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Learning MI. My Journey. BMI. CPN in Alcohol Problems Service Complex needs: higher end of drinking Large caseload Busy, often seeing lots of clients back-to-back with little thinking time between sessions Little prior experience of MI Thought I was reasonable at my job
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Learning MI My Journey
BMI • CPN in Alcohol Problems Service • Complex needs: higher end of drinking • Large caseload • Busy, often seeing lots of clients back-to-back with little thinking time between sessions • Little prior experience of MI • Thought I was reasonable at my job • Managerial rather than clinical supervision
New Opportunity • Support to attend MI supervision group • Very experienced trainer • Monthly meeting with peers • Session revolving round tape analysis with transcription • “This is a great opportunity” • “I’ll really apply myself” • Bought the book
The Reality • Didn’t read the book • “Too busy” to do any work between the sessions • Numbers reduced, recordings often didn’t materialise • Sense of going through the motions for all of us: “ambivalent” • No-one really improved • High anxiety having to present work and have it considered by others
Cognitive Dissonance and Resolution of Ambivalence • Particularly awful session:no direction, no sense of purpose, embarrassing • I had a sense of myself as someone who took pride in their work and was committed to helping others • Here was concrete evidence that this was not the case • Something had to change
Making a Commitment • Read the book • Got the videos from the library and watched most of them • Read through the transcriptions • Started really thinking about what I was doing • Things were going to be different
The Edinburgh Interview • Client late and intoxicated • Not feeling great: dreadful hay fever • Client clear he did not want to stop drinking and wanted to drink himself to death • This client was simply not going to leave the room without me giving it my best shot at MI • Client’s life at stake • My self-respect and belief in myself as an effective helper
What Happened? • Hard work to listen and think with everything he was saying about the assault, his sense of hopelessness, his diversionary tactics • Determined to restrain myself, so many possible roads to go down • I had an incredible sense that something was shifting • Still had to work to stop myself being distracted by my excitement that he was becoming more open to considering change • Transcribed session………………………………..
No Going Back • A dramatic awakening of the power of MI • But also disappointment that I had wasted so much time • Being nice isn’t enough • A sense that I could be helpful if I went about it a different way • Interested in helping others see how they could be more effective
The Next Instalment • Terri Moyers MITI coding • Jeff’s idea about using it as a training resource • Discussion with Steve • Support to undergo MINT training • Exposure of my practice • Discombobulated!
AMI • Strangers think they know me • Delivering training mostly to clinicians in my workplace • Running coaching groups • Developing an e-learning module in partnership with NHS and NHS Education Scotland (NES) • The National Scottish MI Coach Group
National MI Coach Group • Supported by NHS Education Scotland early 2011 • Aims: - to support MI practice development across all the Scottish regions - to change culture and encourage service managers to buy into coaching model
Establishing the Coach Group • Initial selection process to assess level of experience with MI • Workshop offered by MINT trainers to support development of coaching skills to more experienced group • Less experienced group invited to attend workshop facilitated by the newly formed coaching group • Selection process to establish suitability to join coaching group
National MI Coach Group • Meeting every few months • Establishing local forums • Communication via shared space on NHS e-library: support/local developments/teething problems • Winter school to launch coach group: Steve Rollnick & Gillian Tober
Ongoing Issues • How to expand the number of coaches • How to increase the number of forums available • What part can the coach group play in establishing consistent standards for MI training and coaching across Scotland
NHS Lothian Coaching Forum • Trial and error (the usual issues) • Voluntary vs mandatory • Part of PDP (evidence of engagement/participation) • 2-day workshop then extended training over a year • Structured • Moving towards establishing coaching groups
NHS Lothian Coaching Forum • Competences outlined by NTA • MIA-STEP standards to guide practice development • THEME worksheets: self-rating of specific MI skills and strategies (taping) • Group discussion • Practice exercises • Relevant literature
What Have I Learned? • Clinicians are ambivalent about this kind of thing: just because they say they want this kind of supervision doesn’t mean they will actually engage/remain in the programme • Some people find exposure of their practice a terrifying experience: the higher up the food chain, the more you stand to lose
What Have I Learned? • We need to pay attention to and work with ambivalence to help clinicians become more comfortable about exposing what they do • Individuals who form a coaching/learning group need a lot of guidance and support before they can be helpful to each other • It takes a lot of work/patience/time to keep a coaching group going
Questions • How do we help clinicians resolve their ambivalence about on-going coaching? • How do we influence the culture within the workplace in order that on-going coaching is seen as a priority both at management and at clinician level? • Should this kind of thing be mandatory?