C4 Innovations

Motivational Interviewing 17: Helen Mentha

An episode of “Changing the Conversation” podcast

Helen Mentha shares real world strategies for helping people move to where they want to be using Motivational Interviewing approaches with host Ali Hall.

April 18, 2022


Ali Hall, Host (00:05): Hello, and welcome to Changing the Conversation. I’m your host today, Ali Hall, calling in from San Francisco, California. I’m a trainer and consultant in Motivational Interviewing. Our topic today is Motivational Interviewing, or MI In the Wild. My guest today is Helen Mentha, calling in from Melbourne, Australia. She’s a clinical psychologist with a background in substance use counseling. For the last 12 years, she’s been training and coaching in Motivational Interviewing. She’s recently the author of Someone Good to Talk To. Helen, thanks for joining us today.

Helen Mentha, Guest (00:42): It’s great to be here.

Ali (00:44): Well, welcome. This idea of MI, Motivational Interviewing or MI in the wild, what’s that about?

Helen (00:52): I spend so much time training people in the principles and skills of Motivational Interviewing, like what’s this framework, what’s this model. Sometimes I can feel a lot of pressure, that now we’ve got to be doing that, or that’s what gets done in research, but the real world is a lot messier. Often, I find people get excited about these ideas, and they feel like it really fits with their values. They maybe try some skills, and they get excited, more excited because it gave them a good conversation back, and then the messiness of real conversations gets in the way, and it can start to feel like, “Oh, if I can’t do this perfectly, maybe I shouldn’t be doing it.”

Helen (01:38): I think this idea of ask not what we can do for MI, but what can MI do for us? How can this help us in the real world? It might not look like it does in a research study, and that’s fine.

Ali (01:53): Yeah, it’s really interesting. I think I hear clinicians talk a lot about “we’ve got so much to do and so little time” and putting a lot of pressure on themselves really to somehow make a lot happen. I’m guessing that working hard and putting burdens on our shoulders and trying to make things happen isn’t quite the idea, it isn’t quite what we have in mind in MI.

Helen (02:17): No, and I think if we think about that from the client’s point of view, I’ve worked with a lot of agencies, and I have never had an agency tell me that when their clients come to intake, ask for help, their clients never say, “Can you give me the really jaded burnt-out worker who wonders if they make a difference anymore and who wonders if they’re getting it right?” We all want to see someone who wants to see us. I think if we can come back to that, we can embrace and make room for more of the messiness and the normalness of human conversations, where these ideas and skills can then support that practice, but it’s not about executing these technical skills at some ideal level.

Ali (03:06): It sounds like there’s a simplicity involved in a certain way, and yet a lot goes into making things simple. What are some tips that you can give to clinicians to make that balance work?

Helen (03:21): Motivation Interviewing is the art of doing basics at an increasingly thoughtful level. The urge can be, “I need more. I need another technique. I need an extension of this practice,” and it can feel counterintuitive to come back to, “Oh, maybe I’ve just got to lean into something even more basic.” I want to lean into listening. I really want to come back to listening and this idea of sometimes we come out of a conversation going, “Oh my goodness, I was just listening,” rather than, “Oh, wow. I was really listening!” And valuing that, honoring that.

Helen (04:03): Coming back to, “If I do nothing else in this conversation, can I show curiosity in their point of view? If I do nothing else in this conversation, can I remember to ask them what they know before I think to tell them what I know?” Sometimes it’s about bringing it back to seemingly fundamental things, but they make a real difference. The research, the process literature, that looks at what works across different kinds of helping conversations, different kinds of treatment, backs that up, that these are the ingredients of good conversations where we’re more likely to have something good happen as a result of them. Coming back to these fundamentals of just a good conversation, leaning into what might help this person feel comfortable with me, and then what might help this person feel like this is time well spent for them and us.

Ali (05:06): What helps the person feel heard and understood, what helps the person feel valued and respected, what helps the person facilitate their own self-exploration, what helps the person move from where they are to where they might want to be, it sounds like.

Helen (05:22): Yeah. That can feel, I think, as you mentioned earlier, that there is so much pressure on clinicians’ time and that urge to achieve more, it can feel like you’re going against the tide. I’m slowing it down in order to try and move further forward. There’s a quote from the Bill Miller, the main person behind MI is saying, “MI can feel like you’re taking the scenic route, but it really might be the shortcut,” this idea of just slowing and coming back to the present moment. I do think a strategy there is in MI we get quite comfortable with asking how ready is this person for change, and yet, how often do we stop before we see someone and ask ourselves, how ready am I for this person, how ready am I for this conversation?

