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Listening as an Art Form
Often in our workshops, we have avowed that motivational interviewing just as accurately might have been called motivational listening. Recently, we came across a superb and succinct video entitled The Art of Listening by author and inspirational speaker, Simon Sinek. Sinek probably is best know for his Ted Talk on Why. Some time ago, in an earlier blog, we addressed the concept of really listening and underscored the importance of learning to listen at 3 distinct levels of listening – all in service of being in full Motivational Interviewing service to our clients. In his impassioned plea for deeper listening – not just hearing and parroting words spoken by clients back to them verbatim – Sinek emphasizes listening as an art form, a skill that needs to be deliberately learned and honed. As he stresses, clients need to feel heard, to sense that we ‘get’ them, we are ‘over there’ with them in empathy. We will let Simon speak on the art of listening, inclusive of his perspective on building trust and “extreme listening”…
What is MI and how can it assist health care professionals
This is a very brief overview, in interview format re what constitutes Motivational Interviewing and how using MI can benefit health care professionals. It was done with Nelly Faghani, owner of Pelvic Health Solutions, 5 clinics in the Greater Toronto area whose employees are registered health care professionals who work in pelvic health. However, the basic principles of MI are the same for any health practitioner:
Advice
Advice, we heard recently, is criticism given in a cashmere sweater. And we give advice so casually in everyday conversation. The intent is admirable; seemingly, we want to help people who are struggling with a decision, an action, a goal or desire etc. Novelist Erica Jong opined, “advice is what we ask for when we already know the answer but wish we didn’t” and there is truth in her wisdom. In motivational interviewing, following its characterization as arranging conversations so that people talk themselves into change based on their own values and interests, it is so tempting to give unsolicited advice. As interviewers, it is particularly magnetic to give advice when we have been in or had experience with similar situations as our clients. In MI circles, we are taught to resist the righting reflex, that is, to be mindful of not providing solutions or trying to fix our clients’ situations. In some cases, clients actually might be seeking advice. How can we know if our clients truly want our advice? The simple answer is, ask them. In MI, when its architects, Miller and Rollnick conceived and taught the process, they promoted what has become a kind of bellwether acronym for learning, teaching, and doing MI – the OARS‘ signifier. If you boil MI down to its basic tactics, the result would be: asking Open-ended questions; Affirming (or Acknowledging); Reflecting back; and Summarizing ~ OARS. read more…
What’s important? What’s important!
Motivational interviewing is, by definition, arranging conversations so that people talk themselves into change based on their own values and beliefs. The key words in this MI description are “arranging conversations.” As interviewers, we arrange conversations by asking open-ended or powerful (full of impact) questions and then listening intently for what our interviewee says and how they speak (voice inflection, hand gestures, facial expressions etc). We propose that the most fundamental question we can ask in every interview is some variation of, “what’s important about _________ ?” where the blank is whatever the interviewee has identified as their focus. The question is the most basic, elegant, and power-full way to get at client values just because you are trying to get them to talk about importance = value. The beauty of the question, if genuinely asked, is that it can be repeated in a chain of questions that keep drilling down on your client’s values and beliefs. The following video provides a brief example of using repeated what’s important questions to determine values behind a desired behaviour change:
satisfied striving
Everything in life is constantly evolving, changing, transforming, moving toward something new. And we are tempted so often, lured to status quo or to the notion that success or even being content is a destination. In working with clients and patients regarding life-goals, it seems to be the case often that they (and maybe we) can live in a place of dissatisfied perfection. The illusion might be that we seek perfection as though it were some kind of destination and in western society we are literally taught that being the best, doing your/our best, getting to ‘the top’ etc are all pinnacle achievements. We would suggest that such goals lead all too oftern to dissatisfied perfection because, for most humans, perfection is impossible to achieve. Robert Waldinger speaks to this illusive and crippling quest for happiness-as-perfection/best in his Ted Talk on “What Makes a Good Life?” We invite you to listen to part of his talk on lessons from the longest study on happiness: read more…
What and how people practice
There is an adage that says, practice makes perfect. And that saying is both overstated and over-simplified. Renowned American football coach, Vince Lombardi refined this platitude to, “perfect practice makes perfect.” In terms of human behaviour and human beings in general, the truth is perfection is unattainable; more accurately, becoming complete with respect to some aspect of self would be a worthy goal or achievement for anyone. Consider the word ‘practice’ in terms of becoming complete. Practice carries all manner of connotations: rehearse, work at, execute, prepare, repeat, train, perform etc. In terms of human behaviour and behaviour change in particular, we practice all the time and the more we practice, the more ingrained our behaviour becomes. In motivational interviewing, desired changes have to be practiced in order to learn the new behaviour. And, as noted in another blog (the tipping point of change), the reality is, we and our clients are always at choice with respect to what and how we practice. Consider this enlightening video from a young boy, Prem Rawat: read more…
