I like to think we are entering an Age of Compassion. Sure, there are horrifying developments happening politically around the world, but the heartening thing is that the people are resisting. They are taking action to advocate for and protect others who are suffering. Thousands of people are marching, protesting and taking part.

Many compassion-based interventions have been developed over recent years. Compassion-focused therapy (CFT; Gilbert, 2014), Compassion Cultivation Training (CCT; Jazaieri et al., 2013), and Mindful Self-Compassion (MSC; Neff & Germer, 2013) are all approaches to enhancing compassion for others and for oneself. Such programs are vitally important to nurture this growing compassionate movement. The challenge is that all of these programs require people to engage, do self-practice and take compassionate action. They require behavioural change!
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This is where motivational interviewing (MI) can contribute to making the world a more compassionate place. MI has long been used as a prelude to other treatments, including CBT-based interventions, and has been found to enhance program engagement, homework practice and program completion (Burke et al., 2003; Hettema et al., 2005). 

Perhaps MI could be incorporated as a prelude to compassion-based interventions?

In particular, MI could help potential participants to explore and enhance their sense of importance regarding living a more compassionate life, and their confidence in being able to do so. 

​Furthermore, these interventions often include (a) engaging with, and attending, the intervention’s sessions, sometimes 8 weekly 2-hour sessions, (b) to complete the self-practice for homework, especially loving-kindness and compassion meditations, and (c) to take steps towards specific compassionate or self-compassionate actions in daily life. These specific behaviours could be the focus of MI in compassion-based interventions.

The world is facing enormous challenges at the moment. Fear and anger are being used to motivate people to hunker down, self-protect, and exclude and reject others. Ultimately this is causing greater suffering. MI could make a wonderful contribution to helping people to explore more deeply their values and their abilities to take part in making the world a more compassionate place.

​References:

• Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.
• Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53, 6-41.
• Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111.
• Jazaieri, H., McGonigal, K., Jinpa, T., Doty, J. R., Gross, J. J., & Goldin, P. R. (2014). A randomized controlled trial of compassion cultivation training: Effects on mindfulness, affect, and emotion regulation. Motivation and Emotion, 38(1), 23-35.
• Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the Mindful Self-Compassion program. Journal of Clinical Psychology, 69, 24-44.

The more I practice MI, the more I research and read about MI the more I am convinced that empathy is both necessary and perhaps at times sufficient for change to occur. I recently facilitated an empathy workshop in my local community in Christchurch. I was inspired by an Amnesty International project in Berlin Germany called ‘Look beyond borders’

https://www.youtube.com/watch?v=f7XhrXUoD6U.

The project aimed to close the gap between different people. In this case refugees and Berliners. It was based on a psychology experiment conducted in 1997 by Arthur Aron In his study, "The Experimental Generation of Interpersonal Closeness," he found that in as little as four minutes of eye contact with a stranger you can develop a bond, a closeness.

I thought it would be interesting to bring a group of about 40 strangers into one place and have them conduct their own four minute experiment, talk about empathy and how to bring down walls between people. I replicated the four minute experiment by asking complete strangers to interact with each other for four silent minutes and to report to each other what they were thinking and what the felt. The results were interesting. Some cried, others laughed, some were silent. Many new friendships were born. I can’t report on every outcome, but the experience was powerful, and I think it made a difference.

We need more empathy, not only in clinical encounters, where we know that relational skills are as important as technical skills. We need more empathy in civil discourse, and we need to remind ourselves that we are not that different from those who might look different or who come from different countries, religions or creeds. We all need empathy and compassion and to feel understood by others. We need to build connections and bridges between people. We do not need more walls.

Many practitioners have found Motivational Interviewing to be a useful addition to their work. While MI has become almost standard care over the past years, it is an individualized approach that requires some adaptation for group work.
MI helps people find their way to a better future – from a single habit or lifestyle change to a broader change in identity and one’s approach to living, MI helps people develop goals, clarify the importance of making changes in their lives, and develop greater confidence, resulting in feeling more energized to move forward and more able to take the risks that are involved in almost any change.
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MI in groups helps clients do this with a team on their side, providing camaraderie, support, and inspiration throughout the process of change. Whether MI groups are theme-based or heterogeneous groups, time-limited or ongoing, their purpose is to harness the power of group support to help people make changes that they believe will meaningfully improve their lives.

Facilitating this process in a way that maximizes potential while minimizing risk takes skill. Not only do group leaders need to provide competent motivational interviewing, but they must also weave together group members who have different styles, beliefs, needs and problems, and who are often at different points along the change pathway.
A positive climate provides the foundation; cohesion and a shared sense of purpose set the stage, and creative brainstorming and altruistic support help build momentum toward change.

Leaders deepen the conversation, exploring values, underlying feelings and other elements that can enhance or interfere with members’ progress toward goals. Members are guided through a series of topics that help them identify their most important goals, gain a clearer sense of themselves and develop greater confidence in their ability to achieve goals they set. MI group leaders balance their focus between individual client issues and broader group processes, keeping the group engaged and supportive, but respectful of differences and individual autonomy.

