MI Peer Support Group

'''Recommendations for an MI Peer Support Group'''

Developing proficiency in motivational interviewing (MI) is rather like learning to play a sport or a musical instrument. Some initial instruction is helpful, but real skill develops over time with practice, ideally with feedback and consultation from knowledgeable others. One way to do this is to form a local group to support and encourage each other in continuing to develop proficiency in MI. When a group like this is well-done, participants enjoy coming and sometimes say that it is one of the most interesting and rewarding aspects of their job. Here are some ideas for such a group.

1. Schedule regular meetings for the sole purpose of working together to strengthen MI skills. Don’t let administrative details or other agenda fill the time. An hour meeting twice a month would be one possibility.

2. In early meetings, it may be helpful to discuss specific readings. There is a rapidly growing list of books and articles at www.motivationalinterviewing.org. Periodically the group may also wish to watch "expert" tapes, coding and discussing the skills being demonstrated in them.. For those particularly interested in new research on MI, a "journal club" of 20 minutes or so might be added. Take it easy with any reading assignments, though. People learn a lot, and fast, just from bringing in and discussing tapes (see #3).

3. A key learning tool to be included in regular meetings is to listen together to and discuss tapes of participants’ MI sessions. Some groups have experienced that the energy and engagement level of the group picked up when they began to listen to each other’s tapes. A rotation schedule can be arranged whereby participants take turns bringing in new tapes. We recommend listening to and discussing one tape per session. A 20-minute segment of tape is probably about right. We recommend using a recording device with external microphone(s) to improve the quality of sound and facilitate listening.

4. Written permission should be obtained from clients for this use of recording, explaining how the tapes will be used, who will hear them, and how and when the tape will be destroyed.

5. Be sure to thank and support those who bring in a tape to share. They are taking a risk and being vulnerable, which can be difficult, particularly early in the life of a group. Beware of having high “expert” expectations when someone is just beginning.

6. Rather than simply listening to a tape, make use of some structured coding tools. Some examples are:
Counting questions and reflections
More generally coding OARS
Coding depth of reflections (simple vs. complex)
Counting client change talk, and noting what preceded it
Tracking client readiness for change during the session, and key moments of shift
Coding forms can be found on http://www.motivationalinterview.org/
Participants may use the same coding form and compare their findings, or participants may use different coding forms to attend to different aspects of the session.

7. In introducing a session to be heard by the group, it is appropriate to indicate what target(s) for behavior change were being pursued. Without this, it is not possible to identify change talk, which is goal-specific.

8. In discussing a participant’s tape, it is appropriate for the person who did the interview to comment first on its strengths and areas for improvement.

9. In discussing any tape, focus discussion the ways in which the session is and is not consistent with the spirit and method of MI. Again, it is useful for the person who did the interview to lead off this discussion. Participants can ask each other, “IN what ways was this session MI consistent?” and "What might one do to make this session even more MI consistent?" When providing feedback to each other, adhere to the supportive spirit of MI. Always emphasize what you heard or saw that seemed particularly effective and consistent with the style of MI. One approach is a “feedback sandwich” in which any suggestion for further strengthening practice is sandwiched between ample slices of positive feedback. The group atmosphere should be fun and supportive, not pressured or competitive. Group participants report that they often learn more from helping others than from receiving feedback on their own tapes.

10. Focus on what is important within MI. There is always temptation to wander off into more general clinical discussion of cases. Focus learning on the spirit, principles, and practices of MI.

11. The group may focus on practicing and strengthening specific component skills of MI. One such sequence of skills to be learned is described in: Miller, W. R., & Moyers, T. B. (2006). Eight stages in learning motivational interviewing. Journal of Teaching in the Addictions, 5, 3-17.

12. Some groups begin with a “check-in” period in which anyone can bring up an issue for discussion.

13. Bringing coffee and refreshments can add to the relaxed atmosphere of a group.

14. Consider whether there is a prerequisite for participating in the group. Some groups have required, for example, that participants complete an initial training in MI before beginning to attend. Others have left the group open for any who wish to learn MI skills.

15. Consider whether you want to contract for a specific length of time or number of meetings together. If so, at the end of this time each member can consider whether to continue for another period.

16. An “MI expert” in the group might resist taking on an expert role, because doing so can stifle participation and learning. Don’t withhold your expertise, particularly if invited, but avoid a pattern of interaction in which the group always looks to the expert for the “right” answers.

17. Most of all, enjoy this privileged learning time together. As with other complex skills like chess, golf, or piano, gaining proficiency in MI is a lifelong process. A real source of fun and learning in these groups is admiration for the many artful ways that people find to apply MI within their own clinical style and population.