The Evidence Basket
Very likely, most health care professionals support the concept, observation, and use of evidence-based practice (EBP). Technically, EBP means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Ideally, it results in more consistent clinical recommendations and practices across health care services. Motivational Interviewing (MI) research and its resultant evidence across a spectrum of health-ameliorating issues, demonstrate MI’s viability as an EBP. As health care professionals, we get to decide what kind of evidence we think meets our threshold of EBP and that might differ somewhat across professions as well as our varying use of evidence in working with the needs of our individual clients or patients. At the same time, it is important to consider what ‘evidence’ our patients/clients bring to us. Years of experience and observation suggest that clients rely on their perceptions of evidence about their health behaviours and potential changes. There is an old adage, the best predictor of future behaviour is past behaviour or, more simply, the past is prologue. There is, in fact, very little real evidence to support this adage as a blanket proof of behaviour. Common sense suggests, in terms of behaviour change, most of us prefer our comfort zone (see our blog on comfort zone meanings and potential) or, ‘we love the beast we know.’ What is intriguing and very likely a great reminder to professionals is how clients perceive their evidence. We are what we believe, as one colleague has told us. Research protocols call this confirmation bias; in some ways, it is as though we go through life gathering ‘evidence’ to support what we believe, almost as though we carry an evidence basket under one arm: read more…
Listening, really listening
In a previous blog (click here), we have addressed the importance of empathy when adopting a Motivational Interviewing (MI) spirit or attitude. More and more we have become convinced that using MI is less about doing, and more about being. That is, MI has conventions, ways of being in an MI spirit – the confluence of being co-llaborative, com-passionate, engendering autonomy, and evoking internal motivations. That is, just as we take up or adopt an attitude of creating music from an instrument or a way of playing a sport, getting into MI is not about adopting or applying a skill set; instead, it is very much about being in an MI approach such that we are living into Miller and Rollnick’s concept of “arranging conversations so people talk themselves into change based on their own values and interests.” Evoking is at the heart of the MI process and the very word, ‘interviewing’ suggests the primary aspect of being in MI is asking questions to evoke change and we believe that is completely accurate. At the same time, to have evocative impact, all motivational interviewers must be adept at listening, really listening. The next ‘best’ question in an MI session comes from what the interviewee or client has just said and how they said what they said. One way to perceive listening as an art to be developed or honed is to think of listening on 3 levels. read more…
Self-Care: Awareness and Practice
There is an adage that suggests, “your life does not get better by chance…it gets better by change.” In the health-caring professions, practitioners are very likely drawn to their professions by their care for humanity and health. Often, that caring component might translate or grow into a practice of putting everyone, certainly our clients or patients, ahead of ourselves in terms of life priorities; that is to say, we become so invested in helping others to make changes to better their health that the investment erodes or side-steps our own care. We might make up that we don’t have time for our own care with a kind of self-righteous devotion to the seemingly greater goal of caring for others. What if self care were to be perceived as a necessity, rather than a luxury in the work that we do? Self-care is not selfish or self-indulgent…it is more about self preservation so that we can continue to care for our clients and patients in the most optimal fashion we can. Consider the larger implications of the familiar safety instructions from flight attendants during pre-flight communications with passengers: ” If there is a loss of cabin pressure, the panels above your seat will open, and oxygen masks will drop down. If this happens, place the mask over your nose and mouth, and adjust it as necessary. Be sure to adjust your own mask before helping others.” read more…
Michelangelo, magnificence, and the attitude of being ‘in’ Motivational Interviewing
In one School of professional coaching training, the Coaches Training Institute, one of the cornerstones of their co-active model of coaching is cogently phrased; the model holds that every person or client or person being coached/interviewed is Naturally Creative, Resourceful, and Whole (NCRW). To engage in coaching communication is to take up this NCRW attitude with every client. In essence, the expression means that behaviourally, nothing about the clent is broken or in need of fixing; instead, the client is whole, a remarkable entity of humanity. Each person inherently or naturally has her or his own level of creativity and resourcefulness. Thus, each person is held to be NCRW from the moment we meet the person and throughout all our interactions with him or her.It is a very different way of being in communication because it puts so much trust and belief on our clients’ potential for change. Miller and Rollnick refer to this same attitude as the Michelangelo Belief and they phrase the belief as this, “the capacity and potential for change and adherence is within every patient.” read more…