Helen (06:18): It might be what you do in the five minutes before you have the conversation, just coming back to the present moment, what’s my intention for today? If I just do one thing, if I just pay attention to one skill of MI or one principle, one quality I want to have in this conversation, more likely that will happen, but if we go in frazzled, we might get a frazzled conversation back.

Ali (06:46): Yeah. When I hear you talk about it feels like, it may not be easy to define, but it feels like there’s a vibe of the thing, for lack of a better word. But if there was a vibe of a thing, what would that vibe be?

Helen (07:02): That’s a good question because we talk about the vibe here in Australia, this is absolutely what we are looking for, that the music is more important than the notes. I think for different workers, if you can find your own definition, what’s that one, two or maximum three words that captures the kind of conversation that you want to have. For me, I come back to my core values, this is about treating people with respect, this is about treating people with curiosity and having faith that they have a whole lot to bring here and let’s find that out before we start thinking that we need to add something that maybe we’ve got to offer or we think that maybe is missing or how do we really meet this person. I think it’s different things for different people.

Helen (07:51): I had a colleague ask me once, “If you could only teach one element of MI and nothing else, what would it be?” I imagine if you line up a whole lot of different MI trainers, everyone will give you a slightly different answer. For me, it’s the idea of autonomy, that if we can just really get this clear sense that it’s not our life, it’s not our consequences, if we can draw a really clear line in the sand that this is about them making decisions that they can live with and honoring that. Also, I think the pragmatic side of autonomy is letting go of this idea that we think we can control someone else’s thoughts or feelings or behavior, because it’s not under our control. That then frees up our energy to go, “Well, what is under my control in this conversation?” Me, only me. Let me be more thoughtful about what I do in my half, let them have their half, but if we’re more thoughtful in our half, maybe the whole conversation will go better.

Helen (08:52): I find, for me, when I just come back to this idea of “it’s not my life, it’s not my consequences, I don’t have to live with the choices that this person makes, they do,” how do I help them make a truly informed decision that they can live with, for me, that brings a lot of the other principles into play, it helps me access more of those skills. For someone else it might be coming back to the idea of curiosity, something else. Finding our touchstone, finding our simple one concept that grounds us, that’s easier to access when you’re out in the wild than trying to remember everything of the model and trying using it all at once.

Ali (09:31): Yeah, you would have to get down to basics if you were in the wild. It sounds like there’s a genuineness, presence, all of that is so key. I also understand the urge to want to grab the steering wheel out of the other person’s hands, and yet we can’t control others’ outcomes. We can take very good care of the process, but that requires a lot of trust. What would you say about the role of trust in this whole thing?

Helen (10:01): Trust is earned, trust is built. This idea, one, we go, “Okay, well they don’t have to trust us. We need to earn that trust.” I think that same process applies in trusting MI. For myself, I’m quite visual or story-based, so I have moments from my own practice that I try and hang onto when that urge is happening, that time that I hung in there even though every fiber of my body was screaming. I remember one conversation with a client who asked me point blank, three times, “What do you think I should do?” and it just felt like we weren’t quite ready to go there, but trust me, I had my thoughts screaming at me. If we’d filmed that conversation, I would’ve looked constipated, she would’ve looked a bit frustrated in moments, but it felt like we were achieving enough in the conversation, she felt okay. I thought, “Well, maybe I can just hang on to this till near the end of the conversation, and I can offer the thought I’m having,” and that helped me hold it.

Helen (11:08): Then right near the end, I thought, “Maybe I don’t need to say this, I think we’ve covered enough. If this is still so important, I can pick this up next time. I’m pretty sure she’ll come back,” I felt like we had enough connection. We made another time, I remember walking her to the front door of our center, she turned around to me, and she said almost word for word exactly what I had been busting to tell her. By the time we saw each other again, she’d been putting that into practice in a way that if I had tried to persuade her of that or convince her of that, if that had come from me rather than from her making that connection, I think the work would’ve really slowed down.

Helen (11:50): I try and remember those kind of moments where it paid off, even though it felt awkward. Even though it wasn’t smooth, it was good. Like I said, I’m quite visual, story based, so I’ll remember specific moments for someone else. It might be they just remember a phrase, something that just brings them back to, “This is what I want to hang onto now.”

Helen (12:18): I think the other part is giving ourselves some grace that we’re not going to achieve that all the time. One of the things that I’ll often talk about is MI won’t stop you giving unwanted advice. It might stop you enjoying giving unwanted advice, but if you do give unwanted information or advice or you jump into that prematurely, that’s okay, just try not to back it up with more. Don’t keep going, give yourself at least five minutes quarantine before you maybe think to do that again. We can give ourselves some forgiveness in the conversation, because I think the intention, I want to catch that. Saying sorry to a client, “I’m sorry. I think I jumped in a bit too quickly with my own ideas, and I don’t think we’ve really explored where you’ve got to with this. Tell me more about that,” we can always stop and recalibrate as well.

