Motivational Interviewing: Encouraging a Collaborative Discussion with Carrie Bader and Ryan Hassan , MD, MPH
In this episode, Boost Oregon's Medical Director, Ryan Hassan, M.D., and Training Director Carrie Bader M.P.H., M.O.T. discuss motivational interviewing (MI) and how to connect with people through listening and understanding.
If you have questions for Dr. Hassan or Carrie Bader, email or send a voice message to boostingourvoices@gmail.com. Your questions will be answered during a future episode!
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Our Host
Ari O'Donovan
Our Guests
Training Director Carrie Bader M.P.H., M.O.T.
Carrie Bader is a health educator, occupational therapist, and former New Yorker who has made Oregon her home since the early 2000s. Her training area of focus is motivational interviewing (MI), an evidence-based, collaborative approach to conversation that promotes positive change; she has been a member of the Motivational Interviewing Network of Trainers since 2009. She has taught MI to therapists, psychiatrists, social workers, nurses, and lawyers. As Training Director, Carrie teaches and promotes the use of MI to help providers best work with families. When not geeking out on MI, Carrie is busy jumping in puddles and collecting leaves with her daughter
Medical Director Ryan Hassan, M.D., M.P.H
Ryan Hassan, M.D., M.P.H., is a board-certified pediatrician working at Oregon Pediatrics in Happy Valley, where he lives with his wife, Christen, daughter, Olivia, and chihuahua, Luna Joe. His professional work centers around improving the lives of children by promoting preventive healthcare and healthy lifestyle choices at the individual and community levels and by empowering physicians to become better advocates for their patients. Dr. Hassan is an avid outdoors enthusiast and enjoys running, biking, swimming, hiking, backpacking, climbing, snowboarding, and kite surfing.
Transcript:
Ari O’Donovan (00:00):
Thank you so much for listening to boosting our Voices. This program has been brought to you by Boost, Oregon. You can find them online@boostoregon.org.
Ryan Hassan (00:14):
I think so many interactions these days are so charged and people are just, they're not listening to each other at all. They're just seeing who can be the loudest.
Ari O’Donovan (00:31):
Welcome back y'all to another episode of Boosting Our Voices. As always, I am your host, Ira O'Donovan, Boost Organs Diversity Program manager. I'm here with my colleague Ryan, Dr. Ryan Hassan. He is also a co-host of this podcast and our new colleague Carrie Bader.
Ryan Hassan (00:52):
Hello. It's great to be here.
Ari O’Donovan (00:55):
We are gonna be talking about something today that I use all the time whenever I'm doing community outreach, connecting with anybody which is motivational interviewing. So first I wanna start with Carrie. Can you please tell us a little bit more about yourself and what you specialize in and your brand new roller boost?
Ryan Hassan (01:14):
Yes, happy to. As of a whopping two days ago, I'm the new training director at Boost Oregon. I came to boost from the Oregon Health Authority. I'm also a licensed occupational therapist and I have a background in working in public health and health coaching settings. And my role at Boost is gonna be focus on promoting motivational interviewing as an approach to having conversations around healthcare decisions, around vaccine decisions. And it's something I've been a trainer in for almost 15 years now at this point. It's something that I just have a whole lot of passion for. I find that motivational interviewing, when people use it and use it effectively, it just makes everything go so much easier. It makes conversations go more collaboratively and just helps people really partner up and work together to just make decisions that make sense for themselves.
Ari O’Donovan (02:17):
I love that. I love this episode. Motivational interviewing is so near and dear to my heart and it's so effective. It's like the best way to connect with people. So I'm glad that we get a chance to talk about that on a whole episode. Carrie, can you give us a crash course in motivational interviewing? A lot of people may not know what it is. They may have never heard that term. And when is it the most useful? Tell us a little more.
Ryan Hassan (02:44):
So, an official definition is that motivational interviewing is a collaborative conversation style for strengthening a person's own motivation and commitment to change. It was developed in the eighties. It was originally developed for working people with, uh, with addictions. And the predominant approach at that time was if someone was struggling with something, you just need to tell 'em all the reasons why they should make a change. And if they argue, you know, get even firmer and with your reasoning, with your logic, use guilt tactics, use scare tactics. You know, you really gotta get people to see everything that's wrong with what they're doing. And you know, lo and behold, that actually wasn't all that effective <laugh>. And so these two guys, Bill Miller and Steve Rollick came along and they started using a very different approach where it was centered around really talking to people with empathy and trying to see their perspective.
