do across the board. Are you all familiar with that term: righting reflex?
Katie Vernoy 3:54
No, I have no idea what you’re talking about. I had like a lunch, a lunch and learn on motivational interviewing. I was like this is amazing. I want to do this and subsequently did not do anything about that. So yeah, tell me everything. I want to know everything.
Hillary Bolter 4:07
Everything. I will give you the download. Yeah, absolutely. And Katie, your experiences very common as well that people along the way have been exposed to MI, like a lunch and learn or a day training, or it was mentioned in a class in graduate school. You know, MI has been around for nearly 40 years. And so it’s a buzzword we’ve all heard it. We know it’s evidence based and most people think they’re doing it or using it to some extent. And I think in order to know if we’re using it or not, we need to really know what it means and what what it means to be doing MI – air quotes doing MI, using MI. And I’ll go back and explain the righting reflex because I think that is one of the things that’s that’s hard for people to kind of pull back or rein in and the righting reflex as defined in MI is that tendency for helping professionals to persuade, or convince others who are ambivalent about change. So say we have a client who’s like, I know I should, but you know, they’re in that place of ambivalence about change. We have a tendency to want to kind of get on the side of change argument. Like, yeah, that’s a great change to make, I could totally see how that would be helpful for you, or have you thought about doing this to help you with that change. That’s the righting reflex at work. Where we have that instinctual response as helping professionals to help people change by helping convince them of the need to change. So that’s what that is. And when we are using motivational interviewing, we are staying out of that righting reflex, because we are falling back on this belief and the skill set that comes with it, of cultivating and evoking from the client. So rather than imparting that information about change, or persuasion to change, we’re evoking their motivation for change.
Curt Widhalm 5:59
And here, I thought you were gonna say that the mistake that most people make with motivational interviewing is just labeling anybody who’s resistance as being in the pre-contemplative stage.
Hillary Bolter 6:10
Yes, oh, the pre-contemplative comment trap. Yes, and you know, many people affiliate, associate the stages of change with motivational interviewing. They are are different. They, the fun fact, they were presented at the same addiction conference back in the early 1980s. So people often associate them together, and they go really well together. Because motivational interviewing is designed to help someone to resolve their ambivalence about change. So we’re working with people in that contemplative stage of change. ‘I should, but.’ You know, there’s that ambivalence, the strength on both sides of change. MI is really useful for folks in pre-contemplative as well, because it gives us gives us some tools to engage with them, and join with them, and explore what they are willing to change in that moment. So confusing the two is one of the common kind of mistakes, like of Oh, yeah, they’re the same, or you have to know one to use the other. They’re helpful to look at. I think of the stages of change is such a helpful assessment tool for us and looking at client readiness. And it can also help us inform when I’m using MI and when not to because MI is used to help people, you know, move along the stages, resolve that ambivalence; pre-contemplative, contemplative stages of change.
Katie Vernoy 7:29
So now, I’m realizing that I actually have learned less about MI, because I think in the two hour training, I think there was at least 45 minutes on the stages of change. So what does using MI really mean?
Hillary Bolter 7:45
Yes. What does it really mean? So I sometimes in my mind, I picture very visual in my mind, like a picture, the Maslow’s Hierarchy of Needs triangle, you know, we’ve got the base of the triangle. So I’m gonna, I’m gonna create a hierarchy of motivational interviewing triangle for us to conceptualize MI. At the base of the MI triangle is the spirit of MI, and the spirit of MI woooh, what is that?
Katie Vernoy 8:12
That sounds really fancy.
