Motivational Interviewing in Corrections-National Institute of Corrections-DC Public Safety Radio

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Radio Program available at http://media.csosa.gov/podcast/audio/2012/03/motivational-interviewing-in-corrections-national-institute-of-corrections-dc-public-safety-radio/

[Audio Begins]

Len Sipes:  From the nation’s capitol, this is DC Public Safety. I’m your host, Leonard Sipes.  Ladies and gentlemen, today’s program is going to deal with motivational interviewing in corrections.  The whole idea of motivational interviewing is something that is really of interest to people throughout the criminal justice system, especially in corrections.  It’s a way of gaining the trust of the people that you’re dealing with, the offender population, the client population.  It’s a way of motivating that individual to do the things that that person should do.  We have two national experts with us today.  The show, by the way, has been arranged by the National Institute of Corrections.  We have Bradford Bogue.  He is Director of Justice System Assessment and Training. He has been a motivational interviewer trainer since 1993.  His Web address is j-stat.com.  We also have Anjali Nandi.  Anjali is currently the Program Director for the Center for Change, a state licensed adult outpatient drug and alcohol treatment facility in Colorado. She’s been a member of the International Motivational Interviewing Trainer, a network of trainers since 2003 and to Bradford and to Anjali, welcome to DC Public Safety.

Anjali Nandi:  Thank you.  It’s a pleasure to be here.

Len Sipes:  Okay.  Bradford, what is motivational interviewing?

Bradford Bogue:  Motivational interviewing is really a form of holding a conversation with somebody to draw out their and help and find their motivation for changing some of the things that are troubling them.  We talk about it as being a style, and it’s sort of situated somewhere between following and listening on the one hand and directing and teaching on the other hand.  It’s kind of an integration of those two very common conventional styles for holding conversations.  And we talk about that place between those two as being guiding.  It’s a place where we guide someone to find their own solutions.  And it’s particularly adept at helping people work through their ambivalence to change, which is a very normal part of changing behavior.  So that’s it in a—

Len Sipes:  Anjali, what is your take on motivational interviewing?

Anjali Nandi:  I think Brad captured it well.  The only thing I will add is that there are primarily two pieces to motivational interviewing, one is a real focus on relationships and then the other is being strategic about what we’re looking for as the client is giving us information about themselves, looking for particular language and things like that.

Len Sipes:  Okay one of the—

Anjali Nandi:  So that’s the only thing I would add.

Len Sipes:  I want to point out to the audience, “Motivational Interviewing in corrections, a comprehensive guide to implementing motivational interviewing in corrections” is available from the National Institute of Justice – I’m sorry – The National Institute of Corrections, U.S. Department of Justice, and we’ll have the link within the show notes. But the bottom line to both Bradford and Anjali is to try to get the individual who is caught up in the criminal justice system – and I understand this goes way beyond the criminal justice system.  But in terms of our bailiwick, what we’re trying to do is to prompt change in that individual and this is a method of prompting that change, correct?

Bradford Bogue:  Yes, that’s right.  I would say it’s with that person and emphasize “with” rather than “to” because prompting often is something we do to somebody but it’s working with and holding that conversation and structuring it in a way that the person is more likely to come up with their own reasons for change.

Len Sipes:  And, Brad, you’re the one, you’re the author of this document that I just mention from the National Institute of Corrections, correct?

Bradford Bogue:  I’m a co-author with Anjali.

Len Sipes:  Oh, both of you were involved in this, okay.

Bradford Bogue:  Yes.

Len Sipes:  Now the part of the document that I like the best is comes on page 52.  It says, “People make their best efforts to change when motivation comes from within and maintaining one’s autonomy of choice.  The notion that people ultimately decide for themselves whether they will change a given behavior is universal and an important attribute as a human being.”  So basically, unless it comes from that person it’s not going to work.  Whatever we in the criminal justice system try to do with that individual that unless it comes from that person, unless it comes from deep inside that person that they want to change, that they want to get involved in change, it’s not going to happen, correct or incorrect?

Bradford Bogue:  Anjali, what do you say?