Ryan Hassan (03:42):
And instead of trying to get them to change using a highly confrontational approach, the approach instead is really to collaborate with them. And so just in the about 40 years since then, there's been a whole lot of research, motivational interviewing has been found to be effective in all kinds of areas where you're really trying to support somebody in making a change around their behavior. And so that can include, you know, helping people eat more healthfully, get into more physical activity, safe sex, and of course vaccine education here too. And so it involves taking a collaborative approach with someone. And if you like metaphors, I like to think of it as you're dancing instead of wrestling. You know, instead of trying to persuade somebody, trying to get somebody to do something differently, it's really the two of you on the same team looking at this issue together and just looking at, you know, what are someone's values, what are their concerns? And essentially when it's going well people, they often end up talking themselves into change. The reasons for change, the thoughts about change are coming from the client as opposed to the case being made by the practitioner that the person in the helping position
Ari O’Donovan (05:03):
That's amazing. How could we possibly not use that in what we all do at Boost Oregon? And it's no surprise that over time people came to the decision that telling people they're wrong and berating them for being wrong wasn't gonna be an effective way to get people to change their behavior. I know with my mom, she does not like to be told what to do by her grown adult child. So <laugh> definitely, I have used motivational interviewing with her <laugh>.
Ryan Hassan (05:33):
That's the most advanced form of motivational interviewing or MI is using it on your family members. I'm not able to do that.
Carrie Bader (05:41):
<laugh> <laugh>, I've been working on that as well. But you know, I think it really is a, I think of it as a way of, as a way that uh, another provider put it to me once and I really resonated that it's just a way to move through the world. I is just more holistic and less centered on yourself and more empathetic and understanding of where other people are. I feel like it's just you embrace the fact that you are in control of only yourself and your actions and you honor the fact that other people are in charge of their own decision making and have their own autonomy in every aspect of your life and your interactions with others. And then it just changes the nature of those interactions because you are no longer trying to convince someone to do what you want. You're putting your wants and needs for yourself and for other people aside.
Carrie Bader (06:35):
And even if I might like that, you know, my patient gets a vaccine or stop smoking or you know, my wife you know, takes my baby or for a certain amount of time or up there does some sure that I don't wanna do. You know, it, it's about understanding like it, it's okay to have my own wants that maybe conflicting with other people's, but I need to understand that at the end of the day I can only make decisions for myself and other people have to make their own decisions and I can help them to make those decisions by respecting that autonomy and helping them, you know, through their own decision making process. But I can't force them to do a dis make a decision that they don't want to make themselves and I shouldn't try. That's just disrespectful. I find the more I've done this work, it really has helped me become more empathetic in general and allowed me to enjoy just interacting with other humans in general. Just it makes me a better listener as well because I think that's a core of MI is listening. You know, we'll talk about reflections I'm sure, which is, you know, I think a cornerstone of it where you spend most of your time thinking about what is this person saying? What do they really mean? How can I interpret that in my own words? And that's what empathy is, is just putting yourself into their position and trying to understand what do they mean rather than, what am I gonna say in response?
Ryan Hassan (07:54):
I think one thing that I have found really helpful in learning motivational interviewing is, you know, a lot of approaches out there or a lot of, you know, often the recommendation is show that you understand, show empathy. And I think where MI has been helpful to me is in figuring out, well what does that mean when somebody is saying, Well why should I believe you? Or you're just trying to push me to do this? And or maybe someone just says, you know, I hear what you're saying but I still dunno what to do. And when I do trainings, we look at those situations and we actually come up with what's a response? What do you actually say back in those situations that demonstrates empathy and it still potentially supports change. So I think it gets really kind of granular and specific in a way that can be really helpful. It takes these concepts that we hear tossed around all the time, you know, partnership, acceptance, compassion, and gives you specific ways in which you actually demonstrate those in a a conversation. Yeah,
Ari O’Donovan (08:57):
It's as Ryan said, and as you elaborated on Carrie, it's really disrespectful to take away someone's autonomy for their own decisions, their own ability to make their own decisions about whatever it is, their health, other things associated with their life. To assume that you have a better understanding of someone else's lived experience. The only understanding to that degree that you have is of your own. So you have to trust another person to know that they have the information about their own lives and they can make their own decisions. They just may need some extra information. And the best way to do that is to approach them in an appropriate way that makes sense.