Hillary Bolter 8:14
I got the spirit. It’s the attitude that we bring to our clients. So there are four elements of spirit and motivational interviewing. And again, this attitude that we bring to our work, and that is empathy. That is collaboration. That’s like, hey, there’s two experts in the room. I have expertise as your provider, you have expertise in your life and wisdom, you know best what’s going to work or not work for you, right? So it’s this attitude, that together, we can put our expertise together and help support you in change, right? It’s not that I’m the expert, and you’re the patient right together. So collaborative attitude, evocation, which is I’m going to learn about my client from my client and pull out their motivations, their ideas, and those are in fact more important than my ideas for them. And we have acceptance and compassion, right, this compassion for our client. The Carl Rogers unconditional positive regard, people are doing the best they can. Unconditional. Yeah, positive beliefs. So that’s the base of the triangle, this spirit, this attitude that we bring. And I think that’s what many listeners and probably you all as well connect to. You’re like, yeah, I have that spirit. I hold that belief when I’m working with my clients in session. Right? So that’s the base of the triangle. How does that land for you all?
Katie Vernoy 9:41
Exactly. I’m like, Okay, I do that except what you already told me about the righting impulse. And I think I do that too. So more to learn still.
Hillary Bolter 9:49
Yes, right. So that spirit resonates and makes sense; the attitude that we bring to the clients. The next sort of notch into that triangle of motivational interviewing is the OARS skill. So O-A-R-S. Are you all familiar with those? You’re like, Yeah, I’ve heard of that.
Katie Vernoy 10:05
Nope, not even a little.
Hillary Bolter 10:09
Honesty. So the OARS are stands for open ended questions, affirmations, reflections, and summaries. And the OARS skills are essentially the micro skills of motivational interviewing. They are the how we get there. We get we guide conversation by asking more open ended questions than closed, by providing affirmations that highlight strengths and abilities and efforts that we see our clients making. We do a lot of reflections, reflective listening. And we provide summaries that help consolidate and guide the conversation. So many people will say, Oh, yeah, I do that stuff, too. I ask questions. And I affirm and I reflect and I summarize.
Hillary Bolter 10:53
Yes.
Curt Widhalm 10:53
Yep. Yep.
Katie Vernoy 10:55
We’re still with you. So except for knowing about this righting reflex, I am totally doing motivational interviewing.
Hillary Bolter 11:02
Yes. So the tip of the triangle?
Katie Vernoy 11:05
Yes.
Hillary Bolter 11:06
Is this change talk component?
Katie Vernoy 11:09
Okay, this is probably where I’m gonna go wrong here. What does this include?
Hillary Bolter 11:13
Yes. So the one of the things we know from change research is that the more people talk about change, the more likely they are to change. And so our task when we’re using motivational interviewing, is to guide the conversation in a way that is going to help our clients talk more about change: why they want to make that change, how they might want to make that change, what values do they have that are really guiding that change? What strengths do they have that they’re going to utilize when they’re making that change? And so this, this change talk component of MI, is this awareness of the need to pay attention to our clients change language, which is their ‘why change’ their motivation for change, versus their sustained talk language, which is like the ‘why not’ that’s the other side of ambivalence. So we pay attention to that change talk language. And we are doing some specific ways methods to cultivate and strengthen change talk over the course of an interview.
… 12:10
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Curt Widhalm 12:11
This seems to be the part that I think a lot of people can kind of over rely on certain kinds of questions here. I hear, you know, some clients totally not mine that are like, you’re asking too many scaling questions. You know, that you’re just making the ask, you know, number and number questions. And you talked about kind of the soft skills with that middle part of the pyramid here. This is where some of those really good clinical skills come out as in kind of this tip of the triangle in eliciting change talk.
Hillary Bolter 12:45
It is, and you named scaling questions. That’s one of the tools of MI. I had a participant in a training recently who was a physician’s assistant. And she, she said, Oh, you know, I’ve taken trainings in MI before, but it felt to tools focused, it felt like here use the scaling questions. And it felt like kind of forced to her, like she was supposed to use these particular techniques. And she took a much longer training with me; longer than the lunch and learn. And really, that’s when it all kind of came together; these pieces of the how do I practice this attitude and spirit? How do I use the OARS skills to selectively guide the conversation towards a specific change? And we integrate those those tools like scaling questions, as well as many other tools in a way that really helps our clients talk themselves into the change, instead of relying upon that kind of traditional advice giving, information giving, or righting reflex, persuading, kind of getting on the bandwagon of yeah, here’s why you should change. Which when somebody’s truly ambivalent, and we start to argue for change, their tendency is to argue against change. Yeah, and I’m imagining we can all sort of think about those clients that we work with, or who have worked with, who are like, I don’t know, I should, and we start saying, you know, sort of arguing and supporting the change side, they tend to say, but, but, but, but, and that’s the….
