Latest / The STA Clinician Podcast / Ep.284 'Communication Skills For MSK Clinicians: Part1 - Motivational Interviewing' with Orla Adams

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Ep.284 'Communication Skills For MSK Clinicians: Part1 - Motivational Interviewing' with Orla Adams · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across healthcare.
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May 2026. Welcome to episode 284 of the STA Clinician Podcast,
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formerly known as the Sports Therapy Association Podcast.
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So as always, this episode is being recorded live on the Sports Therapy Association
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YouTube channel and Facebook page at eight o'clock on a Tuesday.
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And we arrive at a new month and therefore a new focus topic.
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Last month, we delivered four wonderful episodes, if I say so myself,
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on common frustrations for MSK clinicians, available to listen on all popular
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podcast apps and to watch, if you prefer, on the Sports Therapy Association YouTube channel.
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And now with this month starting, we move to communication skills for MSK clinicians
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with four fantastic episodes lined up for your pleasure and listening education.
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Very shortly, I will be joined by the wonderful Orla Adams, a highly respected
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and experienced motivational interview trainer based in Cardiff,
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where she works closely alongside motivational interviewing and co-founder Dr. Stephen Rolnick.
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Then in part two, on Tuesday, May the 12th, I will be joined by Richard Shorter,
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an expert in sports parenting at nonperfectdad.co.uk, who will be giving advice
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on how to tackle awkward conversations.
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And then in part three, eight o'clock UK time, on Tuesday, May the 19th,
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it will be Ben Weibrow returning to the podcast and host of the Clinical Communication
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Podcast, who will be discussing the explaining of diagnoses.
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And then finally, in part four, to be recorded live at eight o'clock on Tuesday,
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May the 26th, I'll be joined by Serena Simmons, founder of thepsychologieschool.co,
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who will be introducing us to the psychological patterning process, PPP,
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a structured way of recognizing the patterns that sit underneath your client
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or patient's behavior and understanding what to do next.
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Right then, so as I say, tonight's episode, part one of communication skills
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for MSK clinicians with my special guest, Paula Adams.
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Hey, Orla, how are you? Good, thank you, Matt. How are you?
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Oh, I'm absolutely hunky-dory. Yeah, I'm totally stress-free and just loving
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life and everything that comes with it.
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Where are you in the world, Orla? I'm in Cardiff in the UK.
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In Cardiff in the UK. But I detect maybe not a Cardiff-born and bred accent there.
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No, I hail from Belfast in Northern Ireland and I landed in Cardiff 31 years
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ago with the fear that I would pick up a Welsh accent and lose my Belfast accent. and it hasn't happened.
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No, no, no, no, that'll never go. It's wonderful. I'm glad it hasn't.
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So normally I would ask you now to give our listeners a little summary of your
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background for people who haven't heard of you and what in this case led to
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you becoming involved in motivational interviewing.
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But I thought, given the nature of the topic, I know how the name can confuse people.
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Maybe we'll just reverse it for this episode and start off, if you'd be so kind,
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with the definition, your definition or the definition of what motivational
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interviewing is. Absolutely.
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It's a great place to start. So the most recent definition for motivational
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interviewing from Professor William Miller and Professor Stephen Rulnick is
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that motivational interviewing is a particular way of talking with people about
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change and growth that strengthens their own motivation and commitment.
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So that's the 2023 most up-to-date definition of MI.
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Fantastic. I remember when I first came across it probably five or six years
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ago now, I didn't like the name at all.
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And I think that was because I hadn't really read it and understood it.
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And it just sounded like probably the opposite, like a technique,
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which is far from what it's being sold as. But now I kind of,
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when you understand that you're not really interviewing someone as in like a
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sports commentator asking questions to somebody.
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But now it makes sense to me. But how would you explain motivation interviewing
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and why it's called that?
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So Professor William Miller spoke about this in Minneapolis just last year.
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And he talked about the title and how he came to it.
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And he said, well, he was talking about motivation to change with people.
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That first paper he wrote was called motivational interviewing
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interviewing he describes it as a
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two-way conversation between two people um so the the name started from there
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and it stayed and it sort of explains when you like you say when you get to
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know what mi is i can't imagine another name for it that would describe it definitely
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not now because you've been training it since 2009 i I think,
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not to remind you of how many years have gone by,
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but 2009, was that the first time you started training in it?
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Yeah, so I started learning it in 2006 and then started to be asked to deliver
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training in it in 2009, even though I still felt clunky and in my infancy with it.
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Fantastic. Yeah, the thing I remember now actually recall about when I realised
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interviewing is a nice word is like you say, it could be, for example...
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A student interviewing their teacher or a teacher interviewing their student.
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It could be anyway. So there's no kind of hierarchy. There's no kind of one
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person higher than the other, isn't it?
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Which is what I think the grace of the word is, which is fantastic.
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Right. So in that case then, so yeah, you mentioned that you started learning
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in 2006 and training in 2009.
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What were you doing at the time? How did it come your way? Were you involved
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in healthcare back then?
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Yeah. So I qualified as a dietician in 1998. I started working in acute care in the hospitals.
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And then I moved into more secondary care and primary care work.
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And I quickly learned that despite my enthusiasm and my great advice and all
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my evidence-based information and, you know, four years of a degree and training,
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that no matter how I put this good advice to people or how I encouraged people,
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the most common response I got was
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a reason not to change or having tried everything and nothing's worked.
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So what was I going to say that was different or that there was too much going
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on in life to even consider making a change?
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I tried many different approaches. I tried to be more friendly.
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I thought maybe connecting more with people on that level might help.
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But what it led to was loss of control of time, loss of focus.
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People tried to veer me away more and more from the topic that we were really there to talk about.
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Then I tried fear as a tactic. I'd heard some people come into clinic to me
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and said, I give up smoking after 40 years. And I said, what made you stop?
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And they said, the GP said I would be dead in six months if I didn't stop.
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So I thought maybe fear is a good motivator. So I tried that a couple of times unsuccessfully.
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The response from one person I remember well was, I'm not really bothered about all that stuff.
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And we were talking about heart attack, stroke, diabetes, you know,
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really chronic ill health. so by that stage I was thinking I'm not very effective at what I do,
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I'd always wanted to be a dietician from a young age. I knew I wanted to work
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in the health service, but I was feeling miserably.
