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Hello everyone and welcome to another episode of Am I for Change?
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All right, guys, so let's get to this.
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I have a little bit of a confession to make.
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Um, I'm gonna tell you something that I don't always love admitting.
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I don't think a lot of us like admitting when we are wrong or when we feel like we're failing, right?
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I'm probably not the only one.
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And this is a, I guess we can call it a funny thing and um or an interesting thing, but I teach motivational interviewing.
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That doesn't come as a surprise, right?
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I talk about motivational interviewing all the time.
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I train people, I speak in conferences about motivational interviewing.
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I tell people that MI can completely change the way we approach parent conversations.
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And there was a time, especially early in my MI practice, when I had a session where I walked out thinking, okay, this stuff doesn't work.
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And I remember being super frustrated because in my mind I had done everything I was supposed to do.
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I use open-ended questions, I reflected, I didn't jump with advice, I try to stay away from my writing reflex, I try to stay curious, I try not to direct the conversation.
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And the parent was nodding.
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She agreed with everything, she said all the right things.
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And when the session ended, I remember thinking nothing is going to change.
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And that was a very uncomfortable thought.
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Because if I'm telling other people that MI works, but I'm sitting in my car thinking, I don't think this is going to work with this parent, then I have a problem.
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And I remember thinking, was this just a really difficult parent?
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Did I miss something?
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Did I do MI wrong?
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Or even does MI actually work?
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Or have I just convinced myself that it does?
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And maybe you've had your own version of that.
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I know that when I started in the ABA field, there were times where we were trying to put a behavior on extinction and it was getting worse.
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And I was like, oh my gosh, if it's getting worse, then that means that I'm doing the procedure wrong.
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I haven't identified the right function.
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I really don't know what I'm doing.
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And that happens sometimes.
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You finish a parent session and you're thinking, I use the open-ended questions, I reflected, I try not to lecture, I did all the things, and somehow nothing.
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The parent agrees, the conversation sounds good, and then absolutely nothing happens afterwards.
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So what do you do with that?
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Do you decide MI doesn't work?
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Do you decide ABA doesn't work?
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Do you decide the parent isn't motivated?
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Do you decide or think, well, this is just one of those families?
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Or do you go back and actually diagnose what happened?
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Because that's what I eventually learned to do.
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And honestly, that changed everything for me.
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It wasn't that MI was not working.
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I didn't yet know how to recognize why the conversation wasn't working.
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And that's what we're going to talk about today.
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Here's something I want you to think about.
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When we say MI didn't work, that's actually a pretty big statement.
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What does that even mean?
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Did the parent not agree?
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Did they agree but not follow through?
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Did they shut down?
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Did they talk a lot but never get anywhere?
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Did they say yes to everything and then do absolutely nothing?
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Because those are all very different things.
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And if you just label all of that like MI doesn't work, we miss the opportunity to figure out what actually happened.
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And that's something that I want to bring up today.
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Because sometimes it's not really about whether it worked or not.
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When we go back and we look at the conversation, you can ask, where did we lose the thread?
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And when I started really doing that and pinpointing where that was, I noticed something.
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A lot of the sessions I thought weren't working weren't actually failures of MI.
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They were failures of timing, process, and yeah, even diagnosis.
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And that distinction matters.
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Lemmly explain what I mean.
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One of the biggest things I realized was that sometimes I thought I was evoking, but I wasn't.
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I thought, okay, now we're going to talk about motivation.
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So I would ask, why is it important to you?
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What would be different if this change?
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Or why do you want this to be different?
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These are excellent at my questions.
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There's nothing inherently wrong with these questions.
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But there's a problem.
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What if the parent is still not engaged?
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Or what if they are still stuck in that engage?
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And what if they're still deciding, do I trust you?
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Are you actually listening to me?
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Are you judging me?
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Are you about to tell me everything I'm doing wrong?
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Because if that's where the parent is, asking them to go deeper into motivation might be way too much, might be way too soon.
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And what happens?
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They give you the answer they think you want.
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They nod, they agree, they say, Yes, I really want to work on this.
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And you're sitting there thinking, great, we're making progress, but you're not necessarily hearing genuine motivation.
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You may be hearing socially appropriate agreement.
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And those are not the same thing.
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That's when I realize something has to change.
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Sometimes a right MI question at the wrong time is still the wrong question.
