Friday, December 16, 2011

Take the MITI Challenge

Are you a private practitioner? I will code a clinical session at no charge! Just send me a recording! Note this offer is not valid for agencies or practice groups.
Wednesday, October 19, 2011

The Spirit of Motivational Interviewing Evolves - Part Two

I suppose it is true that a person trying to sell you into an MLM could arguably be acting out of compassion:  they want to free you from your employer, help you build your own business and find financial success (at least this is some of the typical catch phrases one encounters with MLMs).  So motivational interviewing fits for these folks.

Well at least under the current second edition of Motivational Interviewing. 

However, the upcoming third edition will integrate the core ethical concepts of: nonmaleficence, beneficence, autonomy and justice.

Wow.  Goodbye motivational intervening "applications" to network marketing.  What will Michael Oliver do?

These four concepts, often referred to as bioethical principles, are commonly accepted health care ethics developed by Thomas  Beauchamp, James Childress -- arguably the most well known and influential principles in the world.

How do you think the bringing these concepts to the forefront in the performance of motivational interviewing will impact the field?

Sunday, October 9, 2011

The Spirit of Motivational Interviewing Evolves - Part One

Here is a disturbing fact:  motivational interviewing (or what looks and sounds like motivational interviewing) can be done by people who might not have your best interest at heart.

"Really?" you say.  "I thought motivational interviewing was a counseling technique?"

It is a counseling technique that can be used as a persuasive technique.

Consider the stereotypical car salesman.  This person learns motivational interviewing techniques and when a person comes in "just looking" (read:  ambivalent) the salesman, armed with motivational interviewing, focuses on change talk around buying a certain model.  The unsuspecting person drives out in a new car.

Now you might think I am making this up and if so I would suggest you go over to, buy and read "How to Sell Network Marketing Without Fear, Anxiety or Losing Your Friends!".  This book might alternatively titled, "How to Use Motivational Interviewing to Convince Your Friends to Invest in a Multi Level Marketing Business."

In the next publication of Motivational Interviewing (you can get the current second edition here), this will change with the addition of the concept of Compassion to the Spirit of MI (it was there already, wasn't it) among other things.

Now the real question is whether someone using motivational interviewing strategies to get you to buy into an MLM is compassionate or not?!

Sunday, September 25, 2011

How could you help these people?

Are your clients stuck like these people in this video?

I am sure you have clients like this.  Positively Absolutely.

How do you respond?

What do you do?

Are you the repairman in the video or do you have another role not shown in the video?  Why or why not?

What would a person practiced in motivational interviewing do to help these people?

Please go to my blog and post your comments and thoughts!

Saturday, September 17, 2011

Bye Bye Resistance

If you are like most, you didn't relish the shift from toward "resistance" when the book Motivational Interviewing first was published.  Next year, when the 3rd edition of Motivational Interviewing (MI3) is published, the concept of "resistance" will be gone completely. 

And I for one am glad.

Counselors who slap clients as in "denial" are pathetic and should surrender their license. 
        (what, you don't like being labeled?!). 

Fortunately, labeling clients as in denial has become in many places "politically incorrect" meaning is has been replace with "resistant" (code word:  "denial") when blaming clients for our lack of clinical ability.  What will these people do when this concept is gone in MI3?

MI3 has many changes -- it is looking like it will be as different from the second edition of Motivational Interviewing as the second edition was from the first.  But this shift completely away from "resistance" is, IMHO, the biggest (and best) change.  

"Resistance" has been replaced with sustain talk plus discord between the client and the counselor.

For those unfamiliar with motivational interviewing these days, we are focused on two client verbal responses:  

  • sustain talk and 
  • change talk.

What we know works is change talk.  The more the better.  And, at the risk of over simplifying motivational interviewing, our techniques in counseling are focused on getting more change talk and less sustain talk.

Two other factors come into play here:  the client is either connected with the counselor (there is harmony in the relationship) or disconnected with the counselor (there is discord in the relationship).  Make sense -- are you with me?

Now, let's look at what happens when these factors interact around a particular target behavior:

  Harmony Discord
Sustain Talk High potential to move client toward change talk Low potential to move client toward change talk
Change Talk High probability of behavior change High probability of behavior change

To illustrate, consider this framework using the example of stopping cigarette smoking as a target behavior:

  Harmony Discord
Sustain Talk Client engages with counselor to discuss his smoking. Client argues with counselor, wants to leave treatment, etc.
Change Talk Client comes up with a plan to stop smoking. Client stops smoking despite counselor.