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People didn't come back to see me after meeting me for the first time,
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or people came a few times and
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things didn't change, even though they were maybe motivated to change it.
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So I was feeling out of options, and I thought, I can't do this for the rest of my career.
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Maybe I'll sell my soul and work as a nutritionist for a food company,
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but didn't want to go down that road.
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So as I was starting to feel this and
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colleagues were feeling the same I began reading
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about motivational interviewing just by chance started to
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appear in journals and things I was reading online then I found one day course
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that was running in Cardiff where I live by the co-founder of MI and I thought
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right well this you know this is a brilliant opportunity let's go and hear from
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the co-founder but I walked into it thinking I don't think I should be here
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it's in the field of addiction.
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I don't work in addictions. I don't talk about addictions usually with people.
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If anything, I was trained to veer away from the topic.
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But I thought, I'll give up a day's work. I'll pay. Didn't even tell where I
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was going. Took a day's leave.
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I went into this conference centre in a hotel with about 300 other people on the list.
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And everyone else on the list, the delegate list, was addictions,
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services, psychology, psychiatry, mental health teams.
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I thought, I'm way out of my depth here. But Steve started to speak and he spoke
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about how I started in the field of addictions and then moved into healthcare
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and was moving beyond that into education at that stage that I went to the conference.
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And that began my journey in 2006
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of really clunkily trying
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out some of these skills because they felt they felt so different from
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the way I was generally speaking to people but I
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noticed such a shift in the way people responded that it
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propelled me forward I wanted to get better I wanted to learn this I could see
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the benefits really early on and I thought imagine if I could get really skilled
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at this the impact it could have and that's where i went from then that's really
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interesting that you mentioned you know you're coming from dietetics and because i think.
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One thing we've seen on this show in like 284 episodes hopefully the message
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we've given is that although we're kind of many most of the listeners msk clinicians
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once upon a time the idea was somebody would come in and you'd fix them oh you
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got something wrong with your knee oh that'll be a lateral blah blah blah and
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this and that and i know the protocol for that and blah,
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blah, blah, but now we kind of realize that there's.
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In health in general there's going to be so many other particularly
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pain factors like diet like sleep
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like maybe maybe not well depends i
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mean if with sporting clients it's less likely they're smoking
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but definitely if they're not sporting people then there's a high chance
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that someone could be smoking um as well as uh
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emotional problems with partners and all sorts of
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things which really if we're going to help that person in
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pain we kind of need to have a conversation about and although we
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it'll it'll soon travel out of our scope of
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practice it's something we need to talk about and hopefully work
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as with the magnificent alliance we can get when we are touching people and
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putting hands on people then hopefully act as quite a an effective signpost
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and referral to somebody who will be able to help whereas you know until now
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they've been oh i don't have to change it to my diet what's wrong with drinking
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this and doing that it's fine it's.
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So I'm thinking, I'm hoping that listeners realise that although this came from,
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like you say, addiction,
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just smoking and drugs and alcohol, it is all about helping people make lifestyle
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behaviour changes, which isn't as easy as it sounds, is it?
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Yeah, it's a huge challenge. You know, there's ongoing research.
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And you're right, Matt, that you can't look at one change in isolation,
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particularly when it comes to pain, movement in the field that I work in and
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weight management and people living with obesity.
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If I don't speak about sleep, if I don't speak about stress,
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if I don't speak about emotions, if I ignore smoking and alcohol and physical
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activity, I'm not going to be helpful to them.
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And so it's having a conversation with someone where they understand what is
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happening for them in their lives and then helping them find a focus of change
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and helping them understand that making a change in one area has a huge payoff
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in other parts of their life without having to change everything.
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And that in itself, I guess what you just said, is going to open up conversations
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that probably the patient or the client wasn't expecting to have.
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So that can be, the timing is going to be crucial. And also,
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it's going to require skills as a clinician, which you probably weren't given
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on your MSK course or even degree.
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In your experience, because you've worked with a wide variety of healthcare
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professionals, are people kind of surprised that they haven't got these skills
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and it wasn't part of their initial training?
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Yeah, it is. It's common for many people to come into training and say,
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I wish I had been taught this on my degree.
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I wish I'd been trained in this because it's having a huge benefit.
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But I'm hearing more recently, particularly some of the other allied health
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professional courses, that there is some degree of MI being trained or at least
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it's being talked about and people are being guided to learning resources.
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So it's not like it's not like how I came to it.
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I sort of fell on it, you know, and just so happened it was timing for me,
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you know, to discover this.
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That's good. That's nice to hear if you're hearing that on the grapevine.
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In in the sports therapy and unregulated professions it still seems to be a case of,
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you've got to pay privately you've got to kind of go to
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a private company because all the exams already printed and
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they're not going to change their syllabi and stuff like that is taking a long
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long time but we're seeing a little bit in more modern courses where communication
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is incorporated into it talking of which if you are watching and you have got
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a question or maybe you are in the same situation where you paid thousands of
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pounds for a course and then realized after a few weeks,
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hold on, I've got someone here crying about me, opening up, and I haven't got
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the skills to deal with this.
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How you feel and how maybe you've already discovered something to help you with that.
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It'd be nice to hear from you if you have to on just live. So what I thought
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then all, because we're not really going to get, we're not going to,
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we're not going to produce 3000 downloaders with all the skills and motivation
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interviewing to start tomorrow. No, no, no, no.
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But I thought maybe just because there are a lot of, be careful what I call
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them now. Skills is okay.
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Not techniques. Maybe we can delve into that later on, but there's lots of approaches
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in there and wonderful ways of applying it.
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But I thought we'd go a little bit more about the ethos behind it and what's
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different in it than what people will normally do and kind of gently make
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them think and what they could change for maybe tomorrow but
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so to do that i'm going to put up a few slides which
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i think are quite pertinent and i'd love to now we've
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got you in the studio we'd love to hear your thoughts on them and and
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then tie it in maybe what do you think would be useful for the viewer
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or the listener so i'll just bring up
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my magic slide screen the first one
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is a quote which i'm sure you've seen lots of times it's directly from
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i guess all of the editions i'll read it out for
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people who listen to the podcast it comes from the co-founders or the founders
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as the two of them of motivation for interviewing and it says is there a single
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illness disease or condition that will not be prevented or made less severe
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by thinking or behaving differently.