Anjali Nandi:  Well I’m hesitating a little bit because it’s not entirely correct.  I don’t want to give the impression that if the client comes in and says, “You know I don’t really want to do this.”  But we say, “Okay, well then leave and come back when you’re motivated.”  Motivational interviewing is actually helping the person find these motivators.  Even if there are things that the client doesn’t want to do when they first come in.  So oftentimes when a client comes into our agency they don’t want to do there.  They are upset about being there.  And we look for what their goals are and sometimes they’ll say to me, “Well my goals, my only goal is not to see you any longer.” And to me that’s an excellent goal.  And it’s something that I will absolutely help them work towards because it works in the larger perspective as well to keep them away from crime.

Len Sipes:  It’s the matter of breaking through a barrier?  Help me understand this.  Is it a matter of breaking through a barrier?  We can’t – we, and as far as the criminal justice system, cannot just sit in front of a person and read them the riot act.  We cannot just sit in front of a person and tell them this is what you need to do.  This is how you need to do it and now go out and have a pleasant day.  This involves somehow, some way, breaking through that person, reaching that person, understanding that person, figuring out what motivates that person and to try to get that person to understand that there’s a better way of doing things.

Bradford Bogue:  Well to try to be motivationally adherent with motivational interviewing you can do that.  You could read them the riot act, but you’re not likely to get results related to changing behavior.  The results you’re likely to get from that is a possible reaction effects from the client which they dig in deeper, because all you’re offering them is the very thin side of the argument.  If you’re taking on the side that why they should change when you’re reading them the riot act, all you’re giving them is the side why they may not want to change.

Len Sipes:  Right.  So there is going to be almost immediate resistance to that sort of encounter?

Bradford Bogue:  It would create discord, yes.

Len Sipes:  Okay and so what are the techniques?  What is the secret sauce in terms of getting through to a person who’s resistant to change?

Bradford Bogue:  Well, Anjali, how about I start out with a couple big chunks and then you follow up.  How would that work?

Anjali Nandi:  That sounds great.

Bradford Bogue:  Okay.  Leonard, a couple – looking at it very globally, motivational interviewing is about two basic components.  One is what we call the motivational interviewing spirit, the spirit of MI, and that has to do about how – really how the individual practitioner, the staff person is with themselves, how they relate to themselves, and how they relate to other people in general and it’s as much unconscious as it is conscious.  It’s just how you hold yourself and how comfortable are you in your skin and what do you project onto the world in terms of your view of other people.  So that’s kind of the foundation piece and we talk about that as being the music in MI, and then the lyrics are the technical skills that we learn.  And many of the technical skills are used in many other therapeutic strategies as well.  But some are unique to MI.  And they have – we scaffold them up and I think Anjali could – I’d like to hear her chime in on this too.

Len Sipes:  Go ahead, Anjali.

Anjali Nandi:  So, yes, Brad has sort of laid out the larger picture.  There’s the spirit and then there’s the skills. Within the skills, I would say there is some, what we call, basic or micro skills like open questions or affirmations or reflections which are really at the heart of motivational interviewing.  But I think an important piece here is learning to listen to what the client is saying and listen for change or listen for their own motivations, listen for discrepancies as they’re talking.  So while a lot of it are these kind of skills that we can teach, a huge part of learning motivational interviewing is learning what to listen for and how to work with what you’re getting from the client.

Len Sipes:  And if you’re getting – so help me out because I’ve done gang counseling on the streets of the City of Baltimore.  I’ve done a year of running a group in a prison system. I’ve done jail or job core kids.  These kids and these younger individuals are oftentimes very difficult to reach.  It’s very difficult to find that magic moment in their lives that you can reach out to them and draw them in the conversation and have them truly interact with you in a meaningful way.  Many of these individuals come from extraordinarily difficult backgrounds, harsh backgrounds. They don’t trust you.  They don’t trust us within the criminal justice system.  What breaks through that barrier?

