Nowadays, more and more attention is paid to the importance of assessing MI therapist/ counselor fidelity. Various instruments have been developed to assess MI fidelity, including the MITI, MISC and BECCI. In addition, Madson et al., have developed the CEMI questionnaire in order to assess the client experiences of MI.
Interestingly, I could hardly find any information about the therapist/counselor experiences with their own MI consultations. In other words, is a trained MI therapist/counselor able to correctly classify a conversation as a 'good MI conversation' or a 'bad conversation'? In addition, I could not find a self-assessment instrument to measure the experiences of the therapist/counselor with his/her own level op MI skills.
Therefore, I am wondering if somebody knows more about the possibility of trained MI therapists/counselors to assess their own MI skills correctly. And whether any research has been done on the relationship between such subjective experiences and the (more) objectively measured MI fidelity.
Just basic interviewing skills for helping professionals are essential to follow or to know. These include facilitation skills and these include observing your verbal and non-verbal communication skills during a therapeutic interview. Attentive listening and just focusing on your client without loosing their sight are important.
My experience is that relationship building is very important before MI skills or any skills can be useful. The patient needs to feel a connection and understanding with their therapists before they will take any MI skills seriously. For example with out that connection MI precontemplation stage can just be considered as more "lecturing".With the feeling of connection the patient will look at it as the therapist cares for their well being.
This is my opinion.
David B. Rosengren has a book titled "Building Motivational Interviewing Skills-a practitioner workbook" that has many skill building exercises and self-assessment type tools in it. He states in the preface that the intent of the book is to allow trained practioners to practice MI skills. I personally found it to be helpful
Dear Rolinde,
You are right in noting that most of the focus on treatment fidelity assessment relies on 3rd party behavioral rating schemes (MITI, MISC, etc.). These have a wealth of literature speaking to their validity and are often used in research settings.
In a clinical training environment, self-assessment is quite important. Many variants exist, but I have attached a self-assessment form which I often have supervisees complete if they are new to Motivational Interviewing techniques. There is little-to-no research out there which speaks to the validity/reliability of a self-assessment form such as this. It seems to be more used as a means of self-assessment in training than a reliable/valid measure to be used in research.
You may be on to a fertile topic if you are interested in validating such a self-assessment.
Best regards,
Nick
Hopefully things are moving ahead in order to be able to assess in a proper way professionals skills on MI. Several instruments have tried that although it is not easy as the items to be measured are of a very different conditions. A new tool ( the EVEM questionaire) is being a new tool for that pourpose.
You can have the paper of reference though this link:
http://www.biomedcentral.com/1471-2296/13/112
Best regards
Juan Mendive . MD, PhD: Family Physician. Barcelona
No specific guidelines on how to evaluate skills and competency exists.Lupu (2012) found that pharmacy students were more confident if they were assessed with a standard patient or mock-patient assessments. Little has been published on MI and cultural competency.
Arena, J. (2011). Motivational interviewing: the challenge of developing skills and evaluating competency in dietitians in pediatric practice. ICAN: Infant, Child, & Adolescent Nutrition, 3(1), 25-30. doi: 10.1177/1941406410396081
Marley, S. C., Carbonneau, K., Lockner, D., Kibbe, D., & Trowbridge, F. (2011). Motivational Interviewing Skills are Positively Associated with Nutritionist Self-efficacy. Journal of Nutrition Education and Behavior, 43(1), 28-34. doi: 10.1016/j.jneb.2009.10.009
Brug, J., Spikmans, F., Aartsen, C., Breedveld, B., Bes, R., & Fereira, I. (2007). Training dietitians in basic motivational interviewing skills results in changes in their counseling style and in lower saturated fat intakes in their patients. J Nutr Educ Behav, 39(1), 8-12. doi: 10.1016/j.jneb.2006.08.010
Lupu, A. M., Stewart, A. L., & O'Neil, C. (2012). Comparison of active-learning strategies for motivational interviewing skills, knowledge, and confidence in first-year pharmacy students. Am J Pharm Educ, 76(2), 28. doi: 10.5688/ajpe76228
I do not have a formal approach and am looking for these answers as much as Rolinde. I pay close attention to my client's facial expression and body language during my interview and ask for feedback from my client and from interns observing. I review the principles of MI frequently. I am also interested in meeting with other clinicians who use this technique and who practice in the University City area of Philadelphia to case conference on a monthly basis if anyone has any ideas. Motivational Interviewing is relevant to my practice with pregnant women, who are struggling with adopting new, healthy behaviors.
There are a number of references in the literature that indicate that therapists are not too good at self review. In fact they overestimate their effectiveness. This has something to do with the psychological and at times spiritual/religous attachment to the meaning derived from being a therapist. It is also associated with the investment in training and at times the arduous psychological journey associated with the training. So there is a good deal of investment in feeling that the process and activities of therapy are valid and useful. I would suggest there is a lack of critical analysis within the therapy industry and this impacts on clinicians ability to think critically about their practice.
Dear all, thank you for your replies to my question. In the meantime, I have searched in the literature for relevant evidence on the possibility of counselors/therapists to assess their own MI skills. I have found relevant information in an article of Miller et al (2001/2004). They suggest that counselors' self-report of their MI skills is inaccurate and unrelated to ratings by skilled coders.
Rolinde - with the client's permission, do you record your MI session and then later listen to it. Useful for self-supervision. Even better, take the recording to supervision. I also encourage my clients to record the session for their own development and insight.
Hello, The MIA Step project and materials are quite comprehensive regarding MI supervision, practice assessment and Clinician Self-assessment. The manual and all related forms are included on line. The Clinician Self-Assessment form is at this link (scroll down for complete form): http://www.nyscha.org/files/2011/handouts/WE-PRE%201%20MITools_Scale%2526Self-Assessmt.pdf
The MIA step manual, etc. can be accessed at: http://www.motivationalinterviewing.org/sites/default/files/mia-step.pdf
http://www.nyscha.org/files/2011/handouts/WE-PRE%201%20MITools_Scale%2526Self-Assessmt.pdf
http://www.nyscha.org/files/2011/handouts/WE-PRE%201%20MITools_Scale%2526Self-Assessmt.pdf
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