Ryan Hassan (09:40):
When we are respecting someone's autonomy, we're also just acknowledging reality. I mean it is somebody's decision to, you know, if we're talking about vaccines, whether they want to vaccinate, whether they want to vaccinate their child, there are different outcomes that may result from those decisions. But you know, the decision is really up to them. And so, you know, one thing I talk about in the trainings is being really mindful of our language and when we say things like, you have to do X must do this and that language can sneak in if we're not careful. And so being very mindful that we're using autonomy supportive language and so just making sure we're accurate with our phrasing because yeah, they don't have to, I might recommend something, I might say, here's what I would suggest and see how it lands. See what they think.
Ari O’Donovan (10:31):
Yeah, that's like the natural American way. <laugh>, when they're told you have to do something, most people are like, that's where you're wrong right there. <laugh>. No, I don't, I know I have family members, friends, other people that I've come in contact with doing my community outreach. Nope, you lost me right there. Try again. So that's why MI is really good.
Carrie Bader (10:56):
What I think MI allows us to do is to actually be better partners and be more empathetic is part of what makes it effective at helping people change and helping people trust what you're saying and feel like they're being connected with and listened to is, is that it changes the way you are interacting with and perceiving the person you're talking to because by engaging with MI and you know, embracing the philosophy of MI that we've been talking about, you are forced to become a more empathetic person and to really get a better sense of what is it like to be in this person's shoe? What are they really feeling and thinking and going through? And how does that impact this decision they're having to come with come to. It's what's been really helpful for me is that it makes it easier to interact with patients who, you know, previously I might have been very frustrated by, because you know, they may be making a decision that I very strongly disagree with.
Carrie Bader (11:52):
But now when I am more mindful of the fact that well this is, you know, this is their decision and as you said I already, you know, they have their own lived experience and their own, you know, I have another colleague who said everyone has a PhD in their own life experience. And I think that's a great way of putting it. You know, everyone brings something to the table and when you acknowledge that, you know, there is information that is behind these and feelings and experiences that is behind this decision and you try to understand that, it gets a lot easier to accept that. Okay, I get it. I may not agree with this particular decision, but I understand why you're there and it makes sense to me that you know, this is a struggle for you.
Ryan Hassan (12:30):
Yes. I think you're reminding me too, Ryan, that in the practice of mi, you know, we talk about empathy a whole lot and it's something you feel, but it's also something you need to exhibit. I mean, you need to see things so that the person knows that you're understanding what they're going through and what they're saying. Cause if you're not conveying it, they're not gonna know. They're not gonna know that you understand. And that's why we pay so much attention to language, both from the client and from the practitioner. And so when we're practicing and it does change how we think about people, for instance, affirmations are a very important piece of motivational interviewing. You know, making statements where we are, you know, recognizing someone's strengths or a value that they hold dearly. And in order to do that we need to really be looking for things to affirm.
Ryan Hassan (13:29):
It's a different approach. And that's not something that people often do if they're, I mean if you're sort of facing off with somebody and trying to confront them and get them to change, you're probably not looking for things to affirm in those moments. It can be a very different approach, but it can really shift how you think about people, how you approach these conversations. And I think even when conversations and with somebody maybe they're not doing the thing that you hope they'll do, that doesn't mean it was a bad conversation. You know, you can have very successful, you know, very productive conversations and sometimes you're just planting a seed and sometimes you might talk to someone later and they actually say, you know, I thought more about things and I think I will do X, Y, Z. You never know, who knows, They might go do it down the road and you're just, you're not a part of that. It does change how you judge whether a conversation went well or not. And I've heard from a lot of people who use this approach, it was certainly my experience that I just, I just enjoyed my work more. I enjoyed just talking to people more cause I just felt more effective. And there have been so many times where I've been in these situations where I thought, I dunno what I would've done if I hadn't known how to use a motivational interviewing approach in those situations.
Ari O’Donovan (14:50):
I love that. So first of all, there's a video game called Bloodborne and I promise you it connects to this what we're talking about right now. <laugh> in the game, the more you do and experience and go through the game, you get to gain something called insight. And the more insight you gain, the more stuff you can see in the game. It's a much more enriching experience, it's more fun the more insight you have. I like to connect that to the work I do at Boost and how I use motivational interviewing because it allows me to learn more about not just that individual person, but just the experience of people just in general. And it makes me better at my job. It gives me a more experienced, in a greater worldview of everything around me. And I don't know that I could effectively do my job as well without motivational interviewing. And obviously video games help too.