Bradford Bogue:  Well part of it is relational.  Just building – going through a very set process of engaging people.  I shouldn’t have said “a very set” but a kind of a natural process of engaging someone and helping them work through their ambivalence about even – as Anjali suggested earlier – about even being there in the first place, about working with you.  And so, learning to work with that and touch on and be willing to draw out from the client, what their doubts are, what their hesitations are and ambivalence about being there and then as you build a relationship and find that the person is getting more engaged, then you can begin to focus where you want to go and where the client wants to go, most importantly, in your engagement and what’s troubling them.  And as you begin to get a focus on that, then drawing out from the client very deliberately what their motivations might be, some of the things that – what their strengths are around that particular change target and the reasons and their needs and some of their desires and so that process – we talk about — the new way that we’re looking at MI is really talking about four processes and we talk about engaging, focusing, evoking and planning.  And it’s these are kind of like stair steps and one builds on the other so that at any given time there might be a need to go back to the earlier previous process and then move forward.  So it’s kind of recursive in that way.

Len Sipes:  Is this basically sales?  Is this the same central point that sales people learn about in training when the sales person is training, actively listening to the individual, being really in tune with what it is that they’re interested in, being reflective of what it is that they have to say, all of these are basic sales techniques, correct?

Anjali Nandi:  Well, there is a sales component to it I think except there’s a fundamental difference.  And, to me, a part of that difference is that what I’m selling them on is their own motivation, their own reasons, their own strengths and ability rather than what I want.  I mean if I’m selling somebody something, I have a real goal there to get them to buy this particular item.  Whereas here I’m trying to look for what it is that will support them the most.  So I think that’s one of the differences.  Bard, maybe you can see some others.

Bradford Bogue:  Well I think, I agree with Anjali that there’s some similar aspects but one of the – when you’re selling, I don’t believe you’re having compassion for the other person and having their best interest at heart is really necessary to sell somebody. It might be necessary to collaborate with them.  It might be even necessary to draw out from them their reasons to purchase something, but it isn’t necessary to really respect their boundaries and to appreciate them.  And that’s where – those are aspects of the spirit I mentioned earlier.  They’re really essential for motivational interviewing to build that – to find that trust for people to do the heavy lifting necessary to make some changes in their life.

Len Sipes:  Motivational interviewing has been around for quite some time.  This is nothing new, according to the document.  It’s been around for decades, correct?

Bradford Bogue:  That’s right.  Well it’s been around but it’s still not well known within many sectors, and if it is known, it may only be known nominally and not practiced at a deeper level of proficiency yet.  It takes some doing to learn how to use motivational interviewing.

Len Sipes:  But from reading the document, I got the sense that it’s used within the psychiatric profession, the medical profession, a lot of the professions where it’s vital to maintain or to establish a relationship with an individual within the medical model that this concept has been around for a while.

Bradford Bogue:  Yeah, the development of MI, it’s ARC.  It’s really interesting.  It started out originally just for people with alcohol problems.  It quickly – and it was developed in response to some of the kind of polarizing or punitive approaches that we were using back in several decades ago in the addiction’s field here in this country.  And then it spread quickly to other chemical and then non-chemical addictions such as addictions or anorexia or other disorders.  And then, after that, it continued to spread much to the amazement of the originators, William Miller and Stephen Rollnick, and into healthcare and to a wider – much wider variety of problem behavior issues than they ever imagined.  Post surgery, renal patients, male on male, unsafe sex, all kinds of things, diabetes, and often there’s been clinical trials that have followed the interest and found the evidence that it’s working in these areas.  So motivational interviewing is spread like top seed to many different kinds of social service sectors and continues to spread now.  But now, unlike many of the previous sectors where there might have been small agencies, if there were any agencies or individual therapists, now it’s motivational interviewing is coming into corrections.  The significant different is it’s coming into large bureaucracies.  Typically for corrections you don’t just have one corrections person working corrections in some jurisdiction.  You have organizations and quite often they’re very large involving thousands and thousands of people.  And that entails their organizational culture and all the intrigue and levels and filters and red tape that comes with that.  And so it’s a new kind of engagement to implement motivational interviewing in these larger sectors.  And it’s really an interesting wonderful one too because it’s looking like it’s bringing in a kind of humanizing effect on some of our very punitive or correctional organizations.

Len Sipes: I want to reintroduce our guests, more than half way through the program, Bradford Bogue.  He is the Director of Justice System Assessment and Training.  He has been a motivational interviewer trainer since 1993.  The address is www.j-sat.com.  Also at our microphones today, Anjali Nandi.  She is with the Center for – currently the Program Director for The Center for Change, a state licensed adult and outpatient drug and alcohol treatment facility in Colorado, www.center-for-change.com.  All right. So the idea is that this has been around for a long time within the medical profession, and it works.  I mean that’s the point — either Anjali or Bradford, that is the point is that this has a long history of success in terms of motivating individuals within the medical model, correct?

