Motivational Interviewing 102: Implementing it in your own life
We return to talk more about motivational interviewing with Boost Oregon's own amazing Carrie Bader. She gives us a refresher on what motivational interviewing is, then expands to walk us through how we can use it in our own lives both personally and professionally. This episode will help you to be better equipped to deal with the toxic debate culture that prevents meaningful conversations from happening.
So tune in and know that new content with Ari is returning soon.
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Nadine Gartner
Transcript:
Ari O'Donovan: (00:00)
Are y'all comfortable? We hope wherever you're listening to this, you're comfortable. This show is for the Bipoc communities in Oregon, hosted by a black woman about the amazing work we do every day in this state. So let's build together, connect with our communities, add some laughter and humor, even when it's a difficult conversation, let's boost our voices.
Carrie Bader: (00:25)
But if I do have an idea or perspective, I ask permission first. And even if it feels maybe a little awkward or formal, it's just something I have found. I just feel it's a sign of respect to another person. And typically they say yes. I mean, especially if I'm talking with a friend. But if someone were to say no, I would respect that and respect the fact that maybe that's just not what they're looking for right now, and that's not what's gonna be me being a helpful friend in that moment.
Nadine Gartner: (00:58)
Hi everyone. Welcome back to Boosting Our Voices. This is Nadine Gartner filling in for Ira o' Donovan. We have a really special episode today. We are speaking to Boost Oregon's training director Carrie Bader. She is a motivational interviewing trainer, and so we're going to learn all about motivational interviewing and her interest and history with it, as well as learning how you can learn more and be trained in MI skills to assist with your helping conversations in whatever profession you may be in. So without further ado, welcome Carrie Bader.
Carrie Bader: (01:44)
Thank you. It's great to be here.
Nadine Gartner: (01:46)
Can you tell us a little bit about your professional background and about, you know, how you came to be a motivational interviewing trainer?
Carrie Bader: (01:56)
Sure. I first attended a motivational interviewing, or I'll call it mi, right here on, in an MI training in 2008. And there was just something I, I kind of stumbled onto and just immediately connected with. So I've been an MI trainer since then in a, in a number of different settings. One of the settings I worked for the longest in was in behavioral health. I worked at the Oregon State Hospital for a number of years and did MI trainings there. Also a licensed occupational therapist and a certified health educational specialist, and I am now the training director for Boost Oregon.
Nadine Gartner: (02:36)
What, you said in 2008, you kind of stumbled across mi What was it about MI that you connected to?
Carrie Bader: (02:44)
Yeah, I attended this training not really knowing what to expect. I just kinda like going to trainings in general and just, this sounded interesting. And I realized in this training, it was really focused on how can we have helpful conversations with others? How can we, especially in working relationships, truly be helpful to another person, especially when we're trying to maybe get them to change in some way or hoping that they will move in a certain direction. And so it was a lot about listening and being supportive and all these things that I thought I was already, and as I attended this training and participated in the activities and listened to the information, I realized that I maybe wasn't so good at those things. I was doing a lot of things that I realized perhaps weren't as helpful as I thought they were. And over the course of the training, I picked up ideas for ways in which I could do a better job.
Carrie Bader: (03:47)
And at the time, I was working as a health coach for an insurance company, and it was one of these positions where you talk to people on the phone about various health behaviors, like improving your sleep, your eating habits, your physical activity. And so right away I was trying out these things that I learned in the training, and it just felt so much better immediately I could feel how much more effective I was and how much more of the people I was working with were, were really benefiting from, and, and just enjoying the conversations too. It was really powerful for me. And, and, you know, and when I started having those experiences, I just felt like I wanted, I wanted this to just get out there more. And so I became a trainer and, uh, started, started teaching and helping others learn this approach.
Nadine Gartner: (04:41)
If you can recall, what's one thing that you did previously that you felt was being supportive and then after going through MI training you realized, oh, I need to change how I do that?
Carrie Bader: (04:55)
I think like a lot of people, I just love giving advice. Someone brings up some issues, some problem they're having, and I know the answer and I know if they just did this thing that I came up with, that it would solve their problem. Right? And so I was very quick to, when something would come up, someone would say, um, I, you know, I'm having, can't really get my studying done. Like, whoa, wait, how about you make a schedule and just schedule out that time? Oh, I can't wanna get more active. Oh, if you just walked more, you know, after dinner. And I reali I mean, it's, it's kind of obvious to me now, but you know, during this training we would have these exercises where we would practice having the conversations in different ways. And, you know, when you're on the receiving end, it doesn't feel all that helpful. It's a very different experience. And instead of thinking, oh, that's a great idea, why didn't I think of that? All sorts of other things typically go through your head. Things like, I already tried that. Why is this person telling me what to do? Why do they think they know better? So I think the unsolicited advice is something that really stood out to me, and it, it's definitely stuck with me, and it's a big emphasis when I do trainings these days on trying to tamp down that reflex we have.