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And if you want to go to YouTube and see a nice picture of Stephen Walnick and
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William Miller, then that's fine. Go along there to YouTube.
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But yeah, reading that quote, does that kind of encapsulate the reason for MI?
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What does that mean to you?
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Yeah, it captures it perfectly. I remember one of the very first workshops I
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went into after the first conference.
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Bill Miller happened to come to Cardiff. And so it was a real privilege to meet
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the two of them and be trained by them.
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And Bill spoke about, he started off saying.
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You would think that the risk of amputation and going blind by diabetes and
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losing kidney function would be enough motivation to make somebody change.
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You would think that you know
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the potential risk of losing your family friends job your
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home would be enough to make somebody stop drinking and
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so often it's not and so this was Bill's sort of start my point for us as I
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as I started learning MI and then if I look back over my 20 years of learning
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it and researching it and practicing it and training people in it there is not a single illness,
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disease or condition that I can think of that would not be prevented or made less severe.
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And so if I think about some of the work I do and conversations and training
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around conditions like MS and Huntington's and the life-limiting diseases,
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there are still conversations that
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happen there around helping people make change even when hope is lost.
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And that's what MI's brought, it's brought this conversation that brings back
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hope for people in any situation.
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And so if there is injury, if somebody has had to stop doing a sport that they
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love and they can't see a way through that, MI has been helpful to bring back
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some sort of hopeful, goal-focused future for people.
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So yeah, the quote I think lands really well with me.
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Excellent what as you're saying now i'm thinking of other questions but how.
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What are some of the without going too much into like all
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the nitty-gritty of it and the ways of doing it but what are some of the main
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differences of what you learn on mi that you don't naturally do in clinic even
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if you think you're a great communicator and and you're very successful and
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most people love you what are some of the differences yeah that mi puts your
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way which you probably haven't considered?
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The very first change and shift is to move away from what is called the fix and reflex.
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And the fix and reflex, which is that urge to give the solution or to tell somebody
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what to do or why they should do it or try to convince.
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There's many forms that the fix and reflex can take.
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It's so well-intentioned and it comes from a place of being helpful.
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And if you look at many therapies, if you look at health care,
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education, sport, if you look across the board, people usually come to work
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in those fields because they want to help others learn and grow and develop.
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So the fix and reflex comes from a good place.
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But MI, whenever you first encounter any training in it, the first thing you
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will hear is about moving away from that urge to fix it for people and evoke
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from them the answers that they have and the reasons why they want to change.
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So it's a real 360 shift for a lot of practitioners.
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And it's called the Fixing Reflex because it is almost so automated.
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It's so reflexive in us. We do it with our family and friends.
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And yet on the receiving side, what has been found is that can cause harm in some cases.
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So, for example, you know, if you're trying to persuade somebody to stop smoking
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or stop drinking and the person is using it as a way of coping.
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Whenever they're being told what to do,
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their right to choose and their autonomy isn't being honoured.
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And what the person will do is exert their autonomy by pushing back against
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that and they can end up doing more of the thing that you were trying to encourage them to do less of.
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So that's the very first thing is to move away from the urge to fix it and the fixing reflex.
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The next thing that you come to in MI training is described as the spirit of
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MI or the way that you are with people.
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And that encompasses working in partnership with
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someone working together so there's no hierarchy there's never
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an I'm an expert and I'll tell you what to do situation in
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MI it very much is side by side and absolute acceptance of the person of who
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they are how you know how they live their lives what they choose to do compassion
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and then empowerment helping people grow and develop non-judgmental approach
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seeing people for their strengths.
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And it's that shift that if I look back over my 20 years of learning and putting
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MI into practice, it's been the biggest shift that's had the biggest payoff for me.
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So even before you get to the technical side of the MI approach,
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these shifts in the way that we are have a huge impact, even on my family and friends.
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You know, I've just heard the kid, you know, my son and husband come in from
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training and I step back from trying to fix everybody in house and I've you
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know and it has a big impact conversations are definitely less fraught here.
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There's wow there's less time back there that was brilliant thank you for that,
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The first thing here you mentioned, the fixing, oh no, yeah,
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the fact, the fixing reflex.
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I think, yeah, clinicians and a lot of professionals really,
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particularly in healthcare though, I think listeners, you can all be forgiven for being fixers.
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One, because maybe there's a little bit of human nature in there anyway.
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You think you're helping someone by actually trying to fix their problem.
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I'm going to say particularly men. I don't know, men are for Mars,
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women are for Venus, but I don't want to generalize too much.
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But I think a lot of guys, the typical scenario, I'm just trying to relate to you guys now.
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Forgive me if there's women who do this as well but it's a
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typical scenario where you're talking to your partner i wish i
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hadn't said guys and girls now and get so much heat for that but it's where you're
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listening to somebody somebody's your partner's come in and they're telling you the problems
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of the day and you go well you could have done this you could have done that and it
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just turns into an argument you're thinking i was just trying to help you
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yeah i think that's a nice example of where there's a time to place for everything
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if you just jump in because once you're trying to fix it you're not listening
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and they you know you're not giving in time but then the trouble is i think
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in our profession we're trained to be fixers it's the traditional kind of approach
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to medicine and although not all of us wear white coats where we.
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Metaphorically put one on every time the person comes in and we kind of
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think right and we metaphorically stand to all of them and and
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it's how it's our identity isn't it and if you
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strip that away it can be quite scary for the practitioner but
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we've had a lot of coaches on the
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show like joe turner who has
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kind of said that being a fixer can be really tiring
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because if it doesn't work you're the one who blames
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yourself you're the one who's responsible so so it's really interesting yeah
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the fixing reflex and something that yeah i hope listeners can think of but
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you're going to have to really look at yourself and because we all think we're
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perfect we'll think we're doing a great job because otherwise we just get depressed
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but you need to critically look at yourself think Maybe I could do that a bit better.
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But then you mentioned also after the fixing reflex, yes, these qualities you
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said, which again, we kind of all think we've got.
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I think this is where sometimes it can be really useful to record yourself.