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And we know that timing is everything.
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Imagine telling a joke at like a funeral, right?
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Or saying something and putting your foot in your mouth in the wrong situation or the wrong setting.
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We can't just focus on did I use her right and my technique?
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We have to focus, was it the right technique in the right time?
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And then there's those parents who seem completely on board.
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You know the the ones that are completely on board, and you're having a conversation with them, and they're like, Yeah, absolutely, that makes sense.
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I can do that.
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And you're thinking, wow, this is going great.
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And then the next week comes and nothing happens, and we are confused, but they agreed to the plan.
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They said they wanted to do this.
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Hey, mom or dad, you told me you were going to try it.
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So what happened?
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Sometimes what happened is that we move to the plan before we really understood ambivalence.
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Because here's the uncomfortable truth.
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A person can want something to change and also not want it to change at the same time.
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A parent can say, I really want my child to be more independent, and simultaneously think, but if I stop helping him, what if he fails?
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They can want their child to sleep independently and also be afraid of what that bedtime would look like.
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They can want to be more consistent and also be exhausting.
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And if you're a parent, you know about exhaustion.
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Both things can be true, and that's ambivalence.
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And if we never give that ambivalence space to come out, we can mistake agreement for commitment.
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This happens all the time.
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The parent says, Yeah, let's do it, but internally they're like, I don't know if I can actually do this.
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Oh, then we build this plan on top of that.
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That's not necessarily a motivation problem.
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We may have simply moved on too quickly.
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And this one is probably the hardest to recognize because we like to think I'm very good with parents.
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I get it.
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I like to think that too.
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But being warm isn't the same thing as being engaged.
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You can be friendly, you can be kind, you can have great report or think you have great report.
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And the parent can still not feel safe enough to tell you what they actually think.
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And if they're not telling you what they actually think, you're working with incomplete information.
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Think about it.
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A parent might be sitting there thinking, I don't agree with this intervention, but they don't want to disagree with you.
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You are the authority.
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So they say, okay, or that sounds good, or yeah, we'll try it.
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And then go home and don't do it.
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And we might label that as poor parent follow-through.
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But what if the actual issue was that we never created enough space for them to say, I'm not sure about this.
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That's very different.
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And that's why engage matters so much.
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But engage isn't just about building rapport.
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It's let's create enough safety that the person can actually be honest with me.
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Because I don't want a parent who agrees with everything I say.
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I want a parent who feels comfortable enough to disagree with me, to say, I don't think that's going to work in my house.
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That's useful information.
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Now we're working with something that is the truth.
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This is where the four processes become so helpful for me.
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Because instead of leaving the session thinking, oh, that didn't work, I can actually go back and ask myself some questions.
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Like, where was this parent?
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Was I still unengage?
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Did we ever really establish focus?
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Did I actually evoke their motivation or did I jump straight to the plan?
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And here's a really important part.
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I can diagnose the conversation instead of diagnosing the parent.
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And that's a big difference.
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Because it's very easy to say this parent isn't motivated, or this family doesn't fall through, or they just don't buy into ABA.
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But those statements don't actually tell us what happened in the conversation.
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And sometimes, if we're honest, the problem wasn't the parent.
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We, yes, us pointing the finger at myself as well, we skip the step.
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We move way too quickly.
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We asked the wrong question.
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We didn't reflect enough.
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We didn't explore ambivalence.
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We offered a solution before the parent had identified the problem in their own words.
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And that's much more useful because now I have something I can change.
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Once I started thinking about sessions this way, I became much less afraid of sessions that didn't go perfectly.
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And I actually think that's one of the biggest benefits of having a framework.
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Because now when something goes sideways, I don't have to panic.
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I can ask, okay, where did we lose threat?
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Maybe I moved into the focus too quickly.
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Looking at the transtheoretical model of change that I speak about in a lot of my trainings.
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Maybe the parent is still in the pre-contemplation.
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They're not ready to go to the other stages yet.
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Next time I'm going to spend more time identifying where they are, trying to engage more.
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Maybe I got into evoke, heard some change talk, and immediately I jumped to the plan.
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Okay, next time I'm going to stay there.
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Maybe the parent agreed to the plan, but we never really explored their ambivalence.
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Okay.
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Next time I'm going to slow and ask, what makes this difficult?
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What concerns you about making this change?