The great thing about this framework is that all areas are impacted by the counselor. So blaming the client for clinical shortcomings should be a thing of the past next year!

What do you think?  Share your comments.

Saturday, January 1, 2011

How much does MITI session coding cost?

A single MITI coding of a motivational interviewing session costs $75.00.

Purchase a MITI coding to verify your motivational interviewing skills:

Solo MI practitioner subscription

A 12-month subscription contact for solo practitioners costs $125.00 each month.  This includes up to 2 MITI codings each month.  It also includes one private supervision session via telephone to set motivational interviewing skill goals and group supervision with other solo practitioners twice each month to discuss progress and share strategies.  There is no charge for these supervision services for solo subscribers. 

Additionally, solo practitioner subscribers can attend trainings in motivational interviewing at no charge during the subscription period.

Solo practitioners, purchase a subscription to MITI coding to verify your motivational interviewing skills:

Agency subscription for motivational interviewing development

MITI coding for motivational interviewing skill development

Agencies who contract for on-going MITI coding of motivational interviewing sessions for 12-months or more at the following rates:

  • 1-4 counselors  $125.00 per counselor per month
  • 5-8 counselors $100.00 per counselor per month
  • 9-12 counselors $75.00 per counselor per month
  • 13+ counselors $50.00 per counselor per month

This service includes up to 2 MITI codings each month for each counselor.  It also includes up to 2 MITI codings each month of clinical supervision sessions to debrief the MITI report each month for the clinical supervisor at no additional charge. Clinical supervisors receive 3 30-minute telephone consults during the first 3 months at no additional charge.

Additionally, counselors at agencies who are receiving MITI session coding for motivational interviewing can attend trainings in motivational interviewing at no charge during the subscription period.  Alternatively private trainings can be arranged at your location (travel charges apply) for counselors receiving MITI session coding.

Contact Scott Graham for more information.

MITI coding for quality assurance 

Agencies who have (previously) or are (currently) contracted for MITI coding for motivational interviewing skill development can contract for bi-monthly MITI coding at the following rates:

  • 1-4 counselors  $25.00 per counselor per month
  • 5-8 counselors $20.00 per counselor per month
  • 9-12 counselors $15.00 per counselor per month
  • 13+ counselors $10.00 per counselor per month

This service is for 1 MITI coding every other month (up to 6 per year) for each counselor.

Contact Scott Graham for more information.

What do I need to consider for audio recording a motivational interviewing session?

When setting up the process for recording sessions for MITI coding, consider the following:

Inform your clients

Orient your clients

Simply state to your clients that you are developing motivational interviewing skills or state that you are doing quality assurance of your motivational interviewing skills.  As part of this process you will be recording sessions and then submitting the audio for review.  Tell them that the reviewer essentially listens for words, sentences and questions from the counselor and client that are consistent with motivational interviewing.  Tell them that for example it is better in motivational interviewing to ask open ended questions instead of closed questions and give them an example of each.  This will not only reassure the client about the recordings but should actually help them feel confident your your skills knowing that there is a specific framework you use in your counseling.

Record all the time

If you get in the habit of recording all your sessions and simply recording over your previous session(s) the recording process will move into the background of your counseling process.  If you come up to a client and say this is the day I will be recording our session then the recording process is obvious and you may not have a session that is a reflection of your "typical" motivational interviewing abilities.


Depending upon your context and focus, you may need a release of information to submit a motivational interviewing session for MITI coding.  It is your responsibility to make sure you have all the proper releases completed before recording your sessions.

Digital Recordings of Motivational Interviewing Sessions

Sending an mp3 file via secure email is infinitely easier than keeping track of tapes, mailing them, waiting for them to arrive then waiting for me to send them back.  

Not just any digital recorder will do, however.  You want to look for a digital recorder that allows you to transfer the files to your computer.  Look for terms like "removable SD card" or "USB port" in the description.  You may need to purchase a card reader or USB cable to connect your digital recorder to your computer depending on the model.