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With the permission of the client and then put yourself
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in the shoes of the client and maybe hear yourself and just
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think are you really non-judgmental are you really giving
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them 100% attention you know and then giving them autonomy so really cool listeners
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people are watching live if you've got any reflections on this and do please
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add it to the comments or if you listen to the podcast and you've got some comments
22:34
and you want to share them put it into the probably youtube's the best place
22:37
and we'll get back to you on that right so that was amazing or thank you for,
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introducing that now obviously there's techniques to do this because it doesn't come naturally,
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and and that's what the kind of the books are all about i just
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want to mention as well that the fourth edition i think it came out
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last year july or something like that i think it was but smaller version much
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more compact which i think for a lot of people it's kind of a little bit more
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accessible maybe it's not so scary but what you i'm sure you've read it multiple
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times but what are some interesting things well first of all do you think it
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is an accessible book is it something which you'd encourage, you know,
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clinicians to get and have a look through and how should they look through it
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from beginning to end or dip in and out? What would you recommend?
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Yeah, if I think back to, I started with the second edition of motivational interviewing.
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And as I read it, I find it really challenging because of the psychological language.
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And it was generally sort of aimed at psychologists, psychiatrists on the field
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of addictions and mental health.
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And as the third edition came out, I felt the change in it. Getting to the fourth
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edition, it is much more accessible.
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And Bill and Steve talk about this. There.
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Effort that went in to make the language more accessible, to make it reachable.
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And this has always been Bill and Steve's ethos around motivational interviewing,
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to not put it behind paywalls, to make it freely accessible,
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to make it a way of being with people that most people can sort of engage with and can learn.
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So certainly in the fourth edition of the MI text, you'll find a couple of changes
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from some of the original books and some of the terminology.
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So you're not going to hear the term rolling with resistance in the fourth edition.
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There were changes at that level.
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Things like if you're reading about affirmation and you've looked at MI before,
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you'll notice that Steve and Bill talk about simple and complex affirmations in the fourth edition.
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There's also the MI in healthcare book, and it's generally the one that I would
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bring to but my training's in healthcare.
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Again, much smaller with transcripts, more accessible language again.
24:49
But a combination of the two books is probably the best start.
24:53
So MI in healthcare and the MI4 textbook.
24:58
That's great. And I think, I just saw something there, but I was just listening to you.
25:04
Yeah. I'll come back. But yeah, it's something, yeah, that's what you said.
25:09
Yeah, the fact, that's what just appealed to my kind
25:12
of rules in life but the fact that these guys consciously decided
25:16
not to copyright it or patent it or kind
25:19
of stop anyone apart from them from teaching or something
25:22
i think just represents everything about it i can't really think of many other
25:26
people who would make that decision you know yeah there must have been i imagine
25:30
the conversations from colleagues of theirs who were kind of like professional
25:34
advisors going what are you talking about get that down you've got to pay to
25:36
the name but that's kind of the ethos behind it wasn't it They want people to practice it, try it,
25:42
to help it evolve and move, which is beautiful.
25:45
Definitely. And it's the ethos that runs through the organisation that they
25:50
co-founded as well, the Motivational Interviewing Network of Trainers.
25:54
We stand by our motto or our MOD is always give back more than you take.
26:02
And you'll feel that if you reach out to any member of Mint for support around
26:06
learning MI, they will always give freely.
26:09
They will always give resources. there's nobody hides behind anything so that's
26:13
what I've always loved about the organization as well.
26:16
Very cool. Yeah. It's like the perfect company. There must be problems.
26:20
There must be a dark side to it, but it is everything you dream of. We'll go down that road.
26:24
But it's kind of, if you've got great leaders or leaders, people at the top,
26:28
whether it's kind of how it's laid out and that kind of drips down to everybody
26:32
else, you know, lead by example kind of thing.
26:34
It's great. That's what I get out of it. So, yeah, definitely I would recommend
26:38
people, I know there's so many books to buy, but the lovely thing about this
26:42
book is it will affect everything.
26:46
It becomes so personal so quickly, and the way they write, you'll just pause.
26:50
And, of course, the wonderful metaphors and analogies will just make you think
26:53
in your own mind, oh, my God, that was what happened yesterday.
26:56
And it's just time after time and time, which I think makes it so easy to learn
26:59
that way. Yeah. Really pretty.
27:02
We talked already about the fact that, yeah, telling somebody what to do.
27:05
If that was it then i would see clients once a week don't run so fast next week
27:09
at park run and your achilles will get better done what happened you tried to
27:13
get a pb again did you not hear me and we kind of blame the client don't we
27:16
and often that's where the kind of burnout comes we just.
27:19
Well i told you these exercises and you haven't done them and
27:22
it's like but i think one of the interesting things is
27:26
a lot of the time the non-compliance the
27:29
fact that clients come back which is this famous problem in
27:32
healthcare the non-compliance into the exercise they come back and they didn't
27:36
do it but often that's because you didn't have that conversation wasn't it you
27:40
told them what they're going to be doing and you didn't bother asking them whether
27:43
they'd be able to do it so tell me a little bit about that how can that change
27:46
things when you actually have the conversation with them like you're saying
27:48
on a level playing field how does that affect.
27:51
Compliance and the plan you put into place,
27:53
Yeah, you build engagement first with somebody and that was certainly not something
27:58
I was ever really trained properly in.
28:00
I was told to like be encouraging and be friendly and listening, but nobody told me how.
28:05
So to start off with a platform or a foundation of engagement with the person.
28:10
And then generally you start to ask the person, you know, what are the changes
28:15
that you might want to make or what is important to you to change?
28:18
And in MI you're always in
28:22
the place where you're evoking from the person because something
28:25
really powerful happens when a person speaks out loud
28:28
about what they want to change and why they
28:31
want to change it and how they might go about it so you go into this reflective
28:36
listening space with people and this is the technical side of it but if you're
28:40
curious with your open questions with the intention of I want you to say these
28:45
things out loud people connect with their intrinsic motivation.
28:49
They connect with their why.
28:51
And I don't know if I'm able to say it on here, but one of the big sports companies
28:55
changed their strapline last year.
28:58
So they changed from Just Do It, and they changed it to Why Do It with the question mark.
29:06
And the Minties were, like the members of Mint were all over this then.
29:09
It was like, when I read about the reason for changing this,
29:12
they said it's people are more likely to do
29:15
something and sustain it if they connect with their why of
29:18
change so when you tap in
29:21
and you step away from the fix and reflex and you get the person to speak about
29:25
their why and their how and their reasons and you really listen to that and
29:32
they hear it back again something really strong builds within them and you start
29:37
to hear more language about commitment.