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What would make you hesitate?
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Now I have somewhere to go.
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And that's why I don't want people to hear MI as here's a collection of communication skills.
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Go ahead and use them.
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That's why I stay away from saying these are your tools, which sometimes I do say these are your tools for your toolbox.
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But then I reflect on it and then I say, well, actually, because the reality is that it's not enough.
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You need structure around the techniques.
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You can't just use the techniques in different ways.
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There has to be a framework.
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And I think this is also where we need to be really honest about motivational interviewing because MI isn't magic.
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It doesn't mean that every parent is suddenly going to become motivated because you ask one beautiful, open-ended question.
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I wish it were like that, but it isn't.
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It doesn't mean every conversation is going to end with, wow, you changed my life.
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Sometimes people are still in ambivalence.
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Sometimes they aren't ready to go there yet.
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Sometimes the relationship needs more time.
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And sometimes the issue is bigger than just one conversation.
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And that is completely okay.
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Evidence-based doesn't mean guaranteed.
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I want to repeat that evidence-based or empirically based doesn't mean guaranteed.
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It means we have a structure approach that gives us something we can intentionally apply, observe, and refine.
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That's very different than just be empathetic and hope that it works.
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So I want to leave this with you all.
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If you're in a session and you've thought, MI doesn't work with this parent, I want you to try something different.
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Don't start by asking, what's wrong with this parent?
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Start by asking, where were we in the process?
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Were we still in engage?
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Were we in focus?
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Did I evoke their own reasons for change?
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Did I give enough space for ambivalence?
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Did we build the plan together?
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Or did I get excited because I heard one little piece of change talk and suddenly go, great, here's what we're going to do.
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Don't get ahead of yourselves.
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The goal isn't having a perfect session.
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The goal is to understand your session well enough that when something doesn't work, you know what to look at.
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That's the difference between MI failed and saying, okay, that conversation didn't work.
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Let's figure out why.
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So if you've tried MI and you've had that didn't work moment, don't throw the whole thing away.
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Go back, look at the conversation, ask yourself, where did I lose the thread?
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Because there's probably something there.
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Maybe you moved too quickly.
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Maybe you skipped engage.
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Maybe you never really found focus.
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Maybe you forgot about ambivalence.
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And the beautiful thing about having a framework is that now you have somewhere to look.
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That's why structure matters.
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Not because we want our session to sound robotic.
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We all want to stay away from that.
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Not because we want clinicians walking around with a checklist thinking, okay, I asked my three MI question.
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That's not really MI.
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Structure gives you something much more useful, a way to learn from what happened.
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And that's the belief I really want to reinforce with this episode.
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MI isn't magic, it's not intuition, and it's not just being nice.
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It's structured, evidence-based approach that we can learn, practice, evaluate, and improve.
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And when a session doesn't work, that's not necessarily proof that MI failed.
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Sometimes it's important to ask yourself, hey, maybe I skipped a step.
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It's not just about the parent not being motivated.
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And if you want to go deeper into exactly how to recognize which stage you're in, what to do when you've moved ahead too quickly, and how to troubleshoot some of these things, I would really consider my motivational interviewing bootcamp.
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It's 10 CU Self-Paced and is designed for BCBAs, RBTs, BCABAs, anyone who's really interested in working with parents or who has been working with parents and wants to have a framework of how to use these skills.
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And of course, the free AOA guide is there too.
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If you want something practical, just take a look at it.
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It's on the link in our show notes.
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Thank you so much for sharing this space with me, and I hope to see you in our next episode.
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Thank you for joining me on today's episode of MI for Change.
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If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on demand courses designed to help you put MI into practice with confidence.
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You can learn more at www.drmonicagilbert.com.
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Until next time, keep asking the questions that spark change.
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Hello everyone and welcome to another episode of Am I for Change?
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All right, guys, so let's get to this.
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I have a little bit of a confession to make.
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Um, I'm gonna tell you something that I don't always love admitting.
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I don't think a lot of us like admitting when we are wrong or when we feel like we're failing, right?
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I'm probably not the only one.
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And this is a, I guess we can call it a funny thing and um or an interesting thing, but I teach motivational interviewing.
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That doesn't come as a surprise, right?
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I talk about motivational interviewing all the time.
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I train people, I speak in conferences about motivational interviewing.