Make sure your computer is secure

You want to treat audio recordings -- whether digital or on a tape -- just like you do any clinical record.  Make sure they are secure and that no one other than you has access.  When in doubt about a situation, just ask yourself if the record was written would you be doing what you are doing.  HIPAA, 42CFR and other confidentiality regulations apply equally to audio recordings as they do to written documentation.

Send client data only via secure email and upload motivational interviewing audios through Secure Drawer

You will need my digital ID and should follow the instructions for sending secure email outlined in another FAQ in this section. You will need to contact me and I will create a user account for you on Secure Drawer.

How many sessions should be coded?

For initial practitioners learning motivational interviewing and developing motivational interviewing skills, I recommend, at minimum, that 2 sessions each month be MITI coded for 12 months.

As a quality improvement / quality assurance strategy, I recommend, recommend, at minimum, an ongoing MITI coding of 1 session every other month.

These are both minimums based on my experience and knowledge.  Of course, you are the best judge to determine how much feedback you consider critical in your professional development and maintenance of motivational interviewing skills.

I went to many trainings, do I really need MITI?

You have attended motivational interviewing trainings over the years -- possibly many motivational interviewing trainings -- and you wonder if you really need the MITI.

There are two things for you to consider:

  1. Do you overestimate your skills?
  2. How do you learn to play a piano?

First, do you overestimate your motivational interviewing skills?  Research shows that practitioners consistently overestimate their abilities / skills.1

Second, if you want to learn to play a piano will you do so from attending a training and listening to a teacher talk about how to play, how a piano is made, when pianos are used in orchestras and why piano music is important?  No, of course not.  If you want to learn to play the piano, you sit at the piano and practice.  You take lessons:  meet with someone weekly who knows how to play who observes you playing and gives you feedback on your technique.  You don't do this once or even twice.  You do this for many years.  The question you have to ask yourself is whether the practice of motivational interviewing as complex as the practice of playing the piano. 

For me the answer is clear:  practicing motivational interviewing is an incredibly complex process -- more complex than playing a piano.

If you agree with me then the question that remains is only the when and how of feedback to develop and maintain your motivational interviewing skills.

I am a solo practitioner and I already receive clinical supervision, how is supervision in motivational interviewing different?

This is a great question.

The answer lies in the observation and feedback you get and the kind of clinical supervision you want.  How would observation and feedback of what you say to clients and how your clients respond to you be helpful?  How much of this do you get from your current clinical supervisor (how often do they listen to your sessions)?  Are you looking to grow your skills in motivational interviewing specifically?  Would you like to increase your efficacy with your clients (the research is clear:  the more change talk from the client during sessions the more positive the outcome)?

If you are a solo practitioner and are considering supervision to develop and enhance your motivational interviewing skills, contact me to set up one MITI session coding and a 30-minute debrief of your session at no charge.

How do I send an email that is encrypted?

You best source for learning about digital IDs and encrypted email is here:  This is a white paper on how digital IDs, specifically Verisign (the ID I use) works.

To send an encrypted message follow the following steps:

  1. Email me and ask me to reply with an email that is digitally signed. I typically do not digitally sign all outgoing emails.  You will get an email from me that has my public key attached as part of my digital ID.  You can also download my digital ID by clicking on the secure email icon from the navigation column on the right.
  2. Save me as a contact in your address book.  You may have done this before -- or you may have created one from scratch.  You will have to merge the old information with the new to insure you have my public key.
  3. Send a test email.  Before you email confidential information around the world via the Internet, send a test message an encrypt it.  Wait for a confirmation that I received it and it was secure.
  4. Attach your audio and encrypt it!

How do I send motivational interviewing audios securely?

To protect client data, please use Secure Drawer to transfer audios of your motivational interviewing sessions.

As part of the MITI coding service and motivational interviewing supervision, you will receive a guest login account for Secure Drawer.

Once you have an account, you can login using the form below or by clicking on the green padlock from the menu column at the right.

Transfer documents using Secure Drawer:
Secure Drawer Login Login:
Keep me signed in

How to use Secure Drawer 

The three videos below will help orient you to Secure Drawer and how to use it to submit an audio of a motivational interviewing session.  Watch as much or as little as you need to in order to feel confident in how to use this interface.

Motivational Interviewing Audio Upload Part 1

Motivational Interviewing Audio Upload Part 2

Motivational Interviewing Audio Upload Part 3