29:39
It's about their intrinsic motivation to change, not about something that we're
29:43
trying to persuade them to do.
29:45
I didn't know that about that famous sporting company. That's so interesting.
29:50
I'm going to look that up straight away. Yeah.
29:52
I'm going to be late to bed tonight. I've got some good look up on the internet.
29:55
That's fascinating. Yeah, yeah, yeah.
29:57
You mentioned in there a term which I'm sure some clinicians will have heard
30:00
of, open questions, which is great.
30:03
But what MI does is it just puts that into a context which works.
30:07
And it's not just as simple as asking open question after open question after
30:11
question. But just for people who aren't aware, what is the power of an open question?
30:15
You want to ask a small number of evocative open questions.
30:21
So if I'm moving away from my closed questions and I previously used to ask
30:26
people, do you want to change?
30:29
And are you going to do this? You know, are you going to follow this plan?
30:33
And will you do these things?
30:35
And can't you do these? All my close questions were not evoking anything from deep inside people.
30:42
So to shift to a more open question, what are your reasons and what's making
30:47
it important for you to want to change this?
30:50
How important is it to you to get back to doing the exercise you love?
30:54
How important is it to you to manage your pain?
30:57
When you ask a well-worded open question, the next step is to then listen to the response.
31:03
The other thing I do in training is I
31:06
say don't just ask the question once so if
31:09
you say to somebody what are your reasons for wanting to get back
31:12
to doing what you love or to get through this you know
31:15
recover from this injury and the person voices maybe one or two reasons ask
31:20
again say what other reasons might there be keep being curious with people it's
31:25
usually the third time of rephrasing the question or asking it in a slightly
31:29
different way that it brings something much deeper for the person.
31:33
And when you're on the receiving side of an MI conversation in a workshop or
31:37
a practice session, even for a set up role play, you really feel the impact
31:42
it has when the person stays really curious and they don't just take the first answer and move away.
31:47
I think I got quite stuck in my early days of MI.
31:50
I took the first answer, moved on to the next question. It was like a therapy manual.
31:55
I wasn't getting to the real heart of it.
31:57
That's really good. I love that. And yeah, and asking those open questions.
32:03
Yeah, when you say evoking, then that's kind of means giving the client or the
32:09
patient the opportunity to kind of open up and speak what's on their mind and
32:14
kind of unpeel the layers. Yeah. Is that kind of what evoking means? Absolutely.
32:17
It means sort of bringing out from within the person. That's how Bill and Steve would describe it.
32:23
Their internal reasons, their strengths, their hopes, their dreams,
32:28
what they want for themselves.
32:30
Really good. I love this because I knew you'd be able to do it.
32:34
We're giving listeners, hopefully, an idea of what MI does and also a few of
32:39
the little tools which you employ.
32:41
But there's, it takes some practice, doesn't it? It really does take some practice.
32:44
But one of the things I notice and always laugh at when I've been on training
32:47
schools myself, or when I get people, even at Therapy Expo, Therapy Show,
32:54
which I know you're going to this year, so I'm so excited about.
32:56
We'll talk about that later on. but therapy show last year i think it was i
33:02
had like in one of the theaters 100 people doing some role plays you know using
33:06
some of these kind of techniques and it was so funny because even though.
33:10
It's difficult when you've got 100 people you can't be the element of surprise
33:13
they know what they're doing and they kind of know what the solution or
33:16
the result is supposed to be with one of them being a client one of them being a
33:19
patient but even when i got feedback from them they were
33:22
saying even though i knew what was going on yes i just
33:25
felt so much more listened to you know i felt so much
33:28
more content and happy to
33:31
tell this person more even though they knew it so imagine if this
33:34
works when for people going through role plays even
33:37
with little things it was just and that's how it really is a
33:40
truly powerful thing it's it's amazing so i'd
33:44
encourage people and we'll talk about courses and things later on and
33:46
but to practice it yourself just not with a
33:49
loved one i think that's one of the rules gary said to me gary mendoza don't practice
33:52
this straight away with your wife or your kids it's just it'll go
33:55
to pot very quickly um later on maybe
33:58
okay i'm going to change the slide you mentioned a i think you might have said
34:02
it by the word ambivalence but this is kind of yeah you kind of mentioned how
34:05
when we try and tell someone using that fixing reflex to do something the natural
34:09
response is to kind of go the opposite um can you talk to me a little bit about
34:12
that is that just something which we naturally do when we're told what to do
34:15
we think of the opposites.
34:17
For most people. And that at the heart of it, it's not being honoured for your
34:24
skills and for your abilities and you as a human to make your own choices.
34:30
So a human nature is to push against being told what to do or authority.
34:34
When a person's in a state of ambivalence and this is where MI is used.
34:40
So if a person's not ambivalent, it's a different conversation.
34:43
If a person doesn't care about what's happening and they don't see any issue
34:47
with it, there are still skills within MI.
34:50
But true motivational interviewing is helping a person who's feeling two ways about change.
34:58
They will be describing things like, I know
35:01
I need to do the stretches and I know
35:04
I need to do the you know the strength-based work
35:07
but I just want to get out there and run I don't have time for all of this stuff
35:13
and so what you hear on one side is reason to change bridge usually by the word
35:18
but and then you'll hear reasons against change it's if we think about this
35:23
conversation in our own mind we generally think about things like,
35:27
I should go to bed earlier, but I quite enjoy the time on my own in the evenings to watch what I want.
35:32
We'll talk about change and then we talk about not changing or staying in the same behaviour.
35:37
So ambivalence is a state of this sort of two sides existing at the same time
35:43
and people get stuck there.
35:44
They can't see a way forward because usually they end in their mind on a reason
35:49
not to change or a barrier or a reason to stay in the same habit or behaviour.
35:54
Motivational interviewing will start to evoke more and more talk about change.
36:00
Will start to strengthen the language of change talk, it's called in motivational interviewing.
36:05
And that's any language around, I want to, I need to, it would be good for me,
36:11
it would prevent further injury, I'd be in less pain.
36:14
This is really important because I've got something coming up I need to be ready for.
36:19
I will, I'm going to, that's what MI's listening out for. And that sits on one side of ambivalence.
36:26
But as practitioners, massage therapists, sports therapists,
36:30
physios, dieticians, anyone, education, sport, you know, you name it.
36:36
We hear the language against change, like the barrier, or we hear the thing
36:41
that's getting in the way and then we jump in to fix it.
