MITI Coding

Are you competent in motivational interviewing?

OK, you have been to a training in motivational interviewing.  Maybe two -- or even three.  You have read the book, Motivational Interviewing, Second Edition: Preparing People for Change .  You have even watched some videos.

Do you consider yourself competent in motivational interviewing?  How do you know?  

What did you get from supervision in motivational interviewing?  Was it from someone who they themselves was competent in motivational interviewing?  How did you know they were?  Just because they told you they went to trainings, read they book, watched the videos?

Research shows that practitioners consistently over-estimate their abilities / skills.1

I remember back in the late 80's / early 90's being very interested in Reality Therapy (William Glasser).  I used the technique a lot as an Outward Bound Instructor with "at-risk" youth and as a Wilderness Counselor with Beech Hill's Outward Bound program.  I very much wanted to be competent.  I went to an official intensive week training put on by an Instructor what at that time was called the Institute for Reality Therapy  (now the William Glasser Institute).  After I completed this training I learned that for William Glasser to consider me competent I needed to complete a 6 month Basic Practicum supervision with an approved faculty member of the Institute, then attend an Advanced Week, then complete a second practicum with a different approved faculty member, then pass a certification week, where amongst other requirements I had to present a unique educational session on a concept of Choice Therapy / Reality Therapy and demonstrate competence in a role play in front of my peer.  Wow.  That's some hoops to jump through.  Once I completed the process, there wasn't a shadow of doubt in my mind about my competence.  I knew Reality Therapy.  And, most importantly, I knew I knew Reality Therapy.

There is no such certification structure with motivational interviewing.  The only "official" avenue to validate your skills if you will is to become a member of the MINT (Motivational Interviewing Network of Trainers).  Even then, practitioners are told that they cannot in any way imply that they are "certified" or "approved" or "licensed."  William R. Miller and Stephen Rollnick (the authors of  Motivational Interviewing, Second Edition: Preparing People for Change) take it one step further in telling practitioners who completed a TNT  (Train the Trainers -- the once-a-year training that makes a practitioner eligible to be a member of the MINT) that they happened to facilitate that we cannot say that we were trained by William R. Miller and Stephen Rollnick or say that we were trained by those who developed motivational interviewing etc.

So in the motivational interviewing world, anyone claiming to offer a certification course is selling you some snake oil.

That's not to say you just want to have anyone train you -- those who qualify and complete the requirements to be a member of the MINT bring a level of knowledge, resources and expertise that someone who just read the book and watched a video aren't able to bring.

Good News for Motivational Interviewing Practitioners

There is good news -- I would say great news -- through all of this. And that is the MITI (Motivational Interviewing Treatment Integrity).  The MITI is a one-pass behavioral coding system designed to measure treatment fidelity for motivational interviewing.  It can be used for clinician training or as a quality check over time.

We didn't have this in Reality Therapy -- and for all I know -- my skills in Reality Therapy could have significantly declined over the past 20 years or so.  But with the MITI, I can do a quality check on my motivational interviewing skills.  I can find my cutting edge. And sharpen it.

Understanding the MITI

The introduction below will help you orient you to the MITI and help you set goals to sharpen your skills in motivational interviewing:

The Potential of MITI Session Coding

The MITI opens the door to assessing competence in motivational interviewing and providing a level of quality assurance for clients.

Consider these questions for yourself (all other things being equal) as a motivational interviewing practitioner:

Do you practice motivational interviewing better on Mondays than you do on Fridays?  Do you practice motivational interviewing better at the end of the days work than you do at the start?  Are there "hot" topic areas where your practice of motivational interviewing is worse than others?  Are there particular characteristics of people that impact your practice of motivational interviewing?  Would the answers to these and similar questions be of value to you in your practice?

How beneficial would an independent track record of your ability to practice motivational interviewing be if you ever got dragged into court for malpractice? (Assuming that you have developed your motivational interviewing skills at a competent level).

Consider this scenario for hiring someone for a position that requires skill in motivational interviewing:

Instead of the usual, "Tell us about your skills in motivational interviewing?" question that is asked in many interviews, the applicant is asked to produce 5 third-party MITI reports from recent sessions with clients.  We do this when we hire someone to drive the bus, don't we?  We say that applicants have to have a valid driving license of one sort or another because we want to see documentation of their skills by a third party.  Isn't the impact of effective versus ineffective motivational interviewing skills just as critical as bus driving skills?

If you had two applicants and each handed you 5 third-party MITI reports from recent sessions with clients and these reports showed the second applicant had 50% more change talk in sessions with clients than the first, whom would you hire?  Have you ever hired someone who appeared to be very skilled by a few months later you discover a disconnect between how they presented themselves and how they actually are?

How could MITI Session Coding benefit you, your agency, your clinical practice?

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Scott is a member of the MINT

Scott is a member of the MINT
Motivational Interviewing Network of Trainers