Anjali Nandi:  That is correct.  I think what Brad was pointing out also is how the implementation though is different and difficult, more difficult I think in the corrections field and that’s why this first part of the book focuses on implementation issues in corrections.

Len Sipes:  Yeah and that’s one of the reasons I want to bring – but first I want to fully establish the fact there is a strong body of success.  So if we’re moving this from the medical model into the correctional model, the folks within the correctional system need to understand that there’s a strong scientific basis for this being a practical and workable and successful application.  So we have to agree to that first.  And then we move to corrections.

Bradford Bogue:  Leonard, absolutely true.  So motivational interviewing is on the SAMHSA registry for evidence based practice as well as some others.  And there’s been over 200 random clinical trials on motivational interviewing and the volume of research continues to expand progressively around motivational interviewing.

Len Sipes:  Right and so that’s the principle fault.  It has a long history of success within other fields and now we’re bringing it to corrections and, Bradford, you mentioned that there’s some times a bit of a difficulty in terms of bringing it to the correctional system.  Probation and corrections, I mean it’s a huge entity. I mean there are seven million people under the custody of correctional agencies, either in prisons, jails or in parole and probation supervision.  So and we’re a hard nosed cynical lot and we certainly want the best for the individuals that we deal with.  We certainly want to see them succeed.  But what you’re saying is that it’s time for those of us, if we want to be successful, if we want to get drug addicts into treatment, if we want to get mental health people involved in treatment, if we want that to be successful, if we want them to find jobs, we’ve got to do motivational interviewing because – not because it’s the right thing to do.  We do it because it works.

Bradford Bogue:  Well, yes and it works in a few ways.  It works first of all and foremost with our clients and we need to do a lot of research in the criminal justice system.  Not much has been done with motivational interviewing at this point.  There’s only – but so more of that needs to follow.  But from the research that has been done in other related fields like addictions, folks with cocaine problems or opiates or what have you, we know that it works.  The other thing that it does, though, that makes it the right thing to do, is it’s looking like it helps people that are practicing it as well.  And so there’s evidence that people practice MI, for instance, in the prisons in Sweden who adopted six or seven years ago, I believe, motivational interviewing across the whole nation’s system, they ran some trials and found that with clinical trials that it reduces the cortisone or stress levels of people that are using it as opposed to people that weren’t trained in it.  So it gives people that are working in the system a better sense of agency in what they’re doing day to day and working with other people.  It gives them a purposeful – it clarifies and helps them within in terms of what their mission is and one interaction to the next working with different people.  I like – you know there’s a line from Shakespeare, that kindness is the one virtue that does double duty.  It’s good to the person it’s bestowed on and it’s good for the bestower.  And I see that every – each experience I have training or coaching in motivational interviewing.  Anjali, what’s your take?

Anjali Nandi:  I think you’ve captured it. Not sure what to ask [INDISCERNIBLE] twice given for sure and impacts the clients and in a lot of way makes things easier for me as a practitioner as well.  In trainings, after delivering a training, I will receive a follow up email from people who have been in the training who say it used to feel like I was boxing with a client the whole time and now it feels like I have this conversation and then I leave and it really is up to the client to take the next step and there’s the sense of calm that seems to be experienced by the folks who are using motivational interviewing.

Len Sipes:  But I’m still struggling to find that secret sauce, that magic moment in terms of your interacting with a person either on parole or probation or within the correctional setting what it is that we’re trying to do.  I mean we’re trying to find that spark, that interest in that individual and we’re trying to find that glimmer, that hope, that sense of – you know one of the things I always wanted to do is to become a carpenter or one of the things I always wanted to do was to shake this drug habit of mine but I’ve never been able to do it.  But it doesn’t come that easy.  It doesn’t come that straightforward.  They’re just small pieces of humanity that you latch onto and reach out to and investigate. I mean is that what we’re talking about?