Carrie Bader (15:45):
That analogy reminds me of is the concept of sensory gating, which is, and this is maybe a little tangential, but it's the idea that the, our experience of the world, what we perceive, what our senses tell our bodies about the world around us depends on what we expect to see and perceive. And it's very clear when you watch a child, their sensory gates are wide open, they're taking in everything around them. And as we get older we have to close those gates. We have to, you know, narrow our field of vision, ignore certain things we hear, feel, smell, taste because you know, it's just a lot. And we learn that well some of this is background and we don't really need to pay attention to it. And that helps us to make it through the world without feeling overwhelmed by enormous amounts of input from the world around us.
Carrie Bader (16:32):
But it can also hinder us when we allow ourselves to filter out as background noise that's unimportant, that gets discarded at our subconscious levels. Information that actually can be very useful. Whether it's, you know, a more things to see in a video game or for my own experience as a newly minted plant daddy being to be able to pay more attention to what's going on with my plants. And being more able to notice like is this leaf a little droopy or is the soil a little wetter or drier or in a clinical setting, having a better insight into when a patient tells me, for example, I don't think I wanna get these vaccines from my kiddo. Maybe when they're older I just, you know, I'm worried about how Somali is instead of, you know, what I was trained to do, which is to see oh this is someone who doesn't have the right information about vaccines and I need to correct them and tell them actually it's safest to get 'em now.
Carrie Bader (17:24):
And the side effects are minimal and less when they're younger and this is the best time to do it. I instead perceive a person who's not just, well, you know, misinformed and making a decision I disagree with, but someone who's saying, I am struggling with all the information and I don't know exactly the right decision and I do wanna protect my child by getting them vaccinated at some point. I just don't know if this is the right time because I have also heard that maybe there's reasons why I should do it later and there's concerns that I have. And so they're telling me, as you said Carrie, if we look for it, we find it, they're telling me a reason they do want to vaccinate, they do wanna get this vaccine at some point they just aren't sure about right now. And you know, there's probably some good reasons for that that we could explore.
Carrie Bader (18:08):
So practicing it and looking for those reasons people give to change, it helps you to see them more. And I mean, and I use that example in a talk I give to other healthcare providers, given it I think four or five times in the last two weeks. I offer that up is like someone says to you, I wanna get the vaccines for my kid when they're older. I just not right now. They're so small. And I say, What would you say to this? And everyone's first response, this is after I've talked to them about, you know, user reflection. Don't try to ignore the writing reflex. Try not to just correct right away, try to hear what they're saying and make sure they feel heard and listen to their first response is still, well I mean, you know, it's actually better to get it now. You know, there's not that bad side effects are are minor and they're not dangerous. And this is always what people say first because this is what we're trained to do. I give many examples so people can have the chance to see actively, oh that's me correcting them. I didn't actually listen, I didn't look for how they're really feeling and I didn't even notice that they were giving me reasons that they want to make a change cuz I wasn't looking for it. I was just paying attention to what I disagreed with.
Ryan Hassan (19:11):
It's challenging, especially challenging if you've been interacting in a very different, more traditional approach. You know, something that I really hope we can do with Boost is, you know, not just provide these, you know, not so many just one off trainings but really support people in developing competence, in motivational interviewing. Not just getting exposed to these ideas and sending them off, but really kind of reviewing and practicing over time is so important when it comes to developing and keeping up and my skills.
Carrie Bader (19:46):
I struggle with it, you know, I still have that writing reflex, I will still jump in and make a correction or ask too many questions. And I've definitely gotten a lot better through practicing with patients and you know, talking about it all the time. But at the end of the day, my best teachers have been my patients, the patients I talk to and you know, their feedback of either through their body language and tone that they're not having a great time. And I made them feel worse when they left the office and made myself feel worse, which is never the goal. Or if, you know, I felt better after a visit and saw that they felt better and more empowered. And oftentimes when that happens, patients will tell me outright, they'll say, you know, they may not, as you said earlier care, they may not decide to make a change at that visit, but they will often say, Hey, you know, I really appreciated you taking the time to talk to me and listen to me. It, it was, I just never had that experience before and I've had so many people have negative experiences with their doctors and it was just really nice to feel like you actually wanted
Ari O’Donovan (20:46):
To listen to me.
