Learning Motivational Interviewing: a thematic analysis exploring Health Professionals' training experiences

Abstract

Aims: This study explores how training in Motivational Interviewing (MI) is experienced and given meaning by 23 multi-disciplinary health professionals. It uses a qualitative interpretative thematic analysis, aiming to identify key elements in the process of learning and applying MI consultation skills in their clinical practice. Setting/method: The health professionals were recruited from two MI training programmes in Scotland, they worked in either cardiac rehabilitation or substance abuse settings. The time elapsed since training workshops for each participant varied between 4 months and three years. Data were collected electronically via E-mail and participants completed either an open-ended questionnaire or a reflective diary. Results: The data obtained via these data collection methods was rich and informative and it revealed several key experiences and factors for successfully learning and applying MI. MI training is an emotional experience before, during and after workshops. Learning MI is challenging, and a shift in professional identity with clinicians feeling temporarily deskilled is a common experience. Practice with real clients, supervision and other reflective practices, facilitate and are crucial for learning effective MI skills, and developing competency can take years. MI is also seen as powerful and concerns about sensitive disclosure may arise, that may inhibit practicing MI skills. Clinicians also find it challenging to adjust to new ways of thinking and behaving, and often revert to the more traditional authoritarian expert approach they are used to. When clinicians become more competent and skills are consolidated, they experience an increased sense of professionalism and confidence in their ability to facilitate clients in making informed choices about their health and about illness management. They also experience less stress and dissatisfaction with resistant clients. Several additional facilitators and barriers are discussed. Conclusion: The study raises implications for MI training theory and practice and adult learning theories. The findings suggest that learning MI is emotionally demanding and tiring, and that building MI competency requires a considerable amount of time and resource. This needs to be taken into account, when planning and implementing MI training programmes if these are to succeed in embedding MI culture in health services.