Growing MI: Training Minds, Shaping Practice Pt.3

What does it take to truly learn Motivational Interviewing, and how do we build the kind of environments where that learning can stick?

In this third episode of the ISSUP Exchange series, Dr. Goodman Sibeko continues the conversation with Professor Stephen Rollnick, this time turning the focus to MI training: what works, what doesn’t, and why developing competence is more about mindset than mastery.

They discuss the common struggle practitioners face in shifting from a directive, expert role to a more collaborative, supportive stance, and why that shift matters. The episode also explores challenges in MI training delivery, the limits of cascade models, and the crucial role of leadership and organisational culture in making MI more than a box-ticking exercise.

Whether you’re delivering training or receiving it, this conversation challenges the idea of MI as a quick-fix technique. Instead, it calls for a deeper commitment to shared values, honest reflection, and ongoing learning rooted in the fundamental question: what does it mean to be helpful?

Featured Voices 

Host – Dr. Goodman Sibeko 

ISSUP Global Scientific Advisor.

Head of Addiction Psychiatry, University of Cape Town.

LinkedIn: goodmansibeko

Twitter/X: @profgsibeko

Guest – Professor Steve Rollnick 

Clinical Psychologist.

Co-founder of Motivational Interviewing. 

Visit: www.stephenrollnick.com
 

Transcript

Goodman Sibeko (00:01)
A warm welcome to you and thank you for joining us for this ISSUP podcast. I am Goodman Sibeko, the ISSUP Global Scientific Advisor and your host. You can find me on LinkedIn and all the socials at the handle @profg.sibeko. You can find ISSUP on LinkedIn, X and Blue Sky. Just type in ISSUP and you'll find us easily. ISSUP, the International Society for Substance Use Professionals is a global membership organisation supporting the substance use prevention, treatment, recovery, and harm reduction workforce. With over 42,000 members, ISSUP connects professionals worldwide sharing evidence-based resources, training, and networking opportunities. Membership is free, so visit us at issup.net to join and access webinars, events, and a wealth of useful training and knowledge share materials.

Steve, thank you so much for being back for this next session, where we're really going to be delving into training in motivational interviewing. What does it look like to receive training in motivational interviewing? What does one need to think about? What are the implications for wanting to disseminate capacity building in motivational interviewing? So I guess my first question to get us started, Steve, is it an easy competence to achieve?

Steve Rollnick (01:15)
Brilliant question. You know, I've seen, seen some people fly with it and others less so. Common to both is the need for a kind of a mindset switch from I'm here to solve your problems to, I'm here to have a helpful conversation in which, I've got your back while you work out how you want to proceed. Supported by my advice, not dominated by it. So that's it in like, you know, one sentence, I guess. But some people do struggle to let go that expert position, that paternalistic expert position. And they get a bit confused because they feel they want to give advice, which is perfectly legitimate and very helpful. But they kind of confuse that with everything else they do. And really we're talking here about a mindset switch. So, but if someone is interested in becoming competent and can take on board that mindset switch, I think they can reach a level of competence. You know, the people using motivational interviewing as a form of therapy have got very high standards. Okay, they got high standards, they've done the research as well and it does impact people's behaviour and change. But I don't think every practitioner needs to hit that level of competence to be helped.

Goodman Sibeko (02:33)
That is such an important caveat, that not everybody has to have the same advanced level of competence. Because if we're honest, the core principles of motivational interviewing are actually quite simple. So one doesn't necessarily need to become an expert. I think one thing that is a reality is a lot of folks who will get sent for training in motivational interviewing will have been sent by their managers or by the hospital or by their policymakers. Some of them may not have an interest in motivational interviewing. So I guess my question to you is, does the recipient have to want it? Is it possible to teach someone and have them take on board the principles of motivational interviewing, if they haven't come and said, hey, I want to acquire these skills? I think it's a trick question. I'm sorry, Steve.

Steve Rollnick (03:23)
It's a wonderful question. Look, let me think. That's hard work. And you've got to inspire people with stories and questions. And that I would ask a question of the person who sent them there in the first place and say, what sort of leadership is that? What we need to help them with is to realise that as leaders, this is not sending people away to learn a technique to come back. This is actually asking people to learn something that involves a substantial change in their perspective at work. And the better leaders are people who say, hang on, this is a journey we are all going on. Okay. And this journey is driven by certain common values. And those values are things like we treat everybody as people first, not I'm a doctor, you're a nurse, or I'm a practitioner and you're a patient. There's some fundamental mental values that run right through everything we do in this organisation. Now that's a question for the leaders, okay, not for the practitioners. But if you find yourself in an organisation where those kind of shared values can be expressed and worked on, then those people who've never heard of motivational interviewing and maybe don't want to, they will be brave enough to consider change themselves. But in the absence of leadership and in an environment that is governed by those values, it's going to be hard.

