Brilliant, thanks Sarah, and thanks everyone for joining. It's really exciting to have the opportunity to talk to you a bit more about motivational interviewing, which after many years has become my passion and maybe my slight obsession. What I'm gonna be doing today is talking you through, I guess 4 core points.
So I'm gonna be touching on, you know, why should you even be interested in the method and why might it apply to your work. I'm gonna be talking a little bit about behaviour change theory to give you a context within which we decided to explore motivational interviewing because really understanding how clients proceed through behaviour change is essential to understand the sticking points where we might struggle with having helpful conversations. Leading on from that, I'm going to identify where motivation interviewing might be able to help us in these conversations based on our understanding of behaviour change.
And talk through bits and pieces of the method to give you a very brief introduction to what it entails. And I'm gonna finish up by talking a little bit about the evidence base based in human sciences as well as some of our research in veterinary science. So starting off then, you know, why should you be interested in this method?
Well, there's a general consensus that the evolution of capital practises is moving from this, this sense of looking at clinical cases to being more broadly at prevention. And this is built upon the back of decades of research with increasing recognition of the complex multifactorial nature of disease. And the explosion in research and technology in herd health has really helped to build an extensive scientific knowledge base, underpin the evolution and development of complex monitoring tools for herd health protocols, understanding of risk factors and understanding of management strategies andlicit in disease.
What's really interesting is what we're not seeing is a correlated change in on-farm behaviour in a lot of diseases. So for example, lameness, despite this explosion in research and technology over the past couple of decades, prevalence rates have remained broadly similar on farm. And this means the challenge is really about effective and consistent implementation of research and technology, because if we know that some farmers are engaging and improving as well this a result of these tools and processes, why are others not doing so?
How could we best help to support this process and have these helpful conversations that brings everyone into a positive field for behaviour change? Now recent research has has looked at challenges facing the veterinary profession. And whilst veterinary communication and the roles that you have on farm, it's really at the heart of farmer engagement.
We know that lots of vets report challenges in influencing behaviour change. And Ruston and colleagues in the paper on the challenges, particularly facing farm animal vet profession. Identified the potential for these challenges to really undermine the preventative advisory role itself.
Now we interviewed just shy of about 30 vets and, and one of them gave this lovely quote that I thought I might mention where they said, you know, I think the battleground in farm animal veterinary service is probably not on the science. The battleground is on behaviour change and all this type of thing. It's not knowing more stuff that we need, we need to basically be able to implement it better.
So I was hoping this might give you a sense of why this might be an important thing to focus on. Now I'm sure everyone listening to this has extensive experience in in clinical practise and working with farmers, but maybe has has been interested in this webinar because of this battleground, this this focus on behaviour change. And maybe the motivational interviewing is a tool in the box that might be able to facilitate your work with clients to better achieve the outcomes that are good for them, their farm and their animals.
So that's a little bit of a, a hook into why it might be an interesting method for you. As I mentioned earlier before we discuss the method itself, we really need to have a a bit of a grasp on how people change, because the, the process itself is quite complicated and it's not a binary system. And to really understand why motivation to doing might help, we have to think a little bit about how people proceed through a behaviour change process.
So before we start, perhaps I could just ask you to reflect personally, if you've ever heard yourself of an advisory recommendation to eat 5 fruit and vegetables a day. I'm sure most people in the UK have heard this, perhaps it's actually edged up to maybe 8 or 9 a day right now. But could I ask you to also reflect on whether you've eaten 5 fruit and veg every single day for the past year?
Now what I tend to find having done a lot of training is you get the odd person that has managed to commit to this, but it's quite a difficult thing for people to to consistently eat fried fruit and veg every single day of their lives. That's not a complex behaviour. You might argue it's particularly about improving your own health, your longevity and staying on this planet as long as you can, but it's not always sufficient to change your behaviour.
And if you're anything like me, it's maybe because some of these things turn your eye a little bit more than the fruit and veg. But you know, what we can say from this is that knowledge is necessary but not sufficient to change behaviour. So it's a much more complex process than really knowing what we should do.
And this is often, you know, perhaps when we go out on the farm we think, well, if I can just identify the problem and give the right information, you know, why doesn't this lead to change, it's quite frustrating. If we look at our own behaviour and think about how even a simple message about eating fruit and vegetables can't always lead us to to protect our own selves, we might be able to understand and empathise a bit more with what's going on. So why is it that we struggle with change?
Why is it, you know, this isn't necessarily about farm clients, it's about all levels of behaviour, what's really going on? And what we know from something called the stages of behaviour change theory is that change tends to occur in temporal stages. So this theory was developed from huge metadata and health sciences, but essentially establishes that time in each stage of of changing your behaviour is variable, but the tasks within these different stages are not.
And you have these five core stages where you move from perhaps initially being unaware of the problem to working to sustain behaviour change over time. So I'm just gonna talk through each of these to give you a sense of how change might be occurring, and perhaps you can recognise this happening in yourself if you've ever made a Year's resolution or try to change something personally. So the first stage is something called pre-contemplation, and this is when we're just not really ready, we're not intending to take action in the foreseeable future, often thinking about the next 6 months or so.
This might be because we're uninformed or underinformed about the consequences of our current behaviour, but it could also be that we're just demoralised about change after unsuccessful attempts. If you think about, you know, the fact that, you know, a lot of us have been through a period of smoking or current smokers, we may be very well informed about the consequences, but that doesn't necessarily mean that we want to change. And for our clients, it might be, you know, they, they're just not keen on talking about their lameness problem because they've tried things 7 or 8 times and we haven't seen an effect.
