MITS 2.1
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Motivational Interviewing Target Scheme | MITS 2.1 (updated July 2012)
An instrument for practitioners, trainers, coaches and researchers
An extract from the introduction:
In general, less productive practice is associated with a higher incidence of MI-inconsistency. This is an evidence-based conclusion. The more MI-consistent the practitioner, the more likely the practitioner will exert an influence on outcome in a manner which the patient/client will find helpful and constructive. MITS is designed to measure the MI consistency of practice performance.
MITS is an instrument developed by MiCampus to describe and assess important components of motivational interviewing. It may be used by trainers, coaches and researchers, and also by individual practitioners seeking to develop skilfulness in MI.
The instrument describes, in precise detail, ten practitioner behaviours that are regarded as aspirational targets for attaining the highest standard of MI-consistent practice. The first seven target behaviours are regarded as necessary components of MI, while the last three are regarded as less important components in some practice settings. Each of the ten core definitions has its own elaborations, further extending the description.
Considered as a whole, the ten target behaviour definitions amount to a comprehensive, three-dimensional description of the observable practice of motivational interviewing done well. However, MITS is not intended as a substitute for the various summary definitions offered by the originators of MI, Miller & Rollnick, nor should it be regarded as such. These definitions and MITS sit adjacently and describe the same complex psychological intervention - motivational interviewing - from slightly different viewpoints, and for different purposes.
MITS has an assessment scoring procedure. This provides a straightforward method for making judgements about how close to a particular target is the practice performance under consideration. The scoring procedure may be used repeatedly to assess the extent to which the practitioner’s work is apparently approaching or retreating from each particular target. With sampling over time, the scores for repeated sets may be seen to form a changing profile. Such changing profiles may be helpful in identifying areas of performance requiring attention.
MI is rarely used in its purest comprehensive form as a stand-alone therapy. The deployment, more frequently, is one of integration as a ‘reference’ method - a platform on which work is done. In diverse professional settings, what we might term lessons from MI are implemented. Wherever difficult conversations about change occur, where issues of seriousness, reluctance or uncertainty are centre-stage, many professions call upon the various components of MI to improve engagement and enhance effectiveness. We make this point because the majority of professions do not regard competence in MI as an overarching prerequisite for practice. Rather, it is something to call upon in some circumstances. Irrespective of the advisability of such a standpoint, there are many practitioners whose daily work consists of dealing with people and their ‘problematic’ behaviours who have found MI to be helpful in one way or another. MI is not a substitute for subject-specific professional expertise. It is however a conduit through which such expertise may be delivered - a productive conversational method. As such, while not seeking to become MI experts, many practitioners may wish to establish the extent to which their performance within their own profession and field is consistent with MI. This is one intended application for MITS.
The use of MITS will enable practitioners in any profession or field to make considered judgements about how ‘well’ they are applying this method, and where their strengths and weaknesses lie. Any professional conversation about change may be assessed for its MI consistency - even if the practitioner had never heard of MI. Such elements of MI consistency may be naturally occurring or coterminous with other similar conversational methods. MITS provides a series of lenses through which practice performance is brought into focus.
At the time of publication MITS is not a validated instrument. It results from an inductive process of best-guess discussions and iterations which, without doubt, is yet to be completed. In the reformulations and adjustments to the descriptive text we believe we are getting ever closer to the essential nature of a method that patients/clients and practitioners will find particularly helpful and productive. It is our intention to conduct research to validate MITS in the course of 2012-13.
MITS is impressionistic rather than quantitative. Patients/clients are unlikely to draw conclusions or make judgements about the helpfulness (or otherwise) of practitioners based on the number or type of conversational artefacts present in a conversation. More likely, it is a gut feeling - a summation effect - perhaps difficult to put into words. A patient might say, “There’s something about that nurse I just like - she’s so helpful and kind!’ A recording of that consultation might reveal the nurse offering a high proportion of complex reflections and working to build a collaborative ambience, or indeed a long list of relevant observable ingredients. The patient, however, chose ‘kind’ and ‘helpful’ to describe the practitioner. Some may judge the Achilles’ heel of MITS to be its lack of numeracy. However, we are suggesting that the very impressions gained by the dispassionate professional observer using MITS would correlate significantly with those of the patient/client in the practice sample. The only differences are those of detail. The ten target behaviours in MITS provide the detail that our hypothetical patient distilled as ‘kind’ and ‘helpful’. The patient may be content with the distillation, but the detail is required to assess and learn MI consistency. We want patients to regard practitioners as helpful; the question is, what were they doing to cause that conclusion and could they do it even better?
Download your copy of MITS 2.1 - it's free.