The Evidence of Practice

Motivational Interviewing (MI) has become a gold-standard communication style used in behavioral health and medical settings, but do people who are trained actually become proficient in MI after a standard two-day class? The answer to this question is a resounding “no”. Although participants in an introductory workshop often report feeling confident in their new MI skills, changes in practice behavior are usually modest at best (Miller & Mount, 2001) and quickly diminish after training if nothing more is done to consolidate them (Miller, et al., 2004; Schwalbe, et al., 2014).  Simply providing continuing education workshops can thus be a waste of time and resources if it does not improve client care.

As in learning most any complex skill, what is needed after initial training is ongoing practice with some feedback and coaching (Hall, Staiger, Simpson, Best, & Lubman, 2015; Miller & Mount, 2001; Miller & Moyers, 2006; Miller, et al., 2004; Schwalbe, et al.,2014).  Happily, even a relatively modest amount of additional feedback and coaching significantly improves the quality and maintenance of skills (Hall, et al., 2015; Miller & Moyers, 2006; Miller, et al., 2004; Schwalbe, et al., 2014). It is important that this feedback be based on direct observation since self-report is not an accurate depiction of an interaction and the MI skills used (Miller & Mount, 2001). Imagine piano students merely telling their teacher how well they have been playing.  This is a good analogy for teaching a complex behavioral intervention without directly observing it. This makes the difference between learning about MI and actually being able to deliver it.