And this can lead you into a stage where you're just not intending to take action because you don't really believe in those outcomes. The second stage is something called contemplation, and this is when we intend to change in the next 6 months or so. Or at least are ready to consider that possibility, but we're way more aware here of both the pros and cons of changing.
So we might have decided that something could be on our agenda. We don't really get past that point. So this is where we often see ourselves becoming profoundly ambivalent.
So you might have clients that you speak to that, you know, on the surface they say, well, I do want to make changes in my head. But you can tell they're somehow stuck because they often talk about the, the negatives of changing and how difficult it might be, and they don't seem to make that step forward. And this is quite an interesting part of the contemplation stage is this ambivalence, this having simultaneous conflicting emotions about something is often materialised in our language, so we might hear our clients saying something like, you know, on the one hand, I want to tackle this problem to improve welfare or productivity.
On the other hand, I'm just not that confident about committing to this complicated protocol. And something I'll talk about later in the webinar on motivational interviewing is that we give these two types of language very simple words. We call any arguments for change, change talk.
And any arguments against change, sustain talk. What's really interesting is we almost materialise this ambivalence in the very language that we talk about, so you can perhaps recognise maybe having talked to a client recently where they say, well, what you say is good, but actually I'm struggling a bit this week. And if we recognise that this is a very normal part of change, and there's often nothing to do with the advice, nothing to do with the individual being motivated or unmotivated, but actually considering change and voicing how they might feel about it.
Perhaps it makes you feel a little bit differently about clients we might initially label as resistant because they come up with lots of counterarguments. But if we recognise they're in a contemplation change, what we should expect is that they will come up with these as a natural part talking about it. So it takes the pressure off us just a little bit there.
The next stage is something called preparation. So this is where someone intends to take action in the near or immediate future, and you can kind of tell someone gets here because they start testing the waters. They might be collecting information or making plans, but it's someone that's maybe looking into the cost of a foot trimmer after you have a chat or asking their friends and peers what happened when they they put the behaviour in place.
It's a sign that they're really starting to think about really preparing to take the action rather than still weighing up those pros and cons. The next stage is something called action, and this is where the person is, as the name kind of referred that they're implementing the changes in their own behaviour. The changes are, you know, maybe they started yesterday or maybe they've lasted 6 months, but the goal is currently being achieved.
So maybe that client you talked to about lameness has an active training regime and is tipping along with that in their day to day plans. The final stage is something called maintenance. So the person here is actually implementing the changes in their own behaviour over a sustained period of time, so perhaps 6 months or or more.
And it's say we go back to that kind of the trimming regime. It's now a habitual part of daily management. So this is something that's become quite well established.
Now behind all these areas is something that's called relapse, it can happen at any time. And as the names again, it's, it's really at any point in the stage where someone's moving from a motivation to motivation that you can resume your old behaviours. You know, perhaps that client trying to put in their friction regime, it's the first thing that they struggle to keep in place when someone doesn't come up to work that day or they have other pressures because of the weather.
And if you, you know, constantly have obstructions in the way of behaviour change, it can lead to you being quite demoralised and and push you back into pre-contemplation. So this is something to be a little bit aware of. So why have I spent a few minutes talking about this?
Well, as I mentioned earlier, if we think about changes, this unfolding of stages, and we recognise that clients have to go through this to to work to put something into place to prepare, to make action and maintain it. It takes a little bit of the pressure off from thinking, you know, if I'm raising an agenda with a client and they're coming back with lots of reasons why it might not work, this is perfectly normal. Ambivalence is a normal part of change.
And what we need to do is find ways to support clients in this context, because if we're thinking about herd health, it's probably a safe bet to say that because many of the disease is so complex and multifactorial, ambivalence is going to be a normal part of considering change. And something you're probably familiar with in your own life, if you've ever made a pros and cons list about making a decision, maybe you recognise manifesting this on paper, trying to see which one is the the better option. And this is just what your clients are doing when they're talking through things in this way.
And even recent literature, so Yolanda Jansen and Tao Lamb and the people mastitis communication in 2012, identified farmers have these ambivalent perceptions when they're thinking about intentions to work on other health and their actual behaviour. So we see this cropping up in the literature, which fits well into these theories of change. But what's really key is that people at different status and very different support.
So. The the question is if your client is ambivalent, and if we can make the assumption that this might be the case for quite a lot of our clients dealing with very complex herd health issues. What happens when we communicate with them in, in the typical veterinary style?
So my initial research on this topic was trying to understand, you know, when vets talk to their clients on a typical head health, topic, how might this be materialised? And what we found is that this, you know, as you might expect, and in line with, you know, a lot of helping professions out there, when you have a role where, as I'm sure everyone listens to this and imagine, you go. Right on the farm, your role is to provide advice and solutions to the farmer, and in fact, you're very much paid to do that.
The, the type of communication style tends to be quite directive, so solutions focus, what to do, how to go about it, those kind of things. This is echoed both in our work here in the UK and work with Swedish vets at the Swedish Agricultural veterinary university. So this is cross cultural, it tends to be just perhaps part of the helping response that's part of the veterinary role and other professional helping services.
But the problem here is that when we think about clients that are ambivalent, and as I mentioned earlier, this is having good arguments for change on the one hand, change talk and arguments against change on the other hand. The issue is that if you imagine that in your own mind you have almost a parliament of discussion and perhaps you have good reasons for and against change. When someone comes to you and does their very best to be helpful and gives you all the reasons why why you could make the change and what you can do to achieve it and what it might look like for you, because of a, a, a situation we call psychological reactants, in psychology where we, as a, you know, as a social being, we really hate to have our sense of choice sorted.