36:44
So we often don't hear the language that came before the butt.
36:47
But Emma shines a light and pays attention to what came before the butt,
36:52
shines the light nice certainly does i like
36:55
the way yeah you you highlight the fact and again
36:58
this is an ethos i think from steven and
37:01
bill that it is not a fix for everything
37:03
you only get some clients who don't need it because they're
37:06
not ambivalent and but i think a lot of clinicians will
37:09
feel that particularly with pain normally
37:13
there's either anger because they've probably been trying to
37:16
fix it hasn't worked or there's fear and with
37:19
both of those emotions i think it's quite often to be ambivalent
37:22
isn't it because you're scared and then therefore you're worried about doing
37:25
something and if it's not going to work so a lot of the times i think it can
37:29
work but yeah to various degrees yeah ambivalence is a good word it takes a
37:34
bit of practice to get into your head it's not something we normally say in
37:36
any other kind of scenario or context but yeah it's a good word to be aware
37:39
of listeners and notice whether you're doing it yourself.
37:44
I know you're a fan and i'm a massive fan of this for people
37:47
on listening to podcasts and it's the confirmed smoker okay
37:51
it's a really great video great demonstration um of
37:55
motivational interviewing in practice um with
37:58
dr theresa moyers um who does
38:01
a lot of work alongside um the co of
38:04
the founders motivation interviewing yeah if you tell me or why do you love
38:09
it what what is it what would listeners gain from watching this well it's the
38:13
only it's the only real life example of mi on video with high skill in motivational
38:20
interviewing. So bring those things together.
38:23
Richard in the video is talking about his ambivalence about stopping smoking for real.
38:29
And this was an opportune, this was just a moment that Terry asked Richard,
38:37
would you be happy to talk about your smoking on camera?
38:39
And he said yes, but pointed his finger and said, you won't get me to stop.
38:44
So that was Richard's words to Terry before they sat down and recorded this.
38:48
It's just over 16 minutes long. It is.
38:52
Top quality motivational interviewing with in
38:56
total 56 reflective statements and nine questions
38:59
with a mixture of open and close questions and at
39:02
no point does Terry try to fix it does
39:05
she try to persuade she steps back completely from that um and it's it is so
39:12
worth watching so if you're thinking before you watch the video keep in mind
39:16
this man said you won't get me to quit and then listen to his final statement
39:21
right at the end of the video.
39:23
It's really cool. I'm never, I'm always, I never know whether to get people
39:27
to watch their video first and just without knowing much about MI.
39:31
But definitely if you've introduced yourself a little bit to MI and you're starting
39:33
getting used to the kind of the idea of avoid fixing reflex and open questions
39:37
and evoking, engaging, all that sort of stuff, then it's even more rewarding
39:40
because you can sit there with a little list going, she did it, she did it, she did it.
39:43
And notice also the replies from the guy as well. One thing I can't find anywhere
39:49
is whether he actually gave up smoking or not.
39:53
I don't know whether you're exclusive, if you've got that information. I do know that.
39:58
So Terry met Richard again about a year later, and she asked him,
40:03
no pressure, Richard, I'm just curious.
40:06
But do you want me to give away the answer? Well, I suppose there's no other
40:10
way around it, is there? Oh, it's true, actually.
40:14
Okay, maybe we should just leave that hook there.
40:17
He did actually stop smoking,
40:19
he did he did yeah that's good that's good to know he's such
40:22
a lovable guy as well because that's what's so nice about the conversations because terry
40:25
is giving him all the opportunities to speak he just
40:28
does he unravels his life he talks about his frustrations and
40:31
suddenly you can you can see him going from
40:34
a i'm a smoker i love it it's me it's my identity yeah
40:37
i've never stopped never thought about it too i'm going down
40:40
the sharp three in the morning thinking what am i doing with my life
40:43
and she's just sitting there smiling and nodding and it's just beautiful
40:46
to watch really cool it is obviously not all sessions will be
40:49
as successful as that wonderful and it takes an awful lot of training but and
40:52
then there's also a nice video of william miller as well dissecting it and going
40:56
through it as well which is also available online and we'll put links to these
41:00
in the show notes for people who are interested definitely if you haven't if
41:02
you've looked into my mind know a little bit about it and if you haven't seen
41:05
this video it's wonderful
41:06
really good one wonderful and you as well here we go this is a shot i use of course,
41:14
it's a very pensive look there but um yeah you're on one of the
41:17
videos um psychwire i think it was a video i got off there really cool but what
41:20
was interesting for me was it was uh talking about something mentioned a bit
41:24
early on about burnout and that's something mentioned on the show a lot it's
41:27
a lot of unfortunately across physiotherapy sports therapy sports massage a
41:31
lot of clinicians are just getting burnt out and leaving the profession yeah.
41:35
Can MI help? Yeah, I mean, even before I read the research and knew much about
41:42
the impact that MI had on practitioners, particularly around burnout,
41:45
I was feeling the difference within myself anyway.
41:48
I felt like I didn't carry the burden anymore. I had no frustration with people.
41:54
Before learning MI, you described it earlier, Matt, I was starting to get frustrated.
41:59
Why won't you change? Why why wouldn't you want things to be better?
42:03
I remember this being the way I was feeling and thinking.
42:06
And I would go in with that sort of
42:08
heart sync feeling into some follow-up appointments. That all disappeared.
42:14
It all went. I have no burden of responsibility. I come with the spirit of MI,
42:20
of compassion, and I'm working together with people, helping them decide what
42:24
they want to change and how they want to change it.
42:26
Still bringing expertise, still having a framework within MI of being able to
42:31
give advice and information.
42:33
I haven't stepped back completely from the role in my training,
42:36
but being able to guide these conversations just feels completely different.
42:41
I would have left the NHS and dietetics a very long time ago if it hadn't been
42:46
for MI, but I still work in clinical practice because I absolutely love the
42:51
difficult conversations.
42:52
I love it when someone walks in and they said, I don't want to speak to you.
42:56
And I think, brilliant, I've got to set skills and a strategy that engages somebody pretty quickly.
43:03
So, yeah, so the impact and the research has shown this from some colleagues
43:06
who are doing work around this.
43:09
Teams that work in high pressure crisis, you know, really devastating maybe diagnosis for people.