Nadine Gartner: (06:19)
Yeah. Do you find, has it changed that reflex when you're having a conversation with a friend in a, you know, in a non-professional environment where you're not actively using MI skills, or at least you're not intending to, but do you see that it kind of seeps in and changes how you interact with, you know, friends and family?
Carrie Bader: (06:39)
Absolutely, yes. I think, I think in two ways. One is it makes me more sensitive to receiving unsolicited advice because not only does it bug me, but I know exactly why it bugs me and why it's not effective. But on the other end, I really put an effort into consciously ask permission before I offer an idea or suggestion, which is something we talk about in trainings. And sometimes I don't even offer it because that's often not what someone's looking for. Sometimes they just wanna talk about something, they just wanna vent, they just wanna have a listening ear. But if I do have an idea or perspective, I ask permission first. And even if it feels maybe a little awkward or formal, it is just something I have found. I just feel it's a sign of respect to another person. And typically they say yes. I mean, especially if I'm talking with a friend, but if someone were to say no, I would respect that and respect the fact that maybe that's just not what they're looking for right now, and that's not what's gonna be me being a helpful friend in that moment.
Nadine Gartner: (07:47)
That's beautiful. And for people who may not be familiar with mi, can you just, you know, give us an example of what it means to ask for permission in a conversation and why one would want to do that, or why it would be, you know, beneficial in the conversation?
Carrie Bader: (08:02)
Sure. I think first it can be helpful to look at just the way things typically go. When we don't ask for permission, we just jump in and say, oh, you should do this, you should do that. I'm a parent now. I have a 3-year-old daughter. And so most, if not all parents have experienced, uh, unsolicited needs time. If they hadn't, you know, if they had somehow escaped it before then they've definitely gotten unsolicited advice. And I, I think it can be helpful to just think about how does that feel? And occasionally it can be helpful, the time is right and the relationship is right, but often it's just not. And so the approach we take in motivational interviewing is this framework, it's called explore, and then ask, offer, ask. And so first we would just explore, like talk about what is going on for this person, and then the asking permission can, it's really just what it sounds like, you know, Hey, I, I have an idea.
Carrie Bader: (09:04)
Is it, do you wanna hear it? Or can I offer a suggestion? Whatever words fit for you. But really the spirit of it is to a check in first and see is this helpful and wait for a response. And then if they say yes, we can offer that suggestion or that perspective and, and doing so in a neutral manner too. So it's not saying, well, what you should do is X, Y, Z, but instead it might be, you know, something I've tried is X or Y or Z or I have a friend who tried this, or I read an article about this. And then the final ask is, what do you make of that? You know, what do you think of that? That final ask may or may not be necessary, especially in more informal relationships where it's just a conversation. They're likely gonna tell you what they think anyway. But it's also a way of just saying like, you are the one to decide if this fits for you or not. And so that ask, offer, ask approach can be just a really nice framework to keep in mind when it comes to offering, you know, advice, information, perspective to others.
Nadine Gartner: (10:18)
And what's the benefit to going through those steps as opposed to, you know, especially for folks in helping professions where someone is coming to them specifically or ostensibly for advice, right? To get some feedback or understand some new coping skills or whatever it may be. So in that situation, you know, why not just jump in with, oh, well they've come to me, I'm the therapist or the counselor or the, you know, whatever the profession may be, right? I'm the doctor. What's the case for why it's beneficial to have that approach as opposed to jumping in with the advice,
Carrie Bader: (10:58)
If somebody comes to you and says, Hey, I've got this issue, what do you think I should do? Then I think it's fine to go ahead and just offer that perspective. I would still definitely check in and see what do you think? 'cause you know, our idea may or may not fit, but if someone is really explicitly asking for our help with somebody, then yeah, maybe we don't need to ask permission then. And maybe it might be a little silly to answer permission then, you know, often we're in situations, let's take somebody, you know, they go in for their annual checkup and maybe they use tobacco, right? And so often happens is this, in those situations is the doctor says, you know, I see still smoke. And that's really not good for you. And there's a lot of ways you can stop and hear some ways.