Ryan Hassan (20:48):
The idea that they can voice concerns and have someone just hear them out, not either immediately say, Yeah, you're absolutely right, we shouldn't do this. Or say, No, you're absolutely wrong and where'd you hear that? But instead just creating a space where people can voice this and feel heard and not judged, not feel like someone's jumping all over them and just have a conversation about it. I think for a lot of people it's really unexpected. You know, they're, they're not expecting, especially if they're going to see a doctor, they're not expecting someone to hear them out. And so sometimes in these conversations we're really spending a lot of time just engaging and trying to develop trust cuz they might not even voice that they have concerns. They might be afraid to voice them because they're worried that they'll be judged. And so sometimes statements, you know, sometimes we can help things along by saying things like, you know, I'm, if you're, if you're open to it, I'd love to hear what some of your concerns are. I hear people have all sorts of concerns. I'm wondering what's most on your mind. I'd love to hear.
Ari O’Donovan (21:58):
And that's the great thing, it's so critical with MI for Bipo communities because people of color already have concerns. They already have issues and problems with the government, with you know, hospitals and doctors in the medical field because of past public health failures, medical failures, governmental failures. So to start with that, with motivational interviewing, that is the best place to start. And that leads me to my next question, which we've already kind of talked about is how important motivational interviewing is to vaccine education and interacting with vaccine hesitant folks, we kind of already talked about that, but anything else you guys wanna share about that? Let me know.
Ryan Hassan (22:44):
I, I think just related to what you were just saying, I think it's especially important when there is potentially a significant power differential that could really impact the relationship and typically it does impact the relationship and healthcare interactions are really prone to that. You have this doctor who's, you know, immediately there's this dynamic, this is the expert and I'm just the patient and what MI does at the outset is it, it kind of flips that, you know, instead of having the approach of I am the expert and I'm gonna tell you what to do, that the mindset is more, you're the expert on your life and I have some information that might be helpful to you and think especially with, you know, communities of color. You know, there was a meta-analysis looking at motivational interviewing with communities of color that found twice the effect size in the use of motivational interviewing.
Ryan Hassan (23:42):
And I think a lot of it has to do with addressing the issues of power and also looking at well as compared to treatment as usual, which is gonna be even worse for communities of color. So I think for me, motivational interviewing, it's always a great just starting point. Always a great default. And like Ryan said earlier, it's really, it's more of a way of being, I don't even really like to think of it as a technique so much because then it just ends up being something that someone, you know, pulls out of their pocket when somebody isn't doing what they wanna do. And you know, people just end up feeling manipulated when it's used that way cuz it's not really, the spirit isn't there, just feels like you're doing something to somebody and people pick up on that.
Carrie Bader (24:26):
I think it's more than just a helpful place to have a conversation. It is necessary for any kind of productive conversation because if you not embracing and accepting people's autonomy and focusing on listening first and empathizing and understanding the reality of the situation, which is that you're only in control of yourself and they're in control of themselves, then you're going to end up just pushing people the opposite direction. You're gonna build on distrust and animosity and it's just gonna, no one's gonna make a different decision. You're both just gonna end up butting heads digging into your own views and leaving just feeling disconnected from one another. And building on another thing you had mentioned is I think when you take that approach of what I would call, you know, benevolent curiosity where you're just genuinely interested in figuring out what is this person coming from, how do they feel and what experiences are informing that state of mind, it does allow for people to better understand how they actually feel.
Carrie Bader (25:30):
Because if all you are exposed to is just the yes and the no, like yes you're right or no you're wrong and everyone you've talked to is saying one of those two things to you, then you know you don't have the room to develop any nuance. It's just like, okay, well this clearly I'm in this group of people who agree with me and that other group of people who disagree is wrong and that's all there is to it. But really there is nuance and there is you know, room for more in depth thinking about what are some of the reasons that I have on both sides of this issue that pull me one way or the other. How do I really feel? And I think what MI allows is a space for people to have that conversation with themselves. And you're just kind of, I think that's where the guiding comes in, is you're allowing them to think about, okay, this is how I feel. What does that really mean? Like how do I really feel if I dig deeper into that, what's informing this decision? What are some of the reasons they have to change and not to change because they are always there already. And I think if we don't allow people to find ways to encourage people to explore those for themselves and we just start with, yes I agree, or no you're wrong, then it doesn't get explored and we don't, don't understand even what we really feel cuz no one's allowed us to have that conversation.