43:17
The impact that MI has had on them is now becoming more evident.
43:22
Amazing. And it is a big thing. And we obviously, the STA with members looking
43:27
after members, we hear so much people are struggling.
43:29
And I think so much comes from that, what we talked about at the beginning with
43:33
that sense of responsibility and you being the fixer.
43:36
And if it doesn't work, then yeah, you just pull it on yourself.
43:40
You might kind of say, oh, they don't want to get better than they don't do
43:42
it. But inside you've, you set yourself up as this massively successful operator.
43:46
If it doesn't work out, then you blame yourself.
43:49
It burns away and you can't do so much of that so yeah definitely one of the
43:53
many benefits of it yeah great,
43:58
let's get down to training now obviously
44:01
you are still training like you said with steven walnick co-founder and that's
44:06
in cardiff what sort of things on the website if people go along to www.micardiff.co.uk
44:14
there's all the information there but for somebody who is interested in it they've
44:18
never done anything before what would the root of kind of courses be.
44:22
You're you're best to start off with introductory level
44:25
motivational interviewing so myself and steve deliver a two-day in person we've
44:30
stayed with in person i know there's a lot of online courses but there's something
44:35
really special about a group of people coming together to learn motivational
44:38
interviewing people come from across the world to join these workshops as far as new Zealand,
44:44
people from the States come over.
44:46
So we get together a group of about 40 to 45 people, and we really delve into
44:52
learning and practicing MI.
44:55
So people complete an intro level, that's two days.
44:59
Now, if you're anything like me, I kept going back to intro level each year,
45:04
which is when Steve noticed me and he was saying, why you keep coming back to the same course?
45:08
And I said, because it's quite difficult to learn it.
45:11
The payoff is huge in my clinical practice. I want to get better.
45:15
And every time I hear you speak, I learn something new or I develop a new part of the skill.
45:21
So it's not unusual for people to come back to the same course a few times.
45:25
Like Richard, you'll probably hear him say that he's came to intro and advance
45:29
and practice a few times.
45:31
You get something different each time. But you've also got the benefit of hearing
45:35
Professor Olnick speak about MI and his journey with it. A really humble,
45:40
funny, engaging, just a bloke he describes himself as.
45:45
So someone, like it's a rare opportunity to hear a co-founder of an approach,
45:50
you know, speak and train on it.
45:51
Then people come to advancing practice.
45:54
And that's not expecting someone to come at a high level of MI.
45:59
This is taking it to the next step. It's exploring it a bit more.
46:03
We go into some of the more complex skills within it. More time to practice.
46:07
And one of the huge learnings within MI practice is developing in the moment
46:12
self-awareness, noticing what you're thinking, being able to reflect on the
46:17
skills that you're using, knowing roughly where you're going to go in the conversation,
46:22
feeling confident in how you say, say, for example, affirmations or reflections.
46:26
So we take people through how do you develop this in the moment self-awareness
46:30
through your practice of MI.
46:32
So there's also webinars on there and Steve has a bit of information about some
46:37
of the workshops and a link to his website as well.
46:41
There is so something, I mean, I don't like to be a fanboy and kind of just
46:45
put anyone on a pedestal, but there's something so special about hearing Stephen
46:51
Walnick talk and William or Bill Miller,
46:54
which is just the ethos and yourself, obviously, and Teresa,
46:57
but particularly those guys, because they've got the history, they lived it.
47:00
They would have had these such difficult cases back
47:04
in like 83 or something and there was nothing else really
47:07
there was kind of self-determination theory there's a few other things but
47:10
they weren't kind of involved in that they kind of arrived to it
47:13
didn't they particularly William really just thought hold on this isn't working
47:16
and it's the beauty that it came from that kind of
47:18
passion and desire to help people and it it comes out but I just
47:21
wanted to point out I think this is important as well because it's
47:24
not anyone can kind of do courses and teach
47:27
it educate it then yeah listeners have
47:30
to be careful i would definitely recommend that they stick with you guys
47:32
for the moment to hear it from the horse's mouth as it were and then
47:36
maybe because you you can go down some slippery roads through no
47:39
bad intention that people are doing it but there is other versions
47:42
out there which might complicate you and not take you down the right path is
47:45
that fair to say yeah i've seen all variations i've seen mi described but people
47:52
have given it different titles but it essentially they're training in MI or
47:56
I've seen maybe not great training practices,
47:59
you want to look at the motivational interviewing network of trainers.
48:04
They would be a good starting point for someone who has been through a process that, you know.
48:12
Codes their competency in MI at the very least and helps guide them to be a
48:17
trainer in the ethos from Stephen Bill.
48:20
So you'll find all sorts of things but if you can see they're a Mint member
48:23
that's a good starting point.
48:25
That's really useful. So although it is beautifully no holds and there's no
48:30
rain saying this is ours you can't use it there is the MI network of trainers
48:34
which provides a useful database for people who have gone through this.
48:38
Yeah it is a word of warning and take pride in the book and
48:41
the people who wrote it because it really is worth hearing
48:44
them and there's so many videos again that
48:47
one of the positive things about the internet there are still a few positive things
48:50
you can see interviews any interview with steven rognick or you
48:53
know there's quite there's probably more with steven rognick i think out there
48:57
he's a little bit more active now i think but it's just a joy to watch and you'll
49:01
see it in action it gets asked a question he'll go maybe we should put that
49:05
another way yeah what do you think about how would you and And it's just like,
49:09
gives it back to the interview.
49:10
And the interview is like, okay, didn't expect that to happen.
49:13
It's just MI in action. It's beautiful. It is. And he does it over text.
49:17
You know, so when we're talking together, he reflects and affirms and he lives
49:22
and breathes MI through text. So, yeah.
49:25
That's hilarious. And I think a beautiful thing as well, just appreciate we're
49:29
running out of time now, but how it's been, how it has evolved to look into
49:32
things like parenting, education.
49:35
And and all the other kind of areas where
49:37
it can help it basically when anybody's communicating with anyone which
49:40
is pretty much everywhere so yeah really interesting and definitely in sport
49:44
and i read the yeah the in sport with a sport psychology and things and talk
49:50
about coaches and stuff so there's something there for everybody whatever you
49:52
do there's going to be something that you can use amazing and then we should
49:56
also mention maybe in june,
49:59
in Cardiff. What have we got happening there? Yes, so I am chair of the Motivational
50:04
Interviewing Network of Trainers UK and Ireland chapter. So it is an international
50:08
organisation and different parts of the world have their own chapters.
