Learning MI My Journey BMI CPN in

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-toback 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 elibrary: 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?