Training Motivational Interviewing

Summary

Workshops are one part of the broader process of how people learn Motivational Interviewing (MI). While not enough on their own, they offer an opportunity for people to learn about the principles, practice skills and gain understanding of what the approach looks like in real conversations. It is important that the facilitator is skilled in using MI as both a practitioner and trainer, is up to date on current thinking, and can both demonstrate the skills in practice and model the spirit and skills throughout the workshop.

Structure and content of MI training

The goals, content, and duration of training will vary depending on the needs of the organization or individual practitioner. Research shows that two-day workshops can produce small but statistically significant learning effects. However, skills deteriorate without opportunities for continued learning. Workshop training should be considered the beginning – not the end – of learning MI. It is important to communicate the purpose and limitations of training to an organization’s leadership during the contracting phase as well as to practitioners at the start of training.

• Introduction: Typically one hour to one day in duration, the goal is to introduce MI so that an informed decision can be made as to whether to learn more. At this level, participants learn about MI (e.g. key concepts) and gain some practical understanding (e.g. give less advice, use more reflections) but skill development will be limited.

• Foundation: The minimum recommended duration of MI foundational training is two days and covers the principles, spirit, processes and core skills. Content includes underlying rationale, an overview of the evidence base, and opportunities to practice core skills and start to apply them (e.g. responding to sustain talk & discord, evoking change talk).
• Intermediate: This level aims to develop core skills to build competence in MI and deepen understanding of how the core skills are applied within each process of Engaging, Focusing, Evoking, and Planning.
• Advanced: The goal at this level of training is to help practitioners deepen knowledge and advance skillful practice in an effort to work toward fidelity and integration into routine practice. Application of MI is considered to specific populations, settings, and clinical areas. Demonstration and case consultation will likely be featured, as well as observation of practice and individualized feedback.
• Supervisor or coach training: The goal is to build organizational capacity through staff learning how to support others to learn MI. These staff could include clinical supervisors, peer mentors, or others whose role is to facilitate ongoing learning. The training content may include learning about observation methods, assessment of practice, supportive feedback, facilitating skill and learning activities, and designing a practice improvement process with monitoring for outcomes.

Although design will relate to the goals, format, and duration of training, there are some general guidelines to consider:

• Reflect current understanding of MI: As MI has evolved over time, it is important to present the most up-to-date version and for trainers to commit to ongoing MI education.
• Create an inclusive learning environment: Prioritize engagement, then draw out and build upon practitioner needs, knowledge and experience throughout the workshop.
• Set realistic learning goals: Be selective in what is taught based on relevance for the group and achievable outcomes.
• Keep the content simple and accessible: Although MI represents a complex evidence-based practice, less is more.
• Use multiple methods: Incorporate experiential and active learning methods such as video demonstrations, small and large group discussion, small and large group practice activities, demonstration with observer tracking, and written exercises.
• Use “real plays”: Invite participants to use simple but personal change examples in practice activities. Real plays create more meaningful change conversations and an experience of MI compared to contrived role plays. However, brief role plays may be useful for demonstration or case consultation to help training participants consider application of MI into specific situations.
• Use observers: For practice activities, it can be useful to incorporate an observer role where they have a structure or format for noting observations.
• Reflect the parallel change process: Connect practitioners’ reactions to learning MI with the change process clients experience.

Facilitation of MI training

How training is delivered is just as important as the content of training. MI can be used by trainers as a style of communication to both model the approach and facilitate learning. For example:

• Draw out practitioner’s ideas: Encourage sharing by asking open questions versus closed questions.
• Refrain from the expert trap: Although a trainer should have expertise in MI, pose questions to the group to draw out what practitioners may already know.
• Allow time: When posing questions or setting exercises, give practitioners time to process the content and respond.
• Listen carefully: Reflect participants’ contributions to reinforce learning.
• Affirm: Look for practitioner strengths and effort.
• Summarize: Consolidate learning with occasional summaries of the content and learning.
• Support practitioner autonomy: Acknowledge the right to decide to learn MI (or not).
• Normalize ambivalence for learning and change: Express empathy for practitioners when they express discomfort, disagreement, anxiety, or being overwhelmed by new ways of working.
• Be ready to roll with practitioner push back: Resist the “righting reflex” and the urge to tell practitioners they must or have to do something. Instead, model MI, listen carefully, come alongside, and respect autonomy.
• Be prepared to demonstrate: While planned demonstrations are helpful, brief demonstrations can also be used to illustrate points so that participants can “see and feel” how something might work in practice.