Goodman Sibeko (04:48)
That's an interesting spanner in the works, isn't it Steve? Because I think a lot of the conversation about motivational interviewing is focused around how do you help clients change? Maybe we don't have enough of the conversation about what is the organisational change that needs to happen in order for motivational interviewing to be an effective intervention tool for practitioners. And some of what you're talking about is organisational culture and making sure that folks are in a space that will enable them to be effective practitioners of motivational interviewing.

Steve Rollnick (05:19)
And to see it as a process, not an event. So it's not like you go away on a course and then you learn motivational interviewing. It's a journey. It's a process of becoming more skilful. And that's not easy. And that, and you have to learn from each other. And a workshop is just a single moment of opportunity for people to learn. But really the real learning takes place back in the environment. so leaders need to create, a learning environment. And I don't think that's hugely complicated. That's why I'm inspired by some of the work you guys have been doing, because we're not talking about a high resource process if we're saying, let's get folk together talking about the tough consultations they have once a month and let's talk about it let's be honest with each other and let's learn on the job. I mean, I don't know what your experience has been like. You've been working in your team to distribute good practice in substance misuse. I mean, the best experiences you've had.

Goodman Sibeko (06:27)
I think we've been lucky, Steve. I think we spoke about the fact that a lot of the folks who are in this space are here, driven by either a personal experience or an experience of somebody that they know. But overwhelmingly, these are practitioners who have been in these communities for some time and are hungry and really desperate for measures to help people move forward and adopt change and adopt practices that give them better outcomes in their quality of life.

So we've found that most people that we've trained have been primed already and are ready for the process. And we've retained a faculty and a community of contact with them that allows us to continue to see how they've evolved and how they interact, not just with their clients, but with themselves and with each other. So that element of surrendering to this being a process and not an event is one that really resonates with me, Steve.

Steve Rollnick (07:22)
Yeah. And maybe Goodman, we've got to shift the way we think about it, right? Which is that if we've got an organisation or a treatment environment and we want them to learn MI, maybe we got to start with something more fundamental, which is like, "Guys, what does it mean to be helpful? What is helpfulness?" I would start there. Okay. So that's the big lesson for me that I've learned over the decades. Because if you start with that question, like what is helpfulness, right? What you discover is that in order to be helpful, I've got to be self-aware and I need to think a little bit about what I bring to this and what I don't bring to it. What does it mean to be unhelpful? Okay. Forget about motivational interviewing. What does it mean to be unhelpful? Well, a group of practitioners asking themselves that question will quite rapidly reach the conclusion, agree basic principles or ask them the question, when you've been really helped.

What is it in the other person that was helpful and not helpful? What do you find helpful and not helpful? So, you know, if I had to do this all over again, I'd start there, Goodman. Because otherwise what happens is people think motivational interviewing is something outside of them that they do to or on these clients that they see and they need to be trained in this something else. Actually, no, then what we're trying to do is help people learn how to be helpful themselves. And motivational interviewing is just one set of ways. It's one way of being helpful and it's not the only way.

Goodman Sibeko (08:55)
I feel validated here, Steve, because this is something we ensure that we build into some of our training interventions. What we'll often say to them is, what does it feel like for you to feel like somebody has helped you? What does it feel like for you to feel like someone has heard you? And could you think of someone as an example, who's made you feel like that and describe them to us and what did they do? How did they listen? What was their body posture? How did they reframe what you'd said to them?

Steve Rollnick (09:23)
And you don't need three degrees in order to be able to discuss this. You don't need any. You don't need any degrees. You just need to be a human being who's driven by compassion and an interest in helping other people. That's it. Bang.

Goodman Sibeko (09:36)
You've pre-answered my next question to you, but I know that a lot of the colleagues who might listen to us, to our chat, might have this next question. They might say, so these might be, for example, managers who want to send some of their staff for training, or it might be someone who's considering getting more advanced training and motivation interviewing. So the question is, how important in your view is it to have baseline psychotherapeutic competence?

And I guess I could ask this question on two levels. I could ask this question as how important is it for the practitioner receiving the training to have baseline psychotherapeutic competence? On the other hand, how important is it for the trainer to have that competence?

Steve Rollnick (10:17)
That's a great question. If we could just rephrase the word psychotherapeutic and say baseline helpfulness skills. Okay. It takes some of the sting of specialist psychotherapeutic practice out of it. I would say absolutely, it's essential. So it's essential to have baseline counselling skills or helpfulness skills for both the trainer and the recipients. Because the trainer's got to be able to model good practice. They've got to be able to live and breathe the very methods that they're teaching. And if MI is one of those methods, it's a good idea for them to, it's not just an intellectual task, this.