50:12
Mint UK and Ireland is a large chapter. We have over 330 members and that's
50:18
a mixture of members of Mint and people who just love and are enthusiastic or practicing MI.
50:24
So there's a meeting in June. It's 12th and 13th. Professor Rolneck's coming
50:29
along to do a session at the end of the Saturday with me.
50:32
We've got MI in MSK physio.
50:36
We've got MI implementation into a large organisation.
50:40
MI with frontline animal welfare workers.
50:43
MI in higher education. MI on dental healthcare.
50:47
But what you'll get is a group of people who are passionate about MI at various
50:53
levels of learning it and experience and talking about how they've implemented
50:58
it into services and practices.
51:00
Oh, and also MI and autism from a colleague in Cardiff. Yeah.
51:04
So you'll feel the adaption of MI into different ways.
51:09
Like I use language line and interpreters and can still use MI to some degree through that.
51:15
Not completely, but yeah, Our meeting in Cardiff, everything's on the Mint UK and Ireland website.
51:20
We have about seven in-person tickets left and we have as many remote access
51:27
tickets as people want. Very low price.
51:29
My Mint UK and Ireland is not for profit. Mint Incorporated is not for profit.
51:35
And so it is always about giving back more than you take. So a fantastic meeting.
51:39
Great to come and meet Steve and people from all over the UK and Ireland talking about MI.
51:46
Amazing opportunity and like you say it i don't want to say it too loud but
51:48
it is cheap i mean what were we talking about it's like it's 40
51:52
pounds in person pounds in person i mean you've got to
51:55
go to cardiff but hey lovely any reason to go to cardiff wonderful yeah 40 pound
51:59
in person and then a social in the evening and yeah i'm booked up i'm looking
52:03
forward to it what an opportunity to see steven in person as well crazy but
52:07
only i think seven left you say seven in persons so if you're listening to the
52:10
podcast yeah get in there quick because they should get It snapped up very quickly.
52:14
I'm surprised there's any left.
52:15
Yeah, wonderful opportunity. And I also love the way you're starting it kind
52:19
of lunchtime on a Friday, aren't you, or something like that?
52:21
That's what people can get. They're so thoughtful. You guys are so thoughtful.
52:26
Wasn't it, bud? Amazing. You really are. That's amazing. Yeah, so great opportunity.
52:30
And then also you are speaking at Therapy Show, aren't you? I am. In November.
52:36
Yeah, I'm bringing along my colleague who's a neuro-rehab physiotherapist by
52:42
background, but is in a leadership role now, strategic lead.
52:46
And they come along as a sidekick for me to many of the trainings,
52:50
particularly for any physios, physiotechs.
52:53
And yeah, we're going to do a demonstration and a very brief overview of MI.
52:58
So again, I mean, if you're going to a therapist show, hopefully you've taken
53:01
advantage of the cheaper tickets. If you haven't, then make sure you talk to
53:04
your professional association, STA.
53:07
You've got a great discount, which you can find out by emailing Matt at the
53:11
STA.co.uk or Gary at the STA.co.uk or Jake or go to the membership page.
53:16
If you are part of the Neurodivergent MSK Clinicians Facebook group,
53:20
then you've got a discount code there as well.
53:22
Have a look around. I mean, Therapy Show are really fair and for people who
53:24
have supported them over the years that you'll find discount codes.
53:27
So make sure you have a little look.
53:28
Yeah, another reason to go there. It's going to be absolutely fantastic.
53:30
That's on day two, you said, wasn't it? On the Thursday, yeah.
53:33
On day two, yeah. Wonderful, that's going to be great.
53:36
How exciting. Right then, look, it's 9.04. I've kept you for four minutes longer,
53:40
as well as two minutes of absolute emotional distress beginning on my behalf.
53:45
So thank you so much. If people want to get in contact with you,
53:49
well, then you've got M.I.
53:50
Cardiff, we've mentioned already, the website, and then you're on Instagram as well.
53:53
Not the most prolific of feeds on Instagram, but there is some messages there
53:57
and it helps people keep up to date. It's good. Yeah. Yeah, very modest.
54:01
But yeah, Instagram, M.I. Cardiff, which has got details of webshops.
54:04
And then on LinkedIn as well, you'll find motivation into the M.I.
54:06
Cardiff workshops as well, which is great.
54:09
Right i mentioned already but next week i
54:12
have the pleasure of talking to richard shorter who's an
54:15
expert in sports parenting a founder of non-perfectdad.co.uk if
54:20
you haven't checked out his Instagram account then i would recommend definitely doing that at
54:23
non-perfectdad it's just great straight away you'll realize okay here's someone
54:27
i want to read more about i know about and i'm so thrilled to say that we will
54:30
have richard on the show next week same time so tuesday eight o'clock hopefully
54:35
i've sorted out all the technical difficulties by then but yeah He'll be giving
54:37
advice on how to tackle awkward conversations, which would be a nice segue from today.
54:42
We'll go into a little bit more detail about when you have got those conversations,
54:44
which officially go under the awkward category. So that's going to be next week.
54:49
But for now, I'd just like to say once more, thank you so much to my guest tonight,
54:54
Orla Adams. Thank you, Orla. Thank you so much for having me along.
54:57
Absolutely delightful. And thank you, everybody, who joined us live.
54:59
Sorry about the technical problems.
55:00
Hey, it's out of my hands. I'm a bit calmer now, but I've still got a few emails,
55:03
angry emails to send. There won't be angry emails. Well, they probably will be.
55:07
Sarcastic emails, which I'll be sending later on. Thank you everybody who joined
55:10
us live and for being with us. Thank you everyone who listens to the podcast.
55:13
If you do listen to the podcast, then please, please, please leave a review
55:16
if it's a good one and a rating, just because it helps the good word of our
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55:22
Simple as that. If somebody puts a motivational interviewing,
55:25
they will see this episode with the wonderful All Adams talking,
55:28
as opposed to somebody else who's just purchased 50,000 hits somewhere else.
55:32
So yeah, please help us get quality information higher up in the Google search
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results by leaving a review and a rating.
55:38
That's it, people. Thank you so much for your time. Until next week,
55:41
take care of yourselves and take care of each other. Bye-bye.