Bradford Bogue:  Well I think it’s experienced in moment to moment in a myriad of ways but the common theme across that is that people – when someone is working with them and applying a motivational interviewing a style or engaging on I should say is that they get to hear themselves think and they get to reflect a little bit and that reflection brings up quite often those ah-ha moments for the individual.  But they get to reset, recalibrate who they are and where they want to be with their – so there’s lots of small little opportunities to be had in a conversation.  And I think motivational interviewing it is fascinated with what the language is that we use.  We’re always looking at the kind of language that we use with the clients and the kind of language that they use in turn and how the language we use influences the language that they use and based on that kind of understanding and knowledge we can then begin to more systematically kind of help them focus and find the kind of solutions that they might want to find.

Len Sipes: It’s interesting that you should say that because just last week I did a radio show with Garrett College in terms of a very successful juvenile justice program where two thirds were successful where ordinarily 70 to 80 percent are unsuccessful.  So they had a wonderful result, and I kept hammering away what was the secret sauce, what was the key ingredient, and she kept coming back to the fact that it was the way that we address them, the way that we treated them, the way that we interacted with them.  It sounded as if she embraced the whole concept of motivational interviewing from the very beginning.  She said it was the way staff approached the juvenile population.  Instead of from a custodial approach, it was from a helping approach, a humanistic approach, and she said that that made a huge difference in terms of their rate of success.

Bradford Bogue:  Yeah, Leonard, I’d like to read you something, a quote from a researcher and expert in corrections that says that regarding “how effective any officer is working with offenders will depend to a great extent upon his conviction about people, his respect for them as human beings with all their shortcomings, his appreciation of the uniqueness of each person with whom he is working, his belief in the capacity of people to change and his conviction that true change must come from within.”  That was written 51 years ago in 1961, and I probably don’t need to tell you or probably many in the audience that we’re still struggling with how to bring that part of ourselves to work, you know, that sees the best in other people.  And I think motivational interviewing is not something that’s readily trained.  In fact, we’re not even sure training is the ticket to the movie much less the movie.  The evidence on developing motivational interviewing skills that we have through random controlled trials on training motivational interviewing where we randomly assign different practitioners to different conditions.  You read the book.  You just go to a training and this group over here goes to coaching only for instance, those kind of studies indicate the key ingredients are really getting imperial objective feedback from someone who has trained to code what you’re saying and doing with the client imperially and coaching.  Those are the keys.  And we got into this book – just to give you a quick background in this—

Len Sipes:  We only have a couple minutes left.  Go ahead.

Bradford Bogue:  Okay.  I’ve been training motivational interviewing in corrections for about 19 years and The National Institute of Corrections early on was the only agency that was willing to kind of explore getting tape critiques and giving people feedback through tapes and they began to do that more and more.  At the same time many motivational interviewing trainers were beginning to learn that out approach of train and pray was really bankrupt in terms of bringing motivational interviewing into correctional entities at any significant level and that we needed to shift the paradigm away from just assuming training could do the job and adapt a paradigm that’s more about staff development and following through with tape critiques and coaching.  So we talk about it as wave one, which is the first 10 years that we were trying, experimenting with bringing motivational interviewing into corrections simply through training.  You know send your staff to a two or three day training for instance and then wave two where we still may train, but we’re really interested in the follow up is where the action is and getting tape critiques from folks and then follow up with phone coaching or face to face coaching and get them into a cycle.  It usually takes three or four cycles through that of taping and coaching to get people to a level of proficiency where they really, according to the research, likely to get those nice effects in terms of the outcomes they want.

Len Sipes:  Okay, we have to close with that, Brad.  I guess today – our guests today have been Bradford Bogue.  He is the Director of Justice System and Assessment Training. He has been a motivational interviewer trainer since 1993, www.j-sat.com.  Also joining us today, ladies and gentlemen, has been Anjali Nandi.  Anjali is a Program Director of the Center for Change, a state licensed outpatient drug and alcohol treatment facility in Colorado.  Ladies and gentlemen, this is DC Public Safety.  We’re up to 133,000 requests on a monthly basis. We appreciate your letters.  We appreciate your emails.  We appreciate your phone calls and in feedback in terms of the program and we want everybody to have themselves a very, very pleasant day.

[Audio Ends]

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