Carrie Bader: (11:53)
Just because that person has gone in for their checkup does not mean that they are in a place where they are ready and open to hearing advice on how to quit smoking. Mm-Hmm. , I think we need to be cautious about, you know, what are people coming to us for? Mm-Hmm, and what do we, what are they open to? And not assuming just because they're coming to us, that they're open to any and all suggestions we might have. Even if you go in for like a counseling appointment, a therapy session, that doesn't mean that every single thing you talk about that you wanna get advice on. You know, we talk a lot about MI being like a dance where you're really paying close attention to what is somebody, where are they in this situation and what are they looking for? And really responding in the moment. And sometimes we overstep and that's okay. We just need to respond to that and maybe apologize, take a step back, Hey, sorry, maybe I got ahead of us here. Or maybe that wasn't helpful, and we can find our footing again from there.
Nadine Gartner: (12:58)
Yeah. I love the idea of MI as a dance. And so I wonder if we can zoom out for a moment and just for folks who maybe unfamiliar with mi, you know, what is MI and sort of from a, you know, just a broader perspective and where does MI really play a beneficial role?
Carrie Bader: (13:20)
Yeah, the official definition of MI is that it's a particular way of talking with people about change and growth to strengthen their own motivation and commitment. So we talked about dancing briefly, I think about it as dancing, as opposed to wrestling. A lot of these conversations in, you know, the helping professions, they can have this feel of wrestling to them, like, we're trying to get somebody to do something that they don't really wanna do, and the conversation can feel like a wrestling match. And so instead in an MI approach, we're really taking this role of more of a guide and a partner with a deep sense of respect for the other person having autonomy in their life over their own decisions and, you know, trusting their own decision making abilities. And we have over 40 years of research at this point in motivational interviewing around the world.
Carrie Bader: (14:16)
It, it seems to cross cultures in a way that a lot of other behavioral interventions out there either, either don't do, or we just don't have the evidence on a lot of other interventions. And so am i, it was originally developed in the field of substance use where in the seventies and the eighties too, it was, it was thought that you really had to take a confrontational approach to get somebody to change. You had to, you know, guilt them, shame them, make them see the light. And these two psychologists, bill Miller and Steve Rolnick worked in this field and they saw that this, this just didn't seem to work all that well. And just philosophically it, values wise, it seemed to just not really feel very good , um, to them or to the clients. So they explored this approach that instead focused a whole lot more on showing empathy and understanding, um, and, and found that it was effective.
Carrie Bader: (15:20)
And it's since been shown to be effective in so many fields beyond substance use, really in any field where you're, you're trying to promote positive change. So you look at medical care, social work, public health, and of course vaccinations. The work that we do where we are, you know, speaking to somebody recognizing this is their decision to make and, and of course hoping that they will move in the direction of choosing to vaccinate. So this approach, you know, it can be really useful in any area in which we're trying to promote that change. And I think what happened in the early years of MI was that, you know, Miller enrollment were, you know, using these, like approaching these conversations with that sense of empathy and collaboration and respect, and also over the years found that this is actually a learnable skill and it's a teachable skill.
Carrie Bader: (16:16)
And getting into also these details on, well, what does it mean to have empathy? When is someone is saying, I don't have a problem. Why is everyone making a big deal out of this? Or You can't control me, you can't make me change. You know, what, what does empathy look like in those situations? What does it mean to partner when somebody maybe doesn't wanna partner with you? Mm-Hmm. , we, within motivational interviewing have answers. And that that's what we look at in the trainings. And those are exactly the kinds of things we practice. You know, someone says this, what can I say, ? And so it's absolutely a skill that is learnable from what I've seen. Anybody who really values it enough to believe that they wanna learn it and they want to put in the time and effort to learn it.
Nadine Gartner: (17:02)
That's so great. And I know, you know, here at Boost Oregon, when you and I first started speaking months before, you know, you came to the organization as staff, and it was exactly that of how do we train doctors, nurses, and everyone who may be having a vaccine related conversation with a patient or a client in having useful conversations and not making it adversarial and making it cooperative and empowering the parent or the, you know, patient, like ultimately you're exactly right, it's their decision. And so how do we frame that? And I think MI has just been a huge help for our work in promoting vaccine confidence and uptake. So with that in mind, I know we got into some detail about asking permission and ask, offer, ask, but what are some of the other features of MI that you think are kind of the big bullet points about this training? When
Carrie Bader: (18:00)
I think about motivational interviewing, I think about there being this kind of heart set mindset to it. And then there's, you know, the technical skills, like the things that actually come out of our mouth during an MI conversation. So with that heart set, there's, what we talk about is the spirit of motivation interviewing. So this sense of partnership that we are, you know, we're in this together, not, instead of I'm the expert and I know what you should do, I know what's best for you. It's, you know, you're the expert on your life. I have some information that may or may not be helpful. You're the one to decide. Acceptance is the sense that, you know, you the client have, you know, very valid reasons. And you know, for your beliefs, your values, your actions, it doesn't mean I agree with them agreeing is, you know, besides the point, but that I accept that, you know, this makes sense to you.