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I tell people that MI can completely change the way we approach parent conversations.
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And there was a time, especially early in my MI practice, when I had a session where I walked out thinking, okay, this stuff doesn't work.
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And I remember being super frustrated because in my mind I had done everything I was supposed to do.
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I use open-ended questions, I reflected, I didn't jump with advice, I try to stay away from my writing reflex, I try to stay curious, I try not to direct the conversation.
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And the parent was nodding.
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She agreed with everything, she said all the right things.
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And when the session ended, I remember thinking nothing is going to change.
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And that was a very uncomfortable thought.
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Because if I'm telling other people that MI works, but I'm sitting in my car thinking, I don't think this is going to work with this parent, then I have a problem.
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And I remember thinking, was this just a really difficult parent?
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Did I miss something?
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Did I do MI wrong?
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Or even does MI actually work?
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Or have I just convinced myself that it does?
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And maybe you've had your own version of that.
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I know that when I started in the ABA field, there were times where we were trying to put a behavior on extinction and it was getting worse.
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And I was like, oh my gosh, if it's getting worse, then that means that I'm doing the procedure wrong.
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I haven't identified the right function.
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I really don't know what I'm doing.
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And that happens sometimes.
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You finish a parent session and you're thinking, I use the open-ended questions, I reflected, I try not to lecture, I did all the things, and somehow nothing.
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The parent agrees, the conversation sounds good, and then absolutely nothing happens afterwards.
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So what do you do with that?
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Do you decide MI doesn't work?
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Do you decide ABA doesn't work?
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Do you decide the parent isn't motivated?
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Do you decide or think, well, this is just one of those families?
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Or do you go back and actually diagnose what happened?
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Because that's what I eventually learned to do.
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And honestly, that changed everything for me.
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It wasn't that MI was not working.
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I didn't yet know how to recognize why the conversation wasn't working.
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And that's what we're going to talk about today.
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Here's something I want you to think about.
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When we say MI didn't work, that's actually a pretty big statement.
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What does that even mean?
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Did the parent not agree?
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Did they agree but not follow through?
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Did they shut down?
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Did they talk a lot but never get anywhere?
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Did they say yes to everything and then do absolutely nothing?
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Because those are all very different things.
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And if you just label all of that like MI doesn't work, we miss the opportunity to figure out what actually happened.
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And that's something that I want to bring up today.
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Because sometimes it's not really about whether it worked or not.
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When we go back and we look at the conversation, you can ask, where did we lose the thread?
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And when I started really doing that and pinpointing where that was, I noticed something.
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A lot of the sessions I thought weren't working weren't actually failures of MI.
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They were failures of timing, process, and yeah, even diagnosis.
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And that distinction matters.
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Lemmly explain what I mean.
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One of the biggest things I realized was that sometimes I thought I was evoking, but I wasn't.
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I thought, okay, now we're going to talk about motivation.
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So I would ask, why is it important to you?
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What would be different if this change?
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Or why do you want this to be different?
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These are excellent at my questions.
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There's nothing inherently wrong with these questions.
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But there's a problem.
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What if the parent is still not engaged?
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Or what if they are still stuck in that engage?
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And what if they're still deciding, do I trust you?
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Are you actually listening to me?
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Are you judging me?
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Are you about to tell me everything I'm doing wrong?
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Because if that's where the parent is, asking them to go deeper into motivation might be way too much, might be way too soon.
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And what happens?
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They give you the answer they think you want.
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They nod, they agree, they say, Yes, I really want to work on this.
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And you're sitting there thinking, great, we're making progress, but you're not necessarily hearing genuine motivation.
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You may be hearing socially appropriate agreement.
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And those are not the same thing.
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That's when I realize something has to change.
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Sometimes a right MI question at the wrong time is still the wrong question.
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And we know that timing is everything.
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Imagine telling a joke at like a funeral, right?
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Or saying something and putting your foot in your mouth in the wrong situation or the wrong setting.
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We can't just focus on did I use her right and my technique?
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We have to focus, was it the right technique in the right time?
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And then there's those parents who seem completely on board.
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You know the the ones that are completely on board, and you're having a conversation with them, and they're like, Yeah, absolutely, that makes sense.
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I can do that.
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And you're thinking, wow, this is going great.
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And then the next week comes and nothing happens, and we are confused, but they agreed to the plan.