Whether you wish to lead MI groups or just explore how this approach can work, the two-day workshop can help you learn about and experience this approach. The workshop is highly experiential, with most of the time spent practicing the approach in working groups that allow for development and deepening over the two days together. We hope you’ll join us!

Chris Wagner

“We are really fortunate to have Chris come to Auckland (August 9-10th) to run a two day workshop on MI in groups. Currently there are still a few places left, so if you, or someone you know is keen to attend then click on this link to register” – Ken McMaster

What is “MI Matters”?
We are very excited to be bringing you our first edition of “MI Matters”, a newsletter created by members of MI Oceania, which aims to inform, stimulate discussion, and to bring you links to what is happening in the Motivational Interviewing world. At this stage we aim to publish it twice yearly and are really keen to receive feedback, suggestions and above all, contributions.

What is Motivational Interviewing?
Motivational interviewing is a form of collaborative conversation for strengthening a person's own motivation and commitment to change (Miller & Rollnick, 2013). We are hoping that MI Matters becomes a “collaborative conversation” that helps strengthen our own “motivation and commitment to change” in our work helping other people. 
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What is MINT?
The Motivational Interviewing Network of Trainers (MINT) is an international organization of trainers in motivational interviewing, incorporated as a 501(c)(3) tax-exempt non-profit charitable organization in the state of Virginia, USA. The trainers come from diverse backgrounds and apply MI in a variety of settings. Their central interest is to improve the quality and effectiveness of counseling and consultations with clients about behavior change. Started in 1997 by a small group of trainers trained by William R. Miller and Stephen Rollnick, the organization has since grown to represent 35 countries and more than 20 different languages.

So what then, is MI Oceania?
MI Oceania was formed by the local members of the Motivational Interviewing Network of Trainers (MINT). This not for profit group covers Australia, New Zealand and the South Pacific Islands.  
The founding members of MI Oceania are all passionate about representing an evidence-based, up to date face of MI, particularly in our region.
"I am so happy we have finally launched MI Oceania. This gives us a platform to really promote the key ideas around best practice which is based upon engaging in respectful ways and privileging the story of those who walk in the door to work with us. They are actually trusting us with their inner lives. I am really excited. We now have 57 MINTies in this part of the world which is just fantastic".
Ken McMaster                                                                                      

The Motivational Interviewing Network of Trainers has a great reputation for generously sharing resources including research and training material. Click here to link to some of the latest in MI resources.
We would love to hear from you if you have a great MI ​resource that you would like to freely share with others. This may include an internet link, a book, cards, games, training or clinical resources.

David Prescott, who is a member of the Motivational Interviewing Network of Trainers recently wrote a blog titled -
“Implementation, Integration, and ‘Implegration’: Science and Practice”. Link to the Blog here…

In 1983, William R Miller published the first Motivational Interviewing article. Since then, the research world has seen an explosion in the number of papers published regarding motivational interviewing. It took twelve years for the number of MI-related papers published in Cinahl, Medline and Psychinfo combined to reach double digits. Since then, we have seen amazing growth, such that in 2013, there were 1,274 papers published. The use of MI has extended far beyond the world of addiction and substance dependence, and now includes areas such as mental health, dual diagnosis, problem gambling, employment, housing, social justice, criminal justice, health care and health coaching, exercise, classroom management, parenting, teaching and supervision. Basically, anywhere that behaviour change is needed. Initially the focus of MI research was firmly focussed on “can MI help in this area?” It has now shifted to “how do we assist people to learn MI, and how do we know when they have learnt it, and can use it effectively?” This is the world of implementation science – moving research from the lab, to real life. These questions that we grapple with, are issues close to the heart of David Prescott, who wrote a blog about “implementation, integration and implegration” (a term coined by Carl Åka Fabring).
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Dean Fixsen, in his keynote address at the MINT Forum in San Diego in 2010 highlighted that people cannot benefit from treatment they do not receive, so our challenge is to strive to use Motivational Interviewing, in the best way possible, in bringing about change. This involves going beyond simple implementation, to thoughtfully integrating the process within the culture and context of the setting. We hope that MI Matters encourages you in this, and we look forward to you sharing your learnings with the broader MI world.

​The newest members of MINT who recently attended the 3 day TNT in Melbourne

MITRIP stands for Motivational Interviewing Training, Research, Implementation, Practice.  MITRIP is an online journal that publishes articles related to these areas, qualitative as well as quantitative studies, case presentations, descriptions of innovations in MI practice or training, and theoretical or conceptual articles, as well as informal contributions related to the activities of MINT members worldwide. It is a place to find out about what is happening in Motivational Interviewing, and to keep up with what is happening in  the world of MINT. However, make sure to browse other Journals and online research pages to keep up to date with MI research.

“It’s moments like these you need MINTies”
A total of 40 people from diverse organisations from Australia, New Zealand and Hong Kong attended a 3 day TNT in Melbourne. The training was facilitated by Terri Moyers, Helen Mentha and Kylie McKenzie. This is what they had to say about the event…

A total of 83 delegates attended the fourth International Symposium on MI. The delegates were privileged to hear opening video messages from Bill and Stephen who set things rolling.  Even though we are on the other side of the world we can still be connected as a community of MI practitioners, trainers and researchers.