Carrie Bader: (18:56)
Compassion is working for your benefit, not to, you know, primarily serve my own agenda. And empowerment is really believing that you have the ability to make good decisions for yourself and that these are your decisions to make. So that's the spirit. And then there's what we call the core skills in motivational interviewing. So those are kind of how we show the spirit. So those core skills are open-ended questions, reflections, affirmations, and summaries. And so in an MI conversation, we're really spending a lot of time using those core skills to kinda explore what's going on for them and show that we are listening, we're listening very deeply, you know, not just to the words, but to the meaning behind the words. And we're also looking for chances to affirm what is positive and what they're doing trying to do, you know, wanting to do.
Nadine Gartner: (19:55)
Right. That compassion piece really rung true to me. The idea of, we're doing this for your benefit. It's not, you know, that I as the provider or the counselor or whatever the role is, it's not that I'm coming in with my own agenda, it's that this is for your benefit. And that's, you know, something we've been training medical providers in for, uh, years since Boost Oregon started, you know, in this, trying to refute this myth out there that somehow vaccines are beneficial only for vaccine manufacturers and the government as opposed to individual families. Um, so that's beautiful. Um, for folks who want to learn about MI and how to use MI in their professional worlds, what would you advise them to do?
Carrie Bader: (20:46)
Yeah, there's a lot of different approaches to take. I mean, there are lots of articles out there on mi there's some wonderful books on motivational interviewing, boost Oregon, of course. We are a great resource for learning about motivational interviewing. So we have monthly free one hour virtual sessions on various topics related to motivational interviewing. There tends to be a focus of course, on vaccine conversations, but really if you have any, you know, interest in learning a little about mi it's a right way to just get a taste of it. And then we contract with organizations, if you're at an organization and you think it would be beneficial to get a training for your group, we do sessions of various lengths that can be anywhere for a one hour overview to a series of, say, three hour virtual session. And of course, if you're in the, if we're in the area, we can often get to you with an in-person session as well. And that can be a full day training where we really dive in, you know, we really get to do practice 'cause that's how you learn this. This is about how we approach conversation. So you're not really gonna learn it from reading a book or watching a video no matter how wonderful the video is, but really gotta dive in and practice. And if you really wanna become proficient, then we do provide coaching and coding sessions where you can get individualized feedback on your own MI skills and some recommendations for further development.
Nadine Gartner: (22:22)
And where can people find details about Boost Oregon's training programs?
Carrie Bader: (22:27)
You go to boost oregon.org, and on our website there's different menus and there's a, a dropdown you'll see for providers and that has information on webinars and on motivational interviewing too. If you're with an organization and you're interested in a training, there's a old form you can fill out to send an inquiry, and then we can be in touch about what, what might be useful. There's never any obligation. I'm always happy to just chat with people about, you know, what they're looking for and what might be the most sensible next steps, whether that's a training or some different direction to go in.
Nadine Gartner: (23:02)
Fantastic. And in your journey with MI from 2008 to today, how has your perception of it, or have you found that you've had to change the way you implement MI skills? Have they changed over time? I know it's a field that's been around for 40 years. Is it something that is changing as, you know, other forces and dynamics in our society are changing? Um, or does it seem pretty static? What's been your take on how flexible MI can be?
Carrie Bader: (23:38)
I've found it to be very flexible and it's dynamic. There's just active research going and going on in motivational interviewing, and we have over 2000 published controlled clinical trials of motivational interviewing at this point. And I think one thing that's been really wonderful about the field is that it has, you know, adjusted and changed in response to what's come out in the research. And we've had, you know, anything from, you know, large scale studies on, on behavior change to really intricate studies on these, the psycholinguistics of these conversations and what happens when you offer an affirmation, what happens when you offer a complex reflection or a simple reflection. And the, the founders of motivational interviewing, they actually just last year published the fourth edition of the motivational interviewing book. So there have been substantial changes since I was first trained in mi I was trained in the, the second edition back in 2008.