Ryan Hassan (26:49):
Yeah, I think we can fall into a trap of thinking we know what reasons might be most important to somebody. And just an example, I have a friend who was initially very hesitant to get the vaccine when it first came out and she had concerns about the, you know, speed with which it was developed, side effects, et cetera. And she did end up getting vaccinated because she was gonna go see her parents and she was concerned about them. Now she still had all her concerns, you know, about the vaccine. Those didn't change, but she had this other very compelling reason that ended up overshadowing these other concerns. So if I or anyone had tried to argue with her about, you know, side effects, the development, tried to educate her on that, it just, it wouldn't have been necessary cuz that's not why she ended up changing and that's not why she ended up making her decision.
Carrie Bader (27:47):
You know, that brings to mind a distinction that we've talked about before about the difference between MI and vaccine confidence versus MI in something like alcohol addiction or something. Which is a lot of what makes it harder in some ways for vaccines is that if you're dealing with helping someone with other substance use, you know, the reasons they have for wanting to continue, you know, drinking is their reality base of reality. You know, I, I like to drink because it makes me feel better, it relaxes me, it helps me forget things I don't wanna think about, you know, whatever those are things that they really experience that are happening and that it makes sense, we can all understand like this is why something that is actually a real benefit for them when we're talking about vaccines. So a lot of the reasons people don't want to vaccinate, I mean sometimes they're based in fears of things that are, you know, possible, but a lot of times they're based in fears that are invented fears of like, well I wonder if there's, you know, risk for, you know, the more serious side effects we don't know about.
Carrie Bader (28:55):
And in reality like there isn't, there are people who legitimately wonder, you know, does this vaccine affect fertility And there's valid reasons for believing that it could be, you know, people have, as you mentioned ira, there is historical and ongoing trauma of people of color and particularly being forcibly sterilized by the US government. This has happened as recently as this decade. So you know, it makes sense that they might worry that wonder that, but it's also a fact that vaccines have no impact on fertility, no negative impact on fertility. And that is very well established. And so I think it makes it a lot harder to, as we said earlier, avoid that writing reflex when someone says, for example, I worry that this vaccine is gonna affect my fertility. It's very tempting to say, well I know for a fact that it's not going to, that's the truth.
Carrie Bader (29:46):
But speaking that truth to a patient who's not ready to hear it is not helpful and it still is to an extent disrespecting the valid reasons why they have that fear. Even if it is an unfounded fear, the reasons for it are not unfounded. But I do think it makes it a little more tricky because we do have to, in addition to what we would normally be talking about with with substance use and finding their own reasons, evoking their own reasons for change, there is a space I think where we need to figure out where can we find room to actually educate to, you know say well actually this is an idea that you know that you have that actually is not aligned with the facts. And I think that can be really hard and sometimes people just aren't ready to hear that. And as I've done more practicing, I've given facts about vaccines less often, I tend to not correct misinformation as often as I used to because I know it's not going to be helpful. It's still a hard thing to do to figure out like when and where can I tell someone actually and how can I tell someone that this is actually something you think you know that's incorrect and here's the correct.
Ryan Hassan (30:58):
Yeah. You know, you've mentioned the writing reflex a few times. I just wanna mention for the audience, just in case people, it's kind of built into the name but the writing writing reflex, it's R I G H T I N G, that reflexive instinct we have, when someone says something that is incorrect, we want to immediately correct them, said it right. And so in mi we talking about resisting the writing reflex because it's not so much about what is the correct information, it's about what effect is this going to have on this person in the conversation. And when it comes to offering that information, we do have a framework we talk about in motivational interviewing. It goes by some different terms. I like to call it ask offer, ask where and and again this has to be at the right, you know you don't have to do it right away is a nice thing.
Ryan Hassan (31:48):
It can be something you sort of circle back to later in the conversation, but it might be, you might start out by saying, I know you mentioned something about your concerns about the vaccine and fertility, can you tell me what you've heard about that? And then they might share some information and then we get permission we'll say, yeah, do you know it's okay if I share with you a bit about what I've seen as far as the research goes on that. And typically when you ask they, they typically will say yes. If they say no, then don't push it. But if they say yes, then in a neutral tone, neutral meaning like not saying you need to do this or don't do this or, but neutral meaning, well the research is finding that blah blah blah blah or people have the experience of blah blah blah blah.