Katie Vernoy 14:13
Eliciting the reasons why they’re still ambivalent.
Hillary Bolter 14:17
Exactly, which strengthens that not change side. And so in motivational interviewing one of my cues to myself of like, oh, I need to remember to get back into my MI skills is when I’m arguing for change, and my client is arguing against it. That’s the exact opposite of where we’re going with MI, which is where we’re cultivating this conversation to support the client’s motivation and argument for change.
Katie Vernoy 14:38
I think the time when I am most likely to argue for change is when I see a really unhealthy behavior, whether it’s dangerous relationships, dangerous coping strategies, those types of things. How do you get to a place where you can kind of safely be in that space of helping them Make the decision and kind of talk themselves into change, while also not appearing to collude with really dangerous or unhealthy behaviors? Because as a professional, if I say, sure, you know, yeah, let’s let’s figure out, you know, how do you decide whether you’re going to cut or not? Let’s keep you cutting, like, you know, whatever it is, right? Like, it’s, it’s something where how do you hold both of those things, when trying to stay away from arguing for the healthy behavior? Because I, that’s where I struggle the most. Like, most of the time, I’m like, Oh, well, how do you make a decision? And what would make the difference there? And you know, those kinds of things. Whereas, when someone’s doing something that’s really dangerous it is so hard for me to, you know, not something that’s immediately life threatening, or thing I would need to report like, certainly not that, but like something that’s feels very dangerous if it doesn’t change within the next period of time, how do you what are your recommendations there?
Hillary Bolter 15:51
Right, when you feel some urgency on that, for that change? And you want that to happen soon? You know, this question is a good one. And it makes me pause to take a step back to consider the style of communication that we’re in at any given moment with a client, and how we learn to make some intentional choices around that. And so Stephen Rollnick, the co-creator of MI has identified three styles of communication. There’s the following style, there’s the guiding style, and there’s the directing style. And there are times as a clinician where we are choosing consciously to follow the client’s like what you know, in whatever they’re wanting to talk about, or we’re following them if they’re ambivalent about something like whether to have a second child or not, whether those things that clearly we’re not going to weigh in on that we’re going to follow.
Katie Vernoy 16:46
Yes.
Hillary Bolter 16:47
Then there are times when we are directive, and we make a conscious clinical choice to be more directive in that. Like, we have consent to get, you know, to get say this, we need consent for this, or this is information that I need to provide to you. That’s more directive. And then there’s times where we make a decision to be sort of in between the two of those which is guiding a guiding. And motivational interviewing is a guiding style of communication. And so in the cases of some more sort of scary or alarming behaviors, we may need to make a conscious clinical choice to move into a more directive style of communication. We may be able to stay in that guiding style of communication, join with our clients, clarify what that goal is, evoke from them what motivation they might have, why might they want to decrease or stop the cutting? How is what they’re doing problematic for them? Reflect that to them so they’re hearing themselves speak, you know, and hearing their wisdom, their inner wisdom that we’re drawing out. And, and then we may tool in motivational interviewing is called elicit-provide-elicit, that’s a little acronym, where we elicit first, then we provide and then we elicit again. So I may say in the case of talking with a client who is cutting, I mean, I may first ask some of those open ended questions like, what’s problematic about this for you? Tell me more about ideas you have that might help you to stop this or what you could do instead. And then I might move into the provide part of that acronym and provide some information or provide my concern. I’m concerned about this. There’s this resource that I would really love to give you to follow up with about that, for instance, but I don’t want to forget the other end of that acronym, which is elicit again, which is like, what do you think of that? How does that land for you? What might you want to do about that? So that when we’re providing information, we’re not assuming that it fits the client or that, you know, like, Oh, I just gave you the best piece of information, and assuming they’re gonna take it and run with it. But we’re gonna check back in and say, Yeah, what do you think? What do you make of it?