What we tend to find is that when people take up the good side of the argument and they tell us why to change and what to do it, when we're profoundly ambivalent, it's much easier for us to take up the opposite side. We come up with the reasons why it's not so easy to do, and you might not be thinking about doing it and how, you know, we'll hold up this is a bit difficult. So unfortunately, despite our very best efforts and all of the training that we go into.
This directive style that's built around the expertise that we're very much paid to provide on farm that is, is supposed to be directly about helping our clients can almost counterintuitively, and we have this ambivalence in, in a client can lead to poor engagement. So, you know, as I mentioned, it's, it's a case of recognising that actually a normal part of change is ambivalence and perhaps a typical style of being very solutions focused rather than offering choice and collaboration can actually be one of the problems why we're seeing poor engagement with advice on the farm. Because it's not simply about what we have to do, as you might reflect from.
Eating a 5 fruit and veg a day, the knowledge itself isn't always everything. Sometimes it's about the context and building internal motivation to to carry out that behaviour as much as anything else. So how can motivational interviewing help us here?
And the ease of use I might abbreviate motivation to MI from now on, it's a bit of a mouth as we go through. So MI itself is described as a person centred goal oriented method of communication for eliciting and strengthening intrinsic motivation for positive change. That's a little bit of a mouthful, but what we're talking about here is person centred is about, you know, being centred around that client, about using specific spirit and mindset in an interaction about compassion and collaboration that I'll talk about in a second and having a very relational focus.
Goal orientated is, is about being specifically focused on a behaviour change and an interaction and and gearing your consultation towards that as an outcome. And eliciting and strengthening intrinsic motivation is about accepting that when we deal with ambivalent clients, if we can help to explore and resolve this ambivalence as a mechanism to engage clients and change, this can be the most helpful way to to bring an agenda onto the table because actually if you can work in partnership with someone, if you can have their own good ideas and their reasons for change. Foundation for your agenda, rather than bringing something towards them as a solution, and recognising that farm clients and other clients we work with are the experts of their very particular context with their collaboration, we can probably make our agenda make a little bit more sense and this is really the ethos behind the methodology.
It was developed in medical and psychological sciences. It's evidence-based, which I'll talk a little bit more about later. I over 500 controlled trials, professors Bill Miller and Stephen Bolnick, mainly started off in addiction services but has exploded into a huge variety of health sciences in other areas, particularly because of its efficacy, again, which I'll mention a little bit later.
So the, the basic premise of the method has 3 core areas that I'm going to touch on. So the first of these is something called the spirit or the ethos, or the mindset. The second is about the core skills that we use in a method, and the the final part is the 4 processes.
So I'm gonna touch on each of these just to give you a taster of what you might expect if you wanted to learn more about the method. But I, I hold my hands up. I can't teach you how to use MI in one session.
It's a very practical skill, but I hope this gives you a sense of the kind of thing you might be expected to, to channel and think about if you're talking in an MI style. The first of these is compassion. Now, compassion for a client is really just having an ability and a mindset to actively promote another's welfare and give priority to another's needs in the consultation.
It's really just having a kind of deliberate commitment to pursue the interests of others alongside any agenda that you bring to the table, because it can be quite difficult, particularly in a veterinary role where you really have this obligation to promote health and welfare, to also be mindful and compassionate of all contributors. So it It's really striving and putting this the forefront of any consultation you have is is a mindset to think about, OK, well, what does this look like for this farmer on this day and what might be happening in their world that makes us look a bit different to mine and just striving for that empathic approach and to an interaction. The second aspect is acceptance.
Now, this is about striving, as we've mentioned earlier, for giving someone conscious choice and autonomy in an interaction and recognising that, you know, everyone working on their farms has their own good ideas, their own perspectives on change, and that if we can use empathy to really understand and draw out how they view their world, that we have a better chance at tailoring our advice to really to, to sing with what they know about their world. The third aspect is collaboration and partnership. So it's really that all advice should always be grounded in the point of view and experiences of the client.
So it's a little different to the the typical kind of expert recipient role. What we're looking to create here is a report that's based around kind of a dual expertise. So focusing on mutual understanding, doing something having a consultation with someone rather than for them.
And the final stage is evocation. So this is drawing out from a client rather than imposing ideas. So essentially it's come, come from the understanding that when we think about these ideas for change, these positives and negatives, that commitment to change is at its most powerful and it's most durable when it comes directly from the client.
So it doesn't really, you know, no matter what you might think you can offer to that person, that might be interesting and engaging. If you can draw out from that person, their own motivation and skills for change, rather than telling them what could be the benefits for them first, they're way more likely to engage and be an active participant. So altogether, these, these aspects can be thought of as an acronym.
I put keep up there as I'm the kind of person that rather enjoys these things, but it's just a mindset to guide practise. It doesn't necessarily mean that you have to already be, you know, practising in this mindset before using the method, but being mindful of it really helps us as we proceed to, to keep these in our, in our focus. Now, the second aspect is something called ARS.
So these are the core skills in the method, which again as an acronym could be thought of as open questions, affirmations, reflections, and summaries. So I'm just gonna talk a little bit through these to give you a taste of the the the core behaviours that we'd use to engage with the client whilst maintaining this this MI mindset practise. So open questions, and I'm sure I'm preaching to look about it here, but they are evocative in nature.
They elicit understanding and encourage talking and facilitate abstract thinking skills. They're about obviously getting more than a yes or no answer. They're about really trying to engage clients and telling us their story, you know, what, what matters for them on that day in that hour and why they're speaking to you about a particular problem.
The difference between saying something like, you know, do you want to put those measures in place in the parlour? So tell me how things went with the milking routine yesterday. Now it's very easy sometimes to think, well I, I use a lot of open questions and I'm sure that I'm already doing this behaviour, but what we tend to see when we look at binary consultation is is quite a funnelling effect and it might be something you were encouraged to do in that clinical consultation start very open, and once you get an an understanding of where that's going, you funnel down into more clues to to target into the the the clinical information for a case.