Ryan Hassan (32:31):
You know, offering just in a bite size, not going on for too long and then following up it's what do you make of that? What do you think of that that you know, finding out what's their reaction? I think that's a part that gets skipped a lot of the time. We just sort of, you know, stay a bunch of stuff and assume it lands when you know, sometimes it does or sometimes they might hear it, sometimes it might raise more questions sometimes then they'll start showing skepticism and then we'll go back to our reflections and just showing kind of understanding for where they are at that point. But that's just a framework that I found can be helpful when there are times that you do wanna give information because we don't wanna neglect that entirely. Although that's not the focus of motivational interviewing, it's a necessary part.
Ryan Hassan (33:15):
If we're in a position where we do have expertise on the subjects, it is our responsibility to share that expertise. We just need to do it in a way where it's gonna have the most beneficial effect possible. And I think too, it's focusing on the person and you know, how do they see you? You know, people are more likely to get the vaccines from somebody they trust and when you're able to build that trusting relationship, you know, even if they're hearing this stuff, if they see you as a trustworthy person, they might start coming to you with these questions, you know, I heard this, I read this, what do you think? And then we can engage in that, Gosh yeah, can you show me that? What was that website? Or you know, and if we have that trusting relationship we can share those concerns. Like you know, actually that website, I've got a lot of concerns about it. I, you know, I took a look at it and I saw, I know you can, there's so many directions you can go with that <laugh>, but it might be, I saw who's behind it or who's not behind it. Hey here's a site that I think has some really good information and if you are a a trustworthy person in their life, they're a lot more likely to just listen to you and to come to you when they hear these other things that are, you know, potentially questionable.
Ari O’Donovan (34:36):
Yeah, I like that MI is super useful in the healthcare setting but it has more applications than just that. It's like both of you have said and you brought that up Carrie, it's a way of being. So it's not just for professionals then, right? It's for everybody. Can you tell me a little bit more about that?
Carrie Bader (34:55):
First, I mean it needs to be taught in medical schools. I had three standardized patients, which is actors pretending to be patients that you interact with to practice doing medicine. Three who in my whole medical school curriculum who were, you know, where the goal was to practice motivational interviewing and we had someone who was had a cough because they smoked and we had to figure out how do we talk to them about this using, you know, mi as I do this more, I think it should be taught in grade school it should be. And you know, not necessarily in the same way but just as you know, this is how we should model talking with people and and having conversations and just treating one another is that if someone says something that you, you disagree with or that you might have concerns about, instead of jumping to trying to correct them and say, Hey no you can't say that or that's wrong or you know you're wrong for this reason or I disagree because of this.
Carrie Bader (35:49):
Instead focusing on trying to get a understand and allow them to clarify their position and say, oh huh, that's so that's interesting. So this is what you're saying, this is what you think. And let them kind of develop some nuance and clarify. I think that would be so helpful if we had a society full of people who went confronted with someone who says something, you know, outlandish or completely opposed to everything that they believe in. Instead of saying, No you're totally wrong and I completely disagree with you, you must be one of them and not one of us and I'm gonna put label you right away. Instead say something like, tell me more about that. Like, so is this what you believe? Like I wanna learn more about what you have to say. I think it, it's something that we could all learn from. I try to do this as much as I can in all aspects of my life and I would agree with Carrie.
Carrie Bader (36:38):
I'm not very good at it when it comes to like for example, talking to my wife, you know, with mi adherent principles. But I try to be, and I try to remember that at the end of the day it's more helpful to try and understand where people are coming from than trying to bring them over to where you want them to be. A great way of putting it that my former mentor of mine, Dr. Bill Cosgrove, he was a former president of the Utah chapter of the Academy Pediatrics where I trained, I trained in Utah. And he would say that if someone's on the other side of the street from you, you can't just yell at them and tell them to come over to your side of the street. You have to walk over there, see things from their perspective and then have them walk back to your side of the street with you.
Ari O’Donovan (37:24):
I wrote that one down Ryan, you told me that one other time and I had to write that one down. That one is really amazing. And wouldn't it be a massive improvement in society if you could learn mi from childhood, like your interactions with people, how you empathize with people, how you connect with people deeper, more meaningful connections, how you deal with conflict, everything would be so much better.
Ryan Hassan (37:47):
Instead of the high school debate team, we can have a high school reflective listening team.
Carrie Bader (37:52):
Oh yeah, that's an amazing idea.
Ari O’Donovan (37:55):
I support that
Carrie Bader (37:56):
Fully. Oh we need to, we need to get that on on the curriculum for sure.