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They said they wanted to do this.
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Hey, mom or dad, you told me you were going to try it.
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So what happened?
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Sometimes what happened is that we move to the plan before we really understood ambivalence.
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Because here's the uncomfortable truth.
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A person can want something to change and also not want it to change at the same time.
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A parent can say, I really want my child to be more independent, and simultaneously think, but if I stop helping him, what if he fails?
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They can want their child to sleep independently and also be afraid of what that bedtime would look like.
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They can want to be more consistent and also be exhausting.
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And if you're a parent, you know about exhaustion.
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Both things can be true, and that's ambivalence.
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And if we never give that ambivalence space to come out, we can mistake agreement for commitment.
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This happens all the time.
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The parent says, Yeah, let's do it, but internally they're like, I don't know if I can actually do this.
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Oh, then we build this plan on top of that.
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That's not necessarily a motivation problem.
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We may have simply moved on too quickly.
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And this one is probably the hardest to recognize because we like to think I'm very good with parents.
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I get it.
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I like to think that too.
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But being warm isn't the same thing as being engaged.
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You can be friendly, you can be kind, you can have great report or think you have great report.
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And the parent can still not feel safe enough to tell you what they actually think.
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And if they're not telling you what they actually think, you're working with incomplete information.
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Think about it.
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A parent might be sitting there thinking, I don't agree with this intervention, but they don't want to disagree with you.
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You are the authority.
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So they say, okay, or that sounds good, or yeah, we'll try it.
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And then go home and don't do it.
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And we might label that as poor parent follow-through.
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But what if the actual issue was that we never created enough space for them to say, I'm not sure about this.
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That's very different.
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And that's why engage matters so much.
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But engage isn't just about building rapport.
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It's let's create enough safety that the person can actually be honest with me.
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Because I don't want a parent who agrees with everything I say.
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I want a parent who feels comfortable enough to disagree with me, to say, I don't think that's going to work in my house.
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That's useful information.
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Now we're working with something that is the truth.
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This is where the four processes become so helpful for me.
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Because instead of leaving the session thinking, oh, that didn't work, I can actually go back and ask myself some questions.
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Like, where was this parent?
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Was I still unengage?
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Did we ever really establish focus?
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Did I actually evoke their motivation or did I jump straight to the plan?
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And here's a really important part.
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I can diagnose the conversation instead of diagnosing the parent.
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And that's a big difference.
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Because it's very easy to say this parent isn't motivated, or this family doesn't fall through, or they just don't buy into ABA.
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But those statements don't actually tell us what happened in the conversation.
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And sometimes, if we're honest, the problem wasn't the parent.
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We, yes, us pointing the finger at myself as well, we skip the step.
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We move way too quickly.
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We asked the wrong question.
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We didn't reflect enough.
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We didn't explore ambivalence.
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We offered a solution before the parent had identified the problem in their own words.
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And that's much more useful because now I have something I can change.
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Once I started thinking about sessions this way, I became much less afraid of sessions that didn't go perfectly.
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And I actually think that's one of the biggest benefits of having a framework.
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Because now when something goes sideways, I don't have to panic.
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I can ask, okay, where did we lose threat?
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Maybe I moved into the focus too quickly.
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Looking at the transtheoretical model of change that I speak about in a lot of my trainings.
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Maybe the parent is still in the pre-contemplation.
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They're not ready to go to the other stages yet.
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Next time I'm going to spend more time identifying where they are, trying to engage more.
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Maybe I got into evoke, heard some change talk, and immediately I jumped to the plan.
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Okay, next time I'm going to stay there.
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Maybe the parent agreed to the plan, but we never really explored their ambivalence.
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Okay.
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Next time I'm going to slow and ask, what makes this difficult?
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What concerns you about making this change?
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What would make you hesitate?
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Now I have somewhere to go.
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And that's why I don't want people to hear MI as here's a collection of communication skills.
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Go ahead and use them.
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That's why I stay away from saying these are your tools, which sometimes I do say these are your tools for your toolbox.
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But then I reflect on it and then I say, well, actually, because the reality is that it's not enough.
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You need structure around the techniques.
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You can't just use the techniques in different ways.
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There has to be a framework.
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And I think this is also where we need to be really honest about motivational interviewing because MI isn't magic.