Curt Widhalm 16:49
We send questions over to our guests; here’s some things to prepare to talk about. One of the questions that we had sent over to Hillary was how has MI stayed relevant for so long? And I’m changing this question of why isn’t motivational interviewing, more widely used? It seems to be kind of a I don’t know, in the second tier of theories that gets taught to a lot of clinicians that’s kind of like, Oh, here’s this thing that works. Why isn’t this being more widely used in a lot of therapists education?
Hillary Bolter 19:36
And that is a wonderful question. I think that’s a question that the creators of MI continue to sort of ask and challenge graduate programs. Why is this not a standard? Why is this not taught as a semester course? Some do have it. I’ve taught it as a semester course for a college. Because it is so much about I mean, the research shows that the attitude that we as therapists bring to our clients impact outcomes. Our ability to demonstrate empathy, and to collaborate, and to be genuine, and to evoke and draw forth them really impacts outcomes. So why are we not teaching these skills that are embedded in learning motivational interviewing? I don’t know what the answer to that is because they are available for us to learn. I’m like, here’s the motivation learning platter. It’s like an awesome buffet to munch from.
Curt Widhalm 20:29
And it seems like it fits even within other theoretical orientations, too. Like, these seem to be some of those, you know, universal skills, you know. The unconditional positive regard, you know, is not just limited to humanistic type therapies. It’s, these seem to be skills that are used a lot. And, you know, my first experience with a lot of motivational interviewing was working with substance abuse, where I know that this is widely used in my practicum. I know that there’s a couple of things where MI is not necessarily the best thing you know schizophrenia, bipolar disorder, you know, there’s some of those things where people don’t recognize that they have problems. But this does seem to be such a core set of skills that I think just get bypassed in in getting taught.
Hillary Bolter 21:20
Right, and so that’s a piece of what kind of, we know, we go through school and we learn some skills, and then we hit the rubber meets the road. And we’re out there working with people, and we’re like, how do I become more effective working with the clients that I’m working with? And that was my personal and my story was, you know, I finished grad school, I feel like, literally, I’ve got all these tools in this like backpack on my back. I’ve got all these tools, I’m like, ready to help people, you know, woo hoo. And, and then I’m face to face with clients who say they want help, I have services that are going to help them but they’re not following through with those plans. And I felt such tremendous frustration, and even sometimes resentment, right? Like, what’s the problem here, but I didn’t have the tools, you know, graduate school didn’t teach me everything that I needed to know about how to be with clients. How to talk with clients. And at its essence, motivational interviewing is a conversation style. It’s not a modality, it’s not a skill set, there are skills within it, but it’s a way of talking with people. It is a way of being with people. And I took my first MI training, and which typically kind of a typical intro is usually like 10 to 12 hours of training, and that that first and MI training, I felt this physical shift of this burden of responsibility of me knowing the answers, and me having the tools, you know, in on my shoulders, to this recognition that my task is to walk with clients, and believe that they have the tools or can acquire the tools when they’re ready, and to draw those forth. And so it was this lightning of responsibility. This like, oh, I don’t have to know it all, I don’t have to be a hundred, so prepared with all of the ideas and motivations for and skills for people. I need to first join with and be and believe and draw forth, you know, using these OARS skills and some other specific things that kind of help people connect more deeply to their motivation for change.