Ryan Hassan (38:01):
You know, I'll say too, I think as far as what skills can be just used across the board, I don't necessarily think of like MI as being the thing that everyone needs to know how to do in their day to day life. But I would say components of mi, I think if everyone used more reflective listening in their life, in those conversations, that would be beautiful <laugh> if people knew how to do reflective listening, if people knew there are some main skills in motivational interviewing, there's the use of questions, the use of reflections, the use of affirmations and the use of summaries, you know, and, and I think we tend to be very question heavy and you know, questions can be great but they have a downside and they can be overused. And so I think if people just learned how to reflect more learned how to do reflective listening, you know, for me that would be the most important piece.
Ryan Hassan (38:56):
I mean affirmations would be wonderful too. <laugh>, you know, especially when you're in an argument with someone. I mean that's the hardest time of course. But trying to see like what's something that I can appreciate about this person? What's something that I look up to in this person in this moment? I think so many interactions these days are so charged and people are just, they're not listening to each other at all. They're just seeing who can be the loudest. But if we can just catch ourselves from time to time, you know, you feel it in your body when you're getting into an argument, when you're getting into that kind of face off and just taking that pause and trying to see like, I wonder if I can just try, you know, I'm gonna step back here cuz it's probably not gonna work to try to convince the other person anyway. So we might as well step back, save our energy and just see like can I at least just try to understand things from their perspective.
Ari O’Donovan (39:54):
So Carrie, correct me if I misheard you, but I'm pretty sure you just said that all three of us should tour all around the country educating people about everything we're talking about right now. Is that what you said
Ryan Hassan (40:07):
<laugh>?
Ari O’Donovan (40:10):
I would love that that everything you just said, I agree, I think it would be so good.
Carrie Bader (40:16):
One thing you resonated with Carrie is you said you can really feel in your body when you're starting to have an argument and it just triggered some visceral memories for me of specific times where I was getting into an argument with a patient or or with a friend or family. And you do feel it, you get like, you know, I feel a flesh of warmth, my heart rate quickens and I, I feel like some chills and just a little agitated and I feel antsy and now that's how I recognize like, oh this is something I don't wanna be doing right now and it's happening, what's going on. But now I can use that as a cue to say, oh I probably, you know, it's time to back up and try less wrestling and more dancing, maybe do some reflections. Maybe I'm not listening enough, maybe I'm thinking too hard about what I'm gonna say.
Carrie Bader (41:05):
I should think about what this person's actually saying and focus on finding the good, finding what I look up to. There's another quote I heard recently and I forget who said it, but someone said that every single person you meet knows something that you don't. And I thought that was just brilliant. I was like, that is so true. How much could we better ourselves if we kept that in mind every time we cross paths with someone that, oh you know something I don't know, what could I learn from you? And I think it's a great way of thinking
Ari O’Donovan (41:32):
About about it. That's another one I have to write down now. Just might as well start a book of these important little pieces of information you can carry through life that will help you along the way.
Ryan Hassan (41:44):
Ryan's wisdom.
Ari O’Donovan (41:45):
Yeah, there's a title I just,
Ryan Hassan (41:51):
No,
Ari O’Donovan (41:52):
Please don't, I will be the editor.
Ryan Hassan (41:54):
<laugh>.
Ari O’Donovan (41:58):
Well Ryan, can you, you've already shared a lot about this and Carrie you can share some too. Both of you. Please let me know. How has MI been effective through your interactions as a pediatrician, as an occupational therapist and with the work that you do at Boost Oregon? I know you're very new, Carrie, but what would you anticipate that you'd like to see with using mi?
Ryan Hassan (42:23):
A few things I'd love to see. I mean we, we've already talked a bit about just providing trainings, helping people learn this approach, helping people use this approach. I, I'm hoping we can really get some good solid data on outcomes once people, you know, start using the approach, develop competency and really just see like what effect does this have. I certainly know what effect I hope it has and what effect I think it'll have. But I, it's so important to always take a look and study these things and make sure that it, it's doing what you think it's going to do. So I hope we can get some data on what effect this is having. I mentioned this before, but really support people in developing competence. So we don't just see them once for, you know, a single training but support people in an ongoing way so that they get feedback, they get coaching and really just build and develop this and support this community of people who are, you know, see the value in this approach, really do their best to learn it, to develop their skills.
Ryan