Motivational Interviewing: A conversation with Brian Dickerson

Brian Dickerson, Lantern's Senior Program Director for Schafer and Prospero

Motivational Interviewing (MI) is an evidence-based counselling technique designed to motivate people to change. Lantern introduced it comprehensively across all our sites last year, with NYU’s School of Medicine providing training and ongoing monitoring of staff adherence to the model. We spoke with Brian Dickerson, Program Director at Schafer Hall and a member of our MI peer coaching team, about what it’s been like to implement MI across the organization.

How is MI different from how we were working with clients previously?
As social workers, we understand behavior change and MI is really just one model of supporting people to change their behavior. What’s different is that it’s very specific about how to have that conversation to support change, and is an alternative to direct persuasion. MI has helped all of us focus on “change talk”, so that when a client is talking with you, you’re able to make comparative reflections, comparing their successes with when things haven’t worked well, and using that to motivate change.

What has it been like implementing a model agency-wide?
It’s been helpful that we’re all doing it at the same time. While behavior change models aren’t new to social workers, not all our case managers have been to social work school, so MI training was an opportunity to get everyone onto the same level. I’ve also been trying to tap into what people are already doing that’s in line with the model and supporting them to use that. Looking at the progress notes staff record after counselling sessions and working one-on-one with staff, I can see that MI is sharpening our skills and helping us get to the heart of the matter with our clients. And that’s really what all of this is about: helping clients realize their full potential.

NYU did the initial training, but they’re also staying involved to make sure the model is being implemented properly. How does that work?
All staff submit a taped session with a client every 3 – 6 months, with the client’s consent. The tape is then sent to the NYU trainers, who give us feedback on how well it adheres to the model. This means covering the key elements of the model in the conversation: using open-ended questions, affirmations, reflections, and summaries. It’s more than a checklist, though. At it’s core, the model is about having empathy and supporting clients’ self-efficacy, so that’s what the NYU trainers are listening for. It’s about having the genuineness and positive regard for another human being that is at the heart of our social work ethics.

We’ve also been doing peer coaching internally. How is that going?
Really well. When we’re doing role plays, we’re getting to the point where we’re able to have much more complex reflections and use affirmations that really do affirm. We’re really able to identify with each other, and in role plays, be honest about whether or not we felt supported when playing the role of the client. When you start out with MI, it can feel a bit mechanical, but it’s important that it’s a conversation. I feel like we’re getting to a higher level with implementation now; the conversation doesn’t feel superficial, it’s authentic and it is moving clients toward self awareness.

What has MI meant for clients?
MI gives us a structure, and at it’s best, we can see people developing strategies to overcome hurdles in their lives. Change is still incremental and no-one is suddenly changing overnight because of one MI session. But we know that all our staff are now focused on supporting those small changes and helping clients build on them towards overall wellness, and that’s a good thing.

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