Goodman Sibeko (10:58)
It sounds again to me, Steve, that in some ways we're going back to that, maybe we are, but that organisational culture question. If you're talking about a primary healthcare facility where clients are going to receive medical attention, links to other services, the core or the basic need for them to achieve or to access the assistance they need is baseline helpfulness, isn't it? So the service providers need to be helpful as a baseline.

Steve Rollnick (11:31)
And sometimes they do need to step in with firm advice if they're working in a primary healthcare environment. So that's perfectly legitimate. I'm not saying it's not a good idea, but they need to learn when is the time for me to step in and say, look, okay, yeah, I'll help you manage this because it's a whatever problem, a diabetes regulation problem or whatever. And when are those other times when actually I put a different hat on? I put, if you like, a hat of a guide rather than a problem solver. And it's those hat switching activities that I would want to help them with. I don't know if that's helpful.

Goodman Sibeko (12:07)
It is and it isn't. It is because I think you raise an important point that there's a place for both. There's a place where you ultimately have to manage this client and you have to manage this emergency room if you're in an emergency room. But that on the other hand, we are aware that to achieve certain outcomes security wage lays to change in behaviour for if that when that's the main outcome that you then can't be directive in that way. I feel like that's a discussion we're going to have to have one day. What does the switch look like? How do you effectively train somebody to make the switch? And how do we make sure the switch is not harmful?

Steve Rollnick (12:46)
Very good question. Off the top of my head, would say fundamental is to form a good connection, if you like, with this human being, whatever approach is. If you've got a good connection with a human being and you've actually shown some interest and respect for them, okay, they will give you permission to step in with firm advice if that's what you feel is needed, especially if you ask their permission.

So perhaps we're separating these two inappropriately, you know, that there's a foundation for helpfulness and at times you swing one way towards offering firm advice and at other times you show respect for their ability to solve the problem for themselves, but the foundation is there. How's that? Does that make you feel better?

Goodman Sibeko (13:32)
It does, but it's causing me to ask more questions, which is good. More questions is good. It's causing me to evaluate how I've thought about this in the past. And I'll give it, I'll sit with it some more Steve, and we might have some more conversations about it. I think one thing that we often grapple with on our side when it comes to training, does the cascade model work for training and motivational interviewing. Can a group of motivational interviewing master trainers such as my team is train nurses or social workers to go and train non-specialist providers? Does the cascade model work?

Steve Rollnick (14:08)
Have we seen good examples of it working? I wonder.

Goodman Sibeko (14:11)
I'd argue that part of the challenge is that we've probably all been too hesitant to try it out, certainly in a scientifically robust space. What we've certainly done on our side, which we've shared with you in the past, is developed sort of the core elements of motivational interviewing to share with non-specialists. So if we say we want to train you to be mindful and aware that you need to be collaborative, compassionate, that you need to be good at reframing. So the core, basic elements of motivational interviewing. But then you're not necessarily training someone in the full spectrum of motivation. You're training them in the spirit of motivational interviewing.

Steve Rollnick (14:55)
Maybe that might work. And I confess, like I've done a lot of training of specialists and non-specialists. I'm less familiar with the idea of a cascade. I've seen whole environments change. I've seen whole services change so that they're aligned with motivational interviewing on quite a large scale. I've seen cascaded efforts not succeed. And again, I think that swings back around to the leadership and what the values the leadership in an organisation convey and work on. So it's a tricky one. I fear that there isn't a simple yes, no answer to cascaded training. I fear.

Goodman Sibeko (15:36)
I agree with you, Steve. And I would hope that if someone's listening to this podcast and they have some reflections on this, that they would reach out and share. And we'd love to hear your thoughts. So please go ahead and share those. Steve, I think to a large extent, you've also probably covered what will probably be my last question in this section about training. I guess I'm being repetitive, but I think it will help our listeners. What's the best way to increase competence in motivational interviewing?

Steve Rollnick (16:03)
Change people's hearts to begin with through stories, leadership and rituals, gatherings where people are discussing problems. So like I give you an example. Big London teaching hospital respiratory medicine, specialist respiratory medicine environment. Once a week they have lunch together. I was astonished. I was really astonished because there they are, eating their sandwiches, talking about patient problems, talking about themselves, learning, am I on the hoof? You know, and I think that's the best way to increase competence, is to do it together with stories and case reviews and enthusiasm and heart.

Goodman Sibeko (16:45)
Thank you. We're going to end this one here. We'll come back in the next session to talk about research in motivational interviewing. Please do join us.

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