Click here to watch the ISMI Keynotes speakers who included…

• Dr Terri Moyers - Beyond motivational interviewing: What MI has contributed to the broader field of psychotherapy 
• Dr Denise Ernst - Not leaning in: Integrating equipoise and MI
• Dr Allan Zuckoff - Motivational Interviewing and the Challenge of Improving Treatment Adherence
• Casey Jackson & Kelly Franklin - Effectively implementing system change 
• Jillian Bleazby - Motivational Interviewing: The Queensland Quitline Experience
• Trudy Johnson - The Art and Science of Engaging Young Parents   
• Alison Bell - Capturing the Spirit of Motivational Interviewing in Online Learning  
  
  

The final session included a panel discussion about “What I know (or pearls of wisdom)” featuring Kylie McKenzie, Denise Ernst, Terri Moyers, Allan Zuckoff and Ken McMaster.

We were privileged to have Denise Ernst facilitate a three-day MITI 4 workshop which ran concurrently with the Oceania MINT Endorsed TNT.  The MITI 4.1 is the most recent version of an MI coding system which allows researchers and MI trainers to assess MI practice and provide objective and subjective feedback to MI practitioners.
Dr. Ernst has participated in the development and refinement of the family of MI coding instruments, including the Motivational Interviewing Skill Code (MISC) and the Motivational Interviewing Treatment Integrity (MITI) coding system, to determine treatment fidelity, practitioner skills and the critical elements of good MI practice. She has developed, trained, and overseen coding labs. With strong quantitative and analytic training and experience, she is committed to ensuring inter-rater reliability, utilizing a variety of methods to accurately assess that reliability.
If you are interested in learning more about the MITI, please go to: Motivational  Interviewing   Treatment Integrity Coding Manual 4. 2.1

We hope to bring you examples of MI applications in future editions of MI Matters. These may include stories from the front line, practical practitioner perspective on the use of MI, and examples  from areas such as: corrections, health care, mental health, addiction, youth, families, education, employment, social {housing}, cultural applications, organisational and change management. Please let us know about your use of MI and how it has been applied in your work setting, perhaps even how you have begun to conceptualise the role of implegration in change.

The Berlin forum was a stimulating 3 days with additional preforum workshops. The forum is only open to members of MINT but the organisation is keen for members to continue to share learnings from “the heartland” and bring insights from other disciplines and domains. Every year a plenary session is dedicated to an expert form a field outside of MI. This year it was John Ballatt who gave a fascinating presentation on “Intelligent kindness: Culture and Practice in Care Systems”, outlining a practical, evidence based approach to assisting healthcare systems to be more effective, functional organisations.

In his plenary with Steve Rollnick, Bill Miller spoke about the obligation on psychology to make key learnings freely available in service of others, referencing the seminal paper by George Miller (1969). Bill shared 15 of the key the learnings from MI he considered robust and important enough to share widely with the broader community:
On change:

1. Ambivalence about change is normal
2. Ambivalent people already have their own motivations (for and against) and if we listen, we are likely to hear both
3. Such motivations take different forms of speech
4. There is a balance between pros and cons, and change tends to happen when that balance tips toward the pros of change
5. People literally talk themselves into or out of change

On conversations about change:

1. The mindset of the clinician matters: what you see is what you get
2. Empathic listening matters (and empathy is a learnable, measurable skill)
3. Affirmation also matters
4. When people are ambivalent, persuasion evokes defensiveness
5. Pushing back against the negative normally strengthens it
6. A guiding style that helps people to voice their own motivations for change encourages them to move toward change

On learning complex skills (such as communication about change):

1. Expressing to another person your intention to make change increases the likeliness it will happen
2. Knowledge about a skill (reading, observing, attending workshops) normally does not change practice much
3. People tend to overestimate how much they have learned (ie their use of a new skill)
4. Feedback and knowledgeable coaching based on observed practice improves skill.

He suggested that a key role of workshops on MI was to help people to learn enough about MI to decide if they want to put the effort into learning it - which will take time, practice and, ideally, coaching. This is the equivalent of going to a “try out” session for a sport or musical instrument.
It was announced that the next MINT forum will be held in Montreal, which means anyone who missed the TNT in Melbourne this year can apply to attend the MINT TNT 26-28 September 2016 and join their new MINT colleagues for the forum on 29 September to 1 October 2016. If you are interested in applying, you can register your interest at mint.tnt.applicant@gmail.com and feel free to reach out to any of the local members of MINT for more information.

References:
Ballatt, J & Campling, P (2011) Intelligent kindness: Reforming the Culture of Healthcare, RCPsych Publications, London.
Miller, G (1969) Psychology as a means of promoting human welfare, American Psychologist, 24(12), 1063-1075.

If you know of some funny, curious, puzzling things that have happened in the MI world of training/research or practice let us know. ​