Carrie Bader: (24:39)
And so I've definitely adjusted my trainings over the years in response to what's come out in the research. I mean, the basic philosophy of it has not really changed, and it is really about empathy and respect and collaboration, but some of the details have changed and some in fairly significant ways. And so I think for people out there who maybe were attended a training years ago and and have not in a while, it is worth getting a refresher just to see what's new in the field. And I mean, I think too, as far as my personal draw to motivational interviewing, I think when I first learned about it, I kinda saw it as a technique. I saw it as a, you know, something I use and these jobs where I work as a, a health coach or whatever it is. And I think over the years I've come to see it more as this is kinda a way of being with people.
Carrie Bader: (25:35)
And this is really just, it's how I want to be just in general as a person with other people. And I think as a parent now, especially the reflective listening skills have been so incredibly useful with a three-year-old who, you know, has a little mind of her own. And I found when I read parenting books, it seems like, you know, 80% of them are like my reflective listening. And so it's not that I do it perfectly, but it is been a, um, fantastic foundation for just handling a lot of challenging incidents that come up with a little one.
Nadine Gartner: (26:11)
Yeah. But with that in mind, so whom would find mi beneficial? I think, you know, maybe some people are listening to this and thinking, well, I don't talk about vaccines or I don't, you know, see patients on a daily basis. This isn't applicable to me. What would you respond to that?
Carrie Bader: (26:30)
I think anyone who, in your professional role, you do some kind of work around, you know, supporting people and making positive changes. And so that can apply in a number of different fields. I mean, you think about teachers, you know, working with kids to support them and, you know, doing schoolwork and, um, keeping up the motivation to learn and, and them not always wanting to do what you're asking them to do. So you think about teachers, there's actually a book on mi and sports and coaching. I've seen some interesting work on mi with financial advisors lately, you know, working with people in their finances. So I think it cuts so broadly, uh, across the swath of different subjects or areas that people are working on in their lives. So I, yeah, I mean, really if, if you think about in your, in your work, if you do things where you're trying to work with people, and sometimes it's not even moving in a positive direction, it can just be in like trying to make decisions too.
Carrie Bader: (27:40)
There's some interesting work that's been done in MI and, um, end of life support too Mm-Hmm. Where people have a lot of difficult decisions to make. And it's not necessarily one side is, you know, preferred over the other, but that we wanna support people and making decisions that they feel at peace with. And so MI can be helpful in those conversations as well where especially we need to give up this idea that like, we might know what's best, but how can we approach the conversation in a way to help people explore for themselves what makes the most sense for them?
Nadine Gartner: (28:14)
Wonderful. If there's one takeaway you want listeners of this episode to leave with about mi, what might that be?
Carrie Bader: (28:24)
Oh gosh. I think just that I'm a fan of it. I think it's a, a beautiful thing that I just think we need more of this way of having conversation, especially in the world today. We're in such a arguing, debating, you know, one-upping kind of, um, culture. It seems, I mean, that, that just seems to be the predominant way in which, in the public realm, a lot of conversations take place. You can't even call them conversations. People aren't even trying to hear one another. And to me, this is a, it's a counterpoint to that. It can help counteract a lot of what's out there. I mean, we see people who, I mean, we've talked with providers where people come in talking about vaccines and you know, they're hesitant and they're so shocked that they have a provider who's actually gonna listen to them, and they're so prepared to just be jumped on or criticized or guilted, um, or ridiculed, um, for having certain questions. And so I think learning this and practicing it can just be a real gift to others. And it's kind of a gift to the world that I think we, we really need
Nadine Gartner: (29:40)
More of these days. Yes, I'll amen to that. Thank you so much, Carrie. Really appreciate getting to learn more about mi and your perspective of it. Let's make it the antidote to toxic argumentative culture and really speak and listen to each other more and be kind to one another. So thank you so much, Carrie. Thank you for listening. All. Iro Donovan will be back in a few weeks. She is now a new mom, and so hopefully we'll hear about her experiences so far and how she may be using mi as a parent down the road, just as Carrie has found it useful in her parenting. So until then, be well be kind all we'll see you next time.
Ari O'Donovan: (30:31)
Thanks for listening to this episode. Came bring the community info without the community. Appreciate you showing up. If you wanna reach out, hit us up on ig at boosting our voices or at our website, boost oregon.org. Keep doing great things, keep uplifting one another and we'll do the same. See you next time.