Ali (13:15): Yeah, it really speaks to conversation repair. I’m also wondering about the role of silence. We hear clinicians who are often very uncomfortable when they hear a silence between them and the person they’re serving. There is something so valuable about it at the same time. It is hard, I think, for people to sit still in those moments and not try to fill it with themselves, but to remain connected and let the person come forward into it. But what are your thoughts about the role of silence?

Helen (13:47): It is valuable and, for some of us, it is a learned skill. I think of it being like on a treadmill, you might be able to go 30 seconds, then a minute, then five minutes. It’s something that we can build up our capacity. One of the phrases I’ve found helpful, because as someone who is a chronic over-thinker, this is something I’ve had to really work on, silence is a sound of the other person thinking. If I’m talking, they can’t hear themselves think. That it’s helped ground me. I know other new colleagues who sometimes will just sit there and give themselves a slow count of five, slow, something that just slows them down while staying present and listening. Sometimes we need the strategies rather than the client needs the strategies.

Ali (14:37): That really makes sense. I wonder a little bit about this idea of unconditional regard. I listen to a lot of conversations in my role as an MI coach, and I have heard somewhere it feels like the practitioner is really basking the person being served in the warmth of a vacation sun or something like, that the warmth is so complete and so total and that there’s nothing that person can say that would cause the clinician to withdraw their regard. It’s not merited, there’s just nothing precarious about the situation, the acceptance is just so incredibly strong. What would you say about the role of unconditional regard?

Helen (15:27): Yeah, I think that’s the heart of where Motivational Interviewing comes from, with the roots in Rogerian client-centered therapy. Also, I think it’s fundamental in the change process as well, not just in the conversation. There’s that classic quote from Rogers, which I’m about to butcher, but it’s something like, “When I can truly accept myself, then there is potential for change.” Often we talk about MI as a way of resolving ambivalence, whereas I think really it’s a way of helping someone to experience their ambivalence. If we can’t hold that, if we can’t hold the acceptance that this is where they are, how can they? If we can create that sense of acceptance of who they are, where they’re at, what they’re saying, what they’re struggling with, then they may also be able to tolerate that because so much of the struggle, the push-pull, is it gets so uncomfortable, you want to shut it down, “I’m just going to do what I normally do, I’m going to push that away.”

Helen (16:30): If we can help create that space, not only can the person feel honored and safe and valued, which in itself is part of why they might go on to make change, because they get in touch with their own value, also they get to, “Oh, maybe this discomfort, this tension I’m experiencing, I can tolerate it, I can be in it.” That in itself can free up that possibility, that energy, that maybe something else could be possible.

Ali (17:02): It isn’t always the time for change. I know in your book, Someone Good to Talk To, you’ve written about seasonal change. What’s that about?

Helen (17:13): Sometimes I think we get a lot of pressure on workers, that if their role is about a particular kind of presenting issue, their job is to fix that issue. Whereas if we can take a step back, think about it more like how do we cultivate a garden, the idea of seasons, that there are times in our life, we have these times of more energy for change and then times maybe of more just consolidating something, and if we can tune in to where is this person in their seasons of change, this may be spring, there may be a whole lot about to be possible, or this may be winter, but it’s not nothing happening. Where are they? Maybe this is a time just for a seed to get planted, maybe this is a time to just protect a little brand new shoot for something different, maybe this is a time when they’re about to blossom, but if we can take a step back, I think we take the pressure off ourselves that we’ve got to do it all at once.

Helen (18:19): I’m sure you’ve got those TV programs where they do a renovation of someone’s backyard on a whole weekend, and it goes from looking not so great to amazing. If you’ve ever seen a show that does the follow-up not by that show, someone else, sometimes those gardens have cracks, things die, maybe damage was done because it was all done too fast. This idea of letting nature do its thing, letting change happen in its own cycles and that lets us tune into where are you in your change process, what could we do that makes the next part of the process more possible?

Ali (19:03): A bit back to trust again, it sounds like.

Helen (19:06): Yeah, trusting in a broader idea of this is someone’s life, not just a problem to get fixed. That gives us some space as well.

Ali (19:16): Helen Mentha, thank you so much for joining us today for our conversation, MI In the Wild, and thank you for all that you do to make the world a better place.

Helen (19:26): Thank you. It’s been an absolute pleasure.

Ali (19:28): To our listeners, please join us next time on Changing the Conversation.

Erika Simon, Producer (19:32): Visit C4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.


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