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Katie Vernoy 23:30
I’m hearing a few things on this because I think being able to really walk with I really liked that image. When we’re looking at walking with I think there’s a an inherent trust that the client will get to what’s best for them. That they will come to, with appropriate guidance, support, whatever it is to the change that should, could, needs to; whatever the right phrase is, to be made, right. And there are a lot of things like our own bias, our own idea around what is health, what is right for people, all of those things that we bring to the table. And a million years ago, when I had that very short lunch and learn, it seemed like MI was a way to get people to believe that the change we want them to make is in their best interest. And, you know, it was like, Okay, this is how you frame it like tie the change you want them to make with another change that they want to make and figure out their motivation that will get them to do the change you want to make. Clearly it was not a great training because they didn’t tell me that the Stages of Change were not MI. But but it was interesting because it kind of it felt in some ways manipulative but the way you’re describing it feels not that. It feels like I’m here, I’m trusting my client, I’m walking with him and I’m using my clinical skills to help them to move towards where they want to go. But it for me there is that piece of the guiding type of conversation where you are leading them toward a change that you believe is in their best interest. So how do you hold that tension of not guiding them towards a change that may not be in their best interest? I mean, especially if they have different perspectives or different lived experience than you. Like, you may not know what their best interest is. So how do you hold that tension of health, and this is what society says is in your best interest, and the client, like how do you? How do you hold that?
Hillary Bolter 25:32
That is such a wonderful question, because you named the tension, that is one of the misconceptions of MI, which is that it’s manipulative, and it gets people to do what you want them to do. And that is not motivational interviewing. That’s, that’s sales, potentially. Right? Right. And when we look back at the spirit of motivational interviewing: this domain of compassion, which is that we are always working in the best interest of the client, is the foundational component. So it’s not about what I want them to do. It’s about what is in their best interest. And most of the time, we can agree with a client on what that is, you know, through some exploration. Like, okay, somebody who’s cutting wants to stop cutting. Somebody who’s misusing alcohol wants to get that under control, or stop, right. So I’ll name two pieces. One is this foundational piece of compassion helps keep the client’s best interests at the forefront. The second is motivational interviewing has four processes. So kind of like the stages of change, the four processes are linear, but also recursive, sometimes we have to revisit sort of the…
Katie Vernoy 26:44
Sure.
Hillary Bolter 26:45
…a previous process. And those four processes are engagement. So we first must engage and develop rapport with clients; connect. The second process is focusing. What is that target for change that that person wants to make? The third process is evoking Why do they want to make this change? What are their values? What are their strengths? What is building their why? And then that fourth process is planning. That’s the how, how do we get there? How do we help you get to this change? We are doing MI when we are staying in that spirit that we’ve talked about using the ORS skills, through engagement, through focusing, and through evoking. Those first three processes that’s doing MI. Now your question speaks to the second process, the focusing process. And that is, another kind of misconception of MI is, oh, we can use them all the time with anything or to get them to do what we want them to do. But the focusing process really clearly defines what is it that the client is willing to talk about or willing to consider change around? Are, we’re bringing our expertise in it, we’re evoking their expertise, and we’re helping to discern the direction of the conversation.
Katie Vernoy 27:58
It lands really well. I still think that there is the possibility and Curt will say, well, there’s always a possibility for bad therapy. But I think there’s still the possibility of someone has unchecked bias or unchecked stuff that they bring in, that that focusing process could be fairly manipulative. But I think true MI, good MI is let’s focus and really see where the client is, and meet them where they are, and, and bring our expertise in to that to help them provide that information that may or may not land with them but then pull back out and really rely on the client. I really like that. I think it’s just something where oftentimes I get caught in wanting to tell my clients what to do. And, you know.