When it comes to working with someone that's ambivalent, and we'll talk about the processes later, it can be quite important to think about using open questions freely throughout and using them as much as you can to always place your understanding back into the context of the client when you're talking about behaviour change because it's so complex that sometimes we don't want to have this sort of approach. We want to always be able to kick it back to the experience of the client. Doesn't necessarily mean having anything too complex, you know, I put the silly picture in.
Sometimes the consultations that I analysed as part of my PhD would be dramatically improved if every time someone asked a question and got a response, they just said, you know, tell me a little bit more about that. How do you feel about this? These questions can encourage our clients to open up twice as much as they would with just the the opportunity to respond to questions, they can be really powerful.
The second skill and motivation interviewing is something called affirming. So this is where we actively listen for a client's strengths, values, their aspirations and positive qualities, and we try and echo those back to a client or offer them to a client in an affirming manner. And this can often get slightly confused with praise, which is quite general in cheerleading, you know, something like good job and you're doing well.
But in MI we try and be very detailed and example specific to try and maybe turn around conversations that aren't going so well or try and emphasise strengths where we're seeing challenges and behaviour change. So for example, if a client comes to you and says, you know, you've given me this advice, and every day I've woken up with good intentions and I've been thinking about it, but over the past week I've struggled with these animals and I didn't have someone turn up for work on Saturday and it's just been too impossible, and I just haven't even done it. Often in a typical consultation we might think, OK, well, how can we move forward?
Here's an idea to put something better in place and focus on that solutions, that directive approach. But actually if we can turn it around and use an affirmation and say, you know, well, you've been working really hard on implementing this new machine all week, and I really appreciate that hard work. What, you know, what do you think you'd like to do moving forward?
That turns something from a negative to a positive and allows that client just that breathing space to maybe assess what we come to you with a negative in a little bit of a different light. So we use these throughout just to perhaps bring positivity to a consultation and also emphasise to a client that they are someone with their own strengths and values that contribute and builds on this collaborative quality of a motivational interviewing interaction. The third general skill is something called reflections, and this is just a skillful manner of responding to what a client says, which is trying to facilitate a focus on the client's feelings, their knowledge and their resources, and it's really the foundation of an empathic response.
It's quite powerful and empowering for clients. Because what you're trying to do is recognise their emotion, the content of their speech, and communicate that understanding and recognition back to them in a statement. So forming reflections themselves is really just about capturing something that a client has said and echoing it back.
Now this can be fairly simple, it might be a a sense of repeating the central message of what they've said, or it could be kind of complex where you take a guess at the implicit meaning or the feelings of the client. So if we think about a typical client statement, something like, you know, I know there's a couple of lame cows in the herd, it might be worth us looking at their feet today. If we were making a simple reflection, repeating that central message they gave us, it might be something like, you know, you want us to look at the lane cows today.
Something more complex where we're guessing at the meaning underneath that, we might say something like, you're hoping we might be able to improve things a bit. So the key here is the inflexion is down at the end. If we were asking a question, we might inflect up and say, oh, are you hoping we might be able to improve things a bit?
The difference in that inflexion when we guess rather than ask, is the difference between saying I need you to respond to me with a question or reflecting and saying I've understood you and this is what you mean. And this is why it's so powerful for clients because the more you use reflections, the more the sense of empathic understanding permeates through your consultation. And this is something that allows clients to open up more positively about change, and to really convey their feelings and emotions.
And this is something I've seen in her health data where reflections naturally evoke changes sustained work and more exploration from clients. The final skill is something called summarising. So this is listening to the client and echoing back and reflecting back the main points of what they're thinking and feeling every few minutes or at different points in the conversation.
So perhaps you might want to view direction if you go off off track a little bit, you might want to change focus or slow down. What you're doing is addressing clients' statements, so you might think back about what you've been talking about and say something like, OK, you know what it sounds to me like so far, we've had a little chat about the mastitis problem in you heard. We're interested in working on this, but at the same time you have some, some concerns that with the the ability to implement this in your new regime, and this is something that you'd be happy to give time to to talk about.
Have I got that right? And so these allow you to clarify at different points where you're going with the consultation. But they also bring back that empathy, so the more you can repeat and echo back where you think that client thinks you're talking, the more they'll feel like you're on the same page as them.
It can be really useful to do at the end of every consultation just to recap where you've been and where you're going. And I put a vas of flowers there because for me it helps me remember what you're trying to do is capture the most salient colourful points from that conversation and just give them back in a kind of bouquet and say, you know, this is what you've told me, is this correct? And so it allows people to feel like you've really listened and heard them, which is really the whole point.
So the spirit and the skills and the methods kind of combined to give this this backdrop of of the process of a consultation. So it's something, as I mentioned, that's very much relational about empathy, about proper choice, building collaboration with someone explicitly, and you know, promoting their welfare and thinking about evoking their own good ideas for change as a way of bridging their motivation, and you use these core skills, open questions, affirmations and reflections and summaries to achieve that. The BMI conversation has a four-stage process as well, so all things that are quite easy to, to bring to mind is simple outcome.
So the 4 processes in the MI conversation is something we call engage, focus, evoke, and plan. So essentially what we're trying to do is, even if we acknowledge that as advisors we go on farm, perhaps we have a specific agenda, maybe you've got an NMR report and something's been flagged up we need to talk about. We don't go straight into that planning stage.
We don't go straight into bringing our agenda on the table. We go through a few stages before we get there, we try and settle into a helpful conversation, building rapport with the client, then focusing on what to change by engaging autonomy, then evoking these reasons for and against to strengthen the client's own arguments for change and use evocative questions and reflections to do so. And then we think about planning how to change.