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It doesn't mean that every parent is suddenly going to become motivated because you ask one beautiful, open-ended question.
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I wish it were like that, but it isn't.
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It doesn't mean every conversation is going to end with, wow, you changed my life.
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Sometimes people are still in ambivalence.
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Sometimes they aren't ready to go there yet.
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Sometimes the relationship needs more time.
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And sometimes the issue is bigger than just one conversation.
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And that is completely okay.
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Evidence-based doesn't mean guaranteed.
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I want to repeat that evidence-based or empirically based doesn't mean guaranteed.
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It means we have a structure approach that gives us something we can intentionally apply, observe, and refine.
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That's very different than just be empathetic and hope that it works.
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So I want to leave this with you all.
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If you're in a session and you've thought, MI doesn't work with this parent, I want you to try something different.
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Don't start by asking, what's wrong with this parent?
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Start by asking, where were we in the process?
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Were we still in engage?
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Were we in focus?
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Did I evoke their own reasons for change?
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Did I give enough space for ambivalence?
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Did we build the plan together?
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Or did I get excited because I heard one little piece of change talk and suddenly go, great, here's what we're going to do.
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Don't get ahead of yourselves.
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The goal isn't having a perfect session.
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The goal is to understand your session well enough that when something doesn't work, you know what to look at.
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That's the difference between MI failed and saying, okay, that conversation didn't work.
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Let's figure out why.
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So if you've tried MI and you've had that didn't work moment, don't throw the whole thing away.
00:14:01.360 --> 00:14:05.919
Go back, look at the conversation, ask yourself, where did I lose the thread?
00:14:06.159 --> 00:14:07.759
Because there's probably something there.
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Maybe you moved too quickly.
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Maybe you skipped engage.
00:14:10.799 --> 00:14:12.720
Maybe you never really found focus.
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Maybe you forgot about ambivalence.
00:14:14.960 --> 00:14:19.600
And the beautiful thing about having a framework is that now you have somewhere to look.
00:14:19.840 --> 00:14:21.679
That's why structure matters.
00:14:21.840 --> 00:14:24.799
Not because we want our session to sound robotic.
00:14:25.039 --> 00:14:26.639
We all want to stay away from that.
00:14:26.879 --> 00:14:32.799
Not because we want clinicians walking around with a checklist thinking, okay, I asked my three MI question.
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That's not really MI.
00:14:35.120 --> 00:14:39.519
Structure gives you something much more useful, a way to learn from what happened.
00:14:39.679 --> 00:14:42.879
And that's the belief I really want to reinforce with this episode.
00:14:43.120 --> 00:14:46.799
MI isn't magic, it's not intuition, and it's not just being nice.
00:14:46.960 --> 00:14:53.519
It's structured, evidence-based approach that we can learn, practice, evaluate, and improve.
00:14:53.759 --> 00:14:58.080
And when a session doesn't work, that's not necessarily proof that MI failed.
00:14:58.240 --> 00:15:04.399
Sometimes it's important to ask yourself, hey, maybe I skipped a step.
00:15:04.639 --> 00:15:07.519
It's not just about the parent not being motivated.
00:15:07.759 --> 00:15:22.159
And if you want to go deeper into exactly how to recognize which stage you're in, what to do when you've moved ahead too quickly, and how to troubleshoot some of these things, I would really consider my motivational interviewing bootcamp.
00:15:22.320 --> 00:15:36.799
It's 10 CU Self-Paced and is designed for BCBAs, RBTs, BCABAs, anyone who's really interested in working with parents or who has been working with parents and wants to have a framework of how to use these skills.
00:15:37.039 --> 00:15:39.919
And of course, the free AOA guide is there too.
00:15:40.080 --> 00:15:43.200
If you want something practical, just take a look at it.
00:15:43.519 --> 00:15:46.000
It's on the link in our show notes.
00:15:46.240 --> 00:15:52.799
Thank you so much for sharing this space with me, and I hope to see you in our next episode.
00:15:54.480 --> 00:15:58.480
Thank you for joining me on today's episode of MI for Change.
00:15:58.879 --> 00:16:13.279
If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on demand courses designed to help you put MI into practice with confidence.
00:16:13.519 --> 00:16:20.159
You can learn more at www.drmonicagilbert.com.
00:16:20.399 --> 00:16:24.720
Until next time, keep asking the questions that spark change.