Hillary Bolter 28:40
So, so much so right. And when we do let that righting reflex take over, or we give advice, or we’re just moving out of MI into other, our other styles of communication, which can come from a place of compassion and knowledge and all of those other good things. So it’s it’s not that it’s bad to not be doing MI it’s we’re just shifting, you know, this is a part of as we’re developing as clinicians that we have lots of tools in our tool belt. And and back to Curt’s question earlier, like why is am I kind of not everywhere? Why isn’t everybody not learning? That, that’s a great question, because it’s a great tool, really, for anyone to have not just therapists, but anyone who’s helping people with change. Anybody who’s working with clients who are struggling with ambivalence, that are wanting to change. And motivational interviewing, it started in addiction, but it has been so many fields now, I recently went to a trainer, where I listened to you know, participated in breakouts on MI in work with offenders, MI in education, MI in child welfare, MI in suicide prevention, MI in health coach. I mean it’s it’s….
Katie Vernoy 29:46
It’s everywhere just not as much with therapists.
Hillary Bolter 29:50
Why have what yeah, what’s what’s happening there?
Curt Widhalm 29:54
Well, even beyond the helping field some of the better uses and I love how you frame this as a communication technique. So the best application of this is salespeople that are, you know, kind of have that communication style of, you know, they know that the hard sell on things isn’t gonna work, but it’s being able to bring it in. And so they’re even people outside of our field who utilize it a lot better than us.
Hillary Bolter 30:25
Well said. Yeah, I remember I still this example sticks out from a training early on, I had some people who are former military and in a training, and several of them had worked in interrogations. And as I was going through these skills, you know, and helping to teach each of the OARS skills, they were like, Yeah, this is the stuff we learned and interrogations, and I was like, Oh, wow. And some people in sales will also speak to some of these techniques as like helpful to get people to kind of motivate to do something. And that’s again, where I fall back to that such a central piece of the spirit of MI, which is the compassion, the best interest of the client, not the best interest of my wallet, or the best interest of my organization numbers, or the best interests of my spiritual beliefs, but the best interest of the client.
Katie Vernoy 31:16
Client, that makes sense. So clearly, there is more to learn. Clinicians interested in learning MI look for in training? Or what are what are the trainings that you might recommend that people take?
Hillary Bolter 31:31
Definitely. Yeah. Well, the metaphor: learning to ride the bike is sometimes used in talking about MI. So we don’t teach people how to ride a bike by talking about it, and describing it and showing slides about how to ride a bike. We do it through experiential practice. You really can’t really get that concept of balance until you’re trying to balance. And so what I would look for in a training is experiential, an experiential component where you’re getting to practice the skills with others, getting feedback from a trainer in that in that process. And the motivationalinterviewing.org website lists all the trainings provided by MIN’s trainers, members of the motivational interviewing network of trainers.
Curt Widhalm 32:15
If people are interested in reaching out to you, where can people find you?
Hillary Bolter 32:21
My website is bolterconsulting.com. And I have I’m on Instagram, Hillary Bolter. And I also have a private Facebook group where I am really active in helping people in their MI learning journey. And I also created a code for your listeners for a foundation.
Katie Vernoy 32:40
Super cool.
Hillary Bolter 32:41
Yeah, for our Foundations of MI, course, a 10% off, so I will give that to you all.
Katie Vernoy 32:47
So we’ll put that in the show notes for folks that don’t always get to our show notes, how might they access that special offer?
Hillary Bolter 32:53
So Modern Therapist’s Survival Guide? MTSG that is the coupon code that we’re using
Katie Vernoy 32:59
MTSG is a coupon code. And where what’s the website where they can access that training?
Hillary Bolter 33:04
It’s bolterconsulting.com, B-O-L-T-E-R.
Katie Vernoy 33:09
All right. We’ll put that in the show notes.
Curt Widhalm 33:11
And you can find our show notes over at mtsgpodcast.com. And check out the Therapy Reimagined Conference and all of our latest updates on that. Things are changing as the world opens back up, and we’re part of that process. And so I’m not going to commit to what our changes are at this moment because the website’s easier to update then traveling back in time and changing published podcasts. So check out therapyreimaginedconference.com. And until next time, I’m Curt Widhalm with Katie Vernoy and Hillary Bolter.
… 33:45
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