So I'm gonna talk through each of these in their own way, just briefly to give you a taster. But again, this is more a little whistle stop tour with a a sense of maybe bringing you enough interest to look into it further yourself. So in the engaging process, what we're really thinking about is using these core skills to listen with accurate empathy, striving to understand fully from the client's perspective, without the gender, what matters for them on their farm on that day, and why they think you're there to talk to them.
You know, why have they sought the consultation with you, even if you set it in the diary last week and said, oh, we're gonna review the lameness today, just check in with them. What do they want? Has anything changed?
Getting a sense of how important the goals might be, what they want to talk about in that session. And how they think you might be able to help. They're really getting these expectations out on the table, being welcoming, looking for those opportunities to offer affirmations to be positive and to.
Exercise that empathy and that reflective listening capacity and, you know, presenting a positive and honest picture of what you might be able to achieve in that consultation. It's very much about steering away from this more directive cell that I talked about earlier, avoiding thinking about fixing and thinking really just about building a relational foundation where you understand what the client wants. And you might think, oh well, you know, I've, I've known this guy for 20 years, why are you saying that I need to engage with this person?
Surely, you know, we have this shared understanding. What our research at Bristol has shown is that sometimes that, you know, despite the shared understanding, it can mean that explicit acknowledgement of what each consultation is for and where it should go, can sometimes be left out, you know, left out of the the interaction. But this is really important for every consultation to understand what behaviour change you're focusing on and how you might get there.
So really critical to bring in at the beginning and saves time at the end because you're not talking at cross purposes. The second stage is something called focusing, and this is where you are really thinking about what changes you were hoping will arise from the consultation and whether there's consistency between your ideas and theirs. And really it's about helping a client to identify a target area that you know, they're ambivalent about or struggling to make a change or something that you've highlighted and maybe getting choice on that.
But again, as with the first stage, it's very easy to think we know what our clients' goals and priorities are, but there's good research, . To suggest that when we compare veterinary and harmer priorities by Dirks, that these often are a mismatch. They're not often as as aligned as we think they are, so this focusing process is really keen to get at the heart of of being transparent about what the target you think should be and whether they're on board.
And you can use something like a gender mapping to do this, so. You could list your options, you know, I'm here hoping to talk about A and B. Is there anything more that you'd like to talk about?
Are you happy with this list of priorities or would you like anything added to it? And it should really just help the, the smooth running of the consultation because that person's not thinking about the 27 things they haven't had a chance to mention. And obviously there's a whole host of areas that might contribute to this.
So you quite rightly have your expertise and that's why you've been invited on the farm. And at the same time it's thinking of we're thinking about choice and partnership. The client also has problems that they might wish to present to you and might also be important.
So being explicit about asking. Directly for these and what they think they want to talk about and how that might relate to your agenda. Even if you come in with a particular context in mind, you know, you might have agreed a consultation on a particular issue.
But it's very important to revisit this because things change from day to day, so it might not be as simple as picking up where you were last week. And as we mentioned, a lot of the problem with ambivalence is is psychological reactions, and people don't feel that they have a choice in what they talk about and what decisions are being made for them. So going through this process really reduces that.
It gives people a chance to say, you know what, I, I would be happy to talk about this. This is something we can touch on. The next stage is something called avoke it.
Now this is really at the heart of the motivation interviewing method, and it involves eliciting the client's own arguments for change and really having a sharp ear for their good ideas, their motivations, their, their needs, their reasons, their desires for change in whatever way that might link to the, the areas of focus that you've agreed to talk about. Involves really active participation at the time, and on your part, it's about recognising these different types of language about change that we spoke about earlier. So how is my client talking about this change?
Are they talking about positives? When I hear them, how could I shape them? How could I ask them to talk about them more or reflect them?
And so in this evoking stage, what we're thinking about is well. If we've appropriately engaged and we've got kind of active engagement in the consultation, we've given someone a choice to talk about this, then we have this collaborative, partnership based interaction where we have the freedom to maybe think more strategically about getting to talk positively about change. And we can do this in a number of ways, but as I, as I just mentioned, it is really about focusing on this change talk with an empathic ear for recognising that you, as, as vets who work with clients, you know what's socially appropriate, so you don't completely discount all the same talk, you don't ignore it and that might give you quite the impression that you're not being genuine, but often, as we mentioned, when people are ambivalent, they talk about positives and negatives in the same breath.
They might say, well, I want to tackle this problem and improve welfare, but I'm not that confident about committing. What you might do is just choose to to emphasise the positives that they said. So, oh, well, tell me more about that.
How might things look productivity wise if we could focus on this agenda that we, we just discussed? What might that look like for you? And use those reflections we talked about to echo back what they said.
And as we spoke about earlier, these open questions then become really key. So we can almost try and drive likes to talk more positively about change if we're thinking in this mindset. But we know that the amount of talk that they have about change is really critical in terms of outcomes.
And if we can get a facilitated positive response to the, the focus that we've agreed on between us. That's a brilliant foundation to move on to setting an agenda and planning. So you might want to ask things, you know, like what do you hope to accomplish or what are the downsides of how things are now, or how do you feel about this change even and listen keenly for the positives that they bring up and use those reflections to to capture and offer back the arguments they have to change.
It's really just attentive interest in their language. Or you can perhaps use some tools to to get them to talk more positively. So they often, I often train people in something called the importance ruler.
So you might have a client, you think, oh, they're really, really not that engaged with this. This is really difficult conversation. You could turn to them and say, you know, on a scale of 0 to 10, how important is it for you to put this plan in place?
Maybe they'll say, well, maybe a 2 or a 3, I'm not sure. And you can ask, you know, well, why do you think you're a 2 or 3 or not a 0. And the, the, the key evoking point here is they then have to tell you all the reasons why they're not a zero, and they're actually, you know, 2 or 3, and that turns what might be a slightly negative number into something more positive.
So, Again, you can do this with the confidence order as well. So you might ask the client how confident you feel in doing this, and ask them to tell you how you might support them to shift up a number or do a little bit better. Now, these are just some tools in the box of MI where you think about, OK, I need to engage this client with a more positive conversation on change.
And hopefully if you're interested, you can look into a bit more, but the, the sense of this evoking stage is my client has their own good reasons, their own good arguments for change, and my job is to, to capture those and and present them to a client in a way that means that their own ideas in this this process are really what's pushing the consultation forward towards a plan. And obviously you have your own ideas and expertise and you can share these throughout by asking permission, you know, would it be OK if I mention something that's come to mind? Always offering choice before you give your input, but really emphasising the client's perspective as we go through.
And once you go through this, you might start to get a bit of an intuitive side that someone might be engaging more. So in MI we try and focus on thinking about, OK, does this client seem ready for change? Do they seem ready to have me talk about plan?
Maybe they're being explicit and they're saying, look, you know, I just, can you just give me some ideas here. I'm, I'm quite keen to hear them, you know, we've already got such amount of time on farm. Would you, would you be happy to share them?
And then that permission is explicit and they've given it, but often the issues only arise when we don't ask permission, so that's really key. You might hear that they increasingly talk with change talk, so you might hear more arguments for change than those against change, and this can be a sign that they're kind of mobilising towards positivity. But all of these factors kind of combined to give you a sense that your client is more ready to talk about the plan.
And when you decide to offer this, again, it's with that mindset, that collaborative spirit offering choice. Offering permission to speak and just making sure and checking and using open questions how the client feels about it, how it makes sense to them. So overall, you know, it's a, you might think, wow, that sounds like it takes quite a long time to get through.
But what we see is that when you start off with a real engagement and settle into this conversation and explores the client perspective first and gets agreement to talk before getting their good ideas first, that planning process becomes a lot more simple because they're really ready to hear you. I'm really ready to engage in that conversation. So it does save time in the long run, rather than focusing on putting an agenda on the table at the very beginning and then trying to work through all these problems as you get there.
So motivation is, is really about offering this really solid foundation on which to build an advisory conversation. Now, It's really just as I keep mentioning that as this quote from Carl Rogers really highlights that people are most able to change when they feel free not to. It's a very counterintuitive thing, but it's, it's really at the basis of a lot of human psychology.
So if we can facilitate a way to respectfully recognise our client strength, to evoke these in conversations and use them to to pepper our advisory recommendations, it can really help for these to to create salience for the client. No. That's quite a lot of points to go through and I realised, you know, it's late in the day and maybe.
If you don't go and look into this further, it can be a bit much to take on. So I thought I'd finish with a few goals. It might be just useful if you're talking to someone tomorrow.
Because MI is a tool in the box and you can use some of these skills however you decide. But you know, thinking broadly, if you're able to talk less than your time, there's a sign that you're listening more. So try that, try talking less than them, try giving people space to talk as much as possible.
If you're asking questions, try and ask mostly open ones. Try and make them evoke positive reasons for change, rather than drive towards negatives. Try to use empathic reflections when you do ask questions and try and make complex guesses about what your client means, not just what they've said.
And avoid getting ahead of your client's readiness, you know, ask permission before offering information. Avoid persuading or giving uninvited advice. Whilst you can and you should offer expert advice where appropriate, that is absolutely a role on the farm.
If you can emphasise client autonomy and freedom of choice, your advice is gonna be much more salient. And so this is really the key for, you know, for working with ambivalent clients. We recognise that positives and negatives are a normal part of change.
If we can have a guiding style. Think of it more like dancing and creating space for someone to move with the consultation rather than wrestling them through it. This is really the heart of the method and hopefully it's an idea that you can take away and try out and just see how it feels to step back and see what your clients might say to you if given the opportunity.
And the good ideas that they might be able to invest in the process. So that's a brief whistle stop tour of the method itself, so I was just gonna talk just a tiny bit through the, the evidence base both within the medical sciences and and some of our research at Bristol. So how has MI been up taking broadly at a kind of, you know, level across not just veterinary science but health sciences.
So I mentioned earlier there's about 500, well, increasingly controlled trials, and the systematic review and meta analysis do support the use of MI and the pursuit of positive behaviour outcomes. It's been established internationally as a method, and there's about 3000 trainers representing 50 languages in the organisation I'm a part of called the MI Network of trainers. And the texts are published in 27 languages alone.
So it's something that is really well recognised and validated, so much so that Carol, in 2016 said that there's no other empirically validated therapy that's achieved this level of worldwide dissemination, including cognitive behaviour therapies or structured family approaches. The evidence base behind this. And using these skills and following these processes and using this as a method of engagement and behaviour change really has strength.
And although the evidence base, as I'll talk about in a minute is just starting off in veterinary science, we can rest assured that it really is quite strong across a diverse amount of disciplines. Now how does it actually work? So our hypothesis really focuses on the causal chain between adviser verbal behaviours, client verbal behaviours and outcome change, namely that behaviours that are more consistent with motivational interviewing, so those that are collaborative, emphasise client autonomy, a firm client strengths, use empathic reflections and those kinds of behaviours, lead to client verbal behaviour that is more likely to include the positives of change rather than negatives of change.
And as we see this ratio of the positives in climate change or increasing compared to their level of sustained talk, we see this correlates to positive outcome change. And support for these causal chains is relatively good. It's brought across assignment diverse disciplines, and the evidence base supporting the link between climate change outcomes and their language is also promising following a series of me.
There's there, there's a people at the bottom there that if anyone's interested, you can look to. What's really interesting is this causal chain between what an adviser says, how a client responds, and outcome change has been evidenced across 4 different laboratories looking at things like alcohol addiction treatment, suggesting strong support for the mechanisms hypothesised. So there's something meaningful happening in here and that this method consistently has the ability to, to achieve as good as if not better responses to the more directives that we typically lean on in advisory consultations.
But what about veterinary science? So, in our world, this is a little bit more fledgling in terms of the research, but obviously it's something I've passionately been dedicated to for a few years, and there really is an increasing interest. So I'm hoping over the next couple of years, this will sharply change.
But just to give you a little bit of an overview of of the kind of questions I asked, so I was very interested in my research about whether vets could learn and apply motivation engineering in real herd health consultations. As you can imagine, a lot of the evidence bases and things like GP consultations and those kind of interactions, which was very useful. Everyone I'm sure will experience a slightly more complex environment, maybe you're battling with crashes or tractors or you've got a lot of other things going on.
How does MI work and what does it look like in those real situations with real farmers, real complex advisory herd health talks? So what I did is I recruited 14 vets to a study where I asked them to record real conversations with their clients on any aspect of change for herd health before and after a training experience and motivation interview. And this was about 4 to 5 hours training experience, which is a little less than the literature suggests, which is probably usually more about like 2 days, but this was to fit around a couple of clinical clubs in an evening, something like that, just to, to see what kind of outcomes we could, we could witness.
And the thing I was interested in was how does this training affect the kind of language that vets use? And how does the language that the vets use then impact farmer language as well? Does it align with these hypotheses that I was just talking about where consistent communication increases farmer change talk?
And if so, you could make a proxy for saying perhaps this would be a positive for on the farm change. So what we found was that vets were able to learn and apply the MI method. Before and after training, we saw that there was a statistically significant increase in vet's ability to use those reflective listening statements, the reflections, and how much they were using reflections proportionately to questions, so they increased this amount.
We also saw that they generally increase their relational abilities and empathy and collaboration alongside that kind of spirit, that relational component. And they increased their technical abilities to focus in on and respond to change language and soften sustained language. So they were more aware of this language of ambivalence and how that affected clients.
They also significantly reduced their persuasion. So offering solutions and fixes without a sense of choice or collaboration. So they really became quite quickly more consistent.
Farmers were also more engaged in herd health discussions if we use the presence of change stalk as a proxy measure, we saw, saw a statistically significant increase in change or after training, so this was really exciting. And we also took some probability measures to look at which particular verbal behaviours from our vets are more likely to lead to different types of change languages, we know that these are so important. And what we found is that these MI specific skills of emphasising autonomy, affirmation, and seeking collaboration, the most likely to lead to farmer arguments for change as positive language.
Whereas persuasion, this offering of solutions without any choice or collaboration, most likely to lead to arguments against change. So it's really fascinating that this really did echo the wider literature and got me very excited about the whole thing because it was a a real sense that, you know, training this methodology could actually quite quickly be uptaken by vets and it's a real testament to that the skills of, of how they quickly took this on on farm, but also that the farmers became more engaged in health discussions as a, as a result. So again, something we're looking at developing and doing more studies on and working internationally and collaboratively to do so, really promising first instance.
But just to give you, I guess a, a more real response from one of our trainees who emailed me afterwards, one of our MI trainees contacted me to say the following. He said, you know, I've been trying out the techniques you saw taught this jaw-dropping responses. I particularly like the methods of elucidating the farmer's real concern by rephrasing their comments that reflection statement.
It gets to the heart of the matter very efficiently. Also great responses from asking if you can share your thoughts before delving into the answer that permission seeking. I've had some very soft responses from some very hard farmers.
And I think this really gets at the heart of what this whole presentation is about. You know, how do we engage clients in a helpful conversation? Actually, those very hard farmers, those people that we think are hard to reach, that we can't connect with.
Sometimes it's not really about the person, it's about our interaction and our methods, and I, it's not a magic bullet, it's not the answer to everything, but it's a very effective tool to give you the chance to connect with people in a different way, to turn those hard farmers into something a lot more soft to interact with and soft responses. And again, the principles are, you know, general in psychology, so not even just about your farm clients, but think about other relationships and communication you have. Everyone.
Whatever profession they're in, likes to have a sense of choice and to be engaged with and empathise with. They're very general skills that can be very useful across a whole host of circumstances. That's taking me right to the end of my time now.
So if there was a take home measures to, to go away with, I'd just say perhaps I think about the fact that if you're trying to engage clients that ambivalence and complex change, which is such a part of herd health, is probably common. And the resistance that you see can be interactional. It can be something that's created from taking a very directive and solutions focus focused approach to this.
And that perhaps thinking about the ideas within the motivation interviewing can help you to effectively support your clients and resolve these challenges by taking a slightly different approach and recognising psychology underneath it. Now it is a way of influencing. So the skills I talked about recognising this language and and shaping it in a consultation are are technical influence skills.
And if you're interested in learning more in it, expanding on the method, then you'll learn a bit more about that. But despite this, it's definitely not a way to, to trick people into what you want them to do. And it's so based upon collaboration and promoting of of that person's individual welfare and behaviour, but I hope you get a sense that it can't really be about that.
You can only find a way to positive change if you're guiding your client on a path that they're happy to be on as well. It's also something that we recognise a lot of ourselves in. Many of these skills you'll be doing bits and pieces of, particularly relational skills such as empathy and the collaboration.
The technical approach to language is probably quite difficult to achieve and might not be what you're already doing as lots of studies have shown that you need focused training to do so. So be aware that to really try and model this method, it requires some practise. It's a bit.
Like riding a bike. If I gave you a webinar, I could show you pictures of a bike, I could talk about it. I could tell you how to move those pedals, but until you've got on one and moved it around and fallen off a few times, you probably won't have that great a sense.
So if you're interested, definitely encourage you, a brilliant place to start. It's a BMJ learning module, motivational interviewing, brief consultations. If you Google those words, it's completely free.
You can start the module and it will take you through videos on each of the four processes and the core ideas and the method. There's also a book by Steve Ronick and Bill Miller called Motivational Interviewing Helping people Change. Fantastic way to work through the method.
Well there's a website there, motivationinterviewing.org, where you can look at free resources and videos to learn a bit more. As this has been a whistle stop tour.
But I hope if you're interested, you can look to learn a little bit more and see how it might affect your practise. Yeah, that's the end of the presentation today. I hope, you know, it's, it's given you a little bit of insight into what is essentially just how to have a helpful conversation about behaviour change.
And I will pass back over to Sarah for any comments and questions. Thanks ever so much for listening. Thank you very much, Alison, it's a really, really excellent, presentation.
It's certainly given us, an insight, into your work. I'm sure that everybody listening, has found it very, very useful. I, I certainly have.
Before we go to any questions, could everybody just spare 30 seconds to complete the feedback survey that should have popped up in a new tab in your browser? Depending on which device you're using to watch the webinar, the survey doesn't always present itself. So if, if this is the case, please feel free to email.
Us any feedback you have using the email office at the webinar vet.com. If you are listening to the recording of this webinar, you can add comments on the website underneath the recording or email the webinar vet office as well.
So don't forget that if you've got any questions, we've got Alison here online to answer them. So please feel free to add them into the Q&A box because we have got time for a couple. We have one here from James, and he thanks you for an excellent session.
And says, one of my roles at the moment sees him visiting farmers just once, and he often hears what I need is for you to give me a kick when I forget this in a couple of weeks' time. Given that this isn't possible for him, as he's just visiting the farms once, how could he, how would you advise him to utilise the tools that you've outlined, most effectively within those constraints? Well, I guess motivational interviewing is a bit like playing a piano.
You can play it well if you do it for 1 hour or for 10 minutes or over 3 different sessions. But as long as you have the right ingredients, the motivation to change should, you know, ideally be a bit better than if we took a typical directive approach. So I'd say have confidence in trying out even if you only get that one commitment to change and perhaps have a look at those BMJ videos that are really good insight into how to have quite a short conversation to engage someone's motivation, even if you might not ever be seeing them again, because that can be the big question.
But it is really, you know, about promoting that person's own arguments, getting commitment with a sharp ear for emphasising their choice. And moving them into maybe a more explicit way of committing to a change goal. So maybe doing an agenda setting process on paper, getting them to write down their reasons for change and and writing down their plans as, as we know that maybe putting this out in a physical presence might be a more targeted way to do so that they can rely on after you've gone.
But yeah, have a look through those, those videos in the online course because hopefully that will give you a good suite of behaviours that might help with that question. Thank you very much, Alison. Another question here from Lucy, and I think that we could, probably all relate to this.
Do you have any tips for resistant farmers who are having change imposed on them? So she mentioned she has 15 or so farms who haven't had any experience of proactive herd health, but are having RSPCA farm assurance imposed on them. So, do you have any advice, advice for, for helping those farmers?
I would say that sometimes when I talked in the presentation about that engaging process, that when we're really heightened and aware that we're part of a system and pushing something on someone, we do our best to kind of try and make it OK, you know, try and step back and not be involved and not to explore that, that resistance to you fully. But sometimes. With that engaging process, what someone really needs is just to be listened to.
And I'm sure I'm preaching to averted, but if you think about, you know, how can I really spend the 1st 20% of this conversation not trying to focus on anything but hearing them and listening to them and and trying to form really accurate communications of what they're thinking and feeling about this. A lot of the time, you know. Sometimes a really helpful healing process is feeling that someone really has got exactly why we're struggling and got exactly why things are difficult for us.
And that can be therapeutic in and of itself, and that's what client centred therapy is really about. So stepping back and saying, you know, maybe I'm being honest with your client, I may not have so much in my power to do anything about this, but I'm really interested in knowing how you feel and where you think you might be able to take this despite all of that, and, and really slowly going through those four processes with a real emphasis on positive engagement about just why they think and feel the way they do without trying to shift it, without your own agenda. And sometimes it, you know, again, counterintuitively, because you might think people will entrench just being listened to and heard properly is enough to release a lot of tension.
You know, if you think about when you talk. To your best friend about something when you have a problem. Often you're not specifically trying to get a solution from them.
You just know that that person really listens, and that can be helpful even if you know it's not a problem they can fix. So materialising that and perhaps being willing to open that can of worms and can be a powerful thing for people to feel engaged with, even if you can't change the fight, you can kind of change their mindset on, on being a collaborative partner within that process. Brilliant, thank you very much.
Now we are just, we've just come up to 9 o'clock, so I think we'll leave it there for, for the questions for now so we can finish, on time. But I just want to thank you again, Alison, for your presentation, and for all the stimulation that you've given us this evening in terms of making us think about how we engage and communicate with our clients. Also want to thank, everyone who's attended tonight's live webinar.
And we really look forward to you joining us again for the next one, which will be on Thursday, the 13th of December, when James Breen from Nottingham will be joining us to discuss the latest evidence base on mastitis and the recently launched AHDB mastitis pattern tool. So thanks again, Alison. Thank you everybody for listening and good night.