Other facilitation skills:

• Set up a real play or role play for a successful demonstration.
• Provide instructions for activities that clearly define roles, sequences, and specific activities.
• Debrief activities to allow learning to be processed and shared with others – listen carefully to practitioner experience and reflect to reinforce learning.  
• In debriefing, attend to feedback on the exercise and learning process to keep improving the training.
• Be organized with clear objectives, professional training materials and time management.

Trainer development

Learning and developing as a trainer – similarly to learning MI – is an ongoing process. It is essential that trainers commit to continued self-reflection and openness to learn from feedback, observation and mentoring. Equally trainers need to be comfortable with the limits of their expertise and be willing to refer to other professionals as needed. These are suggested guidelines for trainers to consider, in order to develop the depth and range of their skills in teaching MI to others:

• Beginning trainer: This level builds a solid foundation where the trainer aims to:
  • Develop a contemporary understanding of MI and the evidence base.
  • Develop fluency in MI as both a practitioner and training facilitator.
  • Build confidence and skills in providing demonstration during training.
  • Identify, access, and use existing MI training resources to support the design and delivery of experiential learning.
  • Seek guidance, support, or mentoring and respond to feedback from participant evaluations. 
• Intermediate trainer: This level builds an advanced understanding of the theory, research, and elements of practice, and competence in using MI in demonstrations, practice examples and facilitation of the training. The trainer aims to:
  • Seek improvement through a process of being observed and assessed for trainer effectiveness with performance-based feedback.
  • Seek out opportunities and resources to improve design and delivery of training.
  • Consider results from participant evaluations and research into the delivery of MI training.
  • Have a trainer development plan.
• Advanced trainer: This level builds advanced understanding of the research on adult learning, training outcome, and learning in MI across multiple systems and methods. The trainer aims to:
  • Be able to code for fidelity and coach skill development in individuals and small groups.
  • Train supervisors and coaches to help practitioners learn MI.
  • Train MI in specialist applications and integration with other approaches or clinical tasks.
  • Develop expertise in change management and implementation science.
  • Increase skills in providing consultation on how to implement MI with leadership of organizations.

The Motivational Interviewing Network of Trainers (MINT) is an international non-profit organization of trainers in motivational interviewing representing many languages. MINT aims to promote good practice in the use, research, and training of motivational interviewing. MINT supports the continuing learning and skillfulness of its members through meetings, open sharing of resources, communication, publications, and shared practice opportunities. Membership follows a successful application and completion of a Training New Trainers (TNT) workshop. For more information, see Pathways to MINT (MINT, 2015).

Further questions

• What might help to incorporate more of these ideas into your training?
• Who could offer feedback or mentoring?
• How will you continue to develop your MI skills and training facilitation?

References and Resources

• Berg-Smith, S. M. (2014). The art of teaching motivational interviewing. Access from http://berg-smithtraining.com/ebook.htm
• Madson, M. B., Lane, C., & Noble, J. J. (2012). Delivering quality motivational interviewing training. Motivational Interviewing: Training, Research, Implementation, Practice, 1(1).
• Madson, M. B., Loignon, A. C., & Lane, C. (2009). Training in motivational interviewing: A systematic review. Journal of Substance Abuse Treatment, 36(1), 101-109.
• Miller, W. R., Moyers, T. B., & Rollnick, S. (2013). Motivational interviewing: Helping people change [Training DVD]. Carson City, NV: The Change Companies.
• MINT (Motivational Interviewing Network of Trainers). (2014). Motivational interviewing training new trainers manual. Access from http://www.motivationalinterviewing.org/ sites/default/files/tnt_manual_2014_d10_20150205.pdf
• MINT (Motivational Interviewing Network of Trainers). (2015). Pathways to MINT [Version 1.3]. Access from http://www.motivationalinterviewing.org/pathways-membership
• Schumacher, J. A., Coffey, S. F., Walitzer, K. S., Burke, R. S., Williams, D. C., Norquist, G., & Elkin, T. D. (2012). Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers. Motivational Interviewing : Training, Research, Implementation, Practice, 1(1), 7-15.
• Smith, D., Hohman, M., Wahab, S., & Manthey, T. (2017). Student-perceived quality of motivational interviewing training: A factor-analytic study. Journal of the Society for Social Work and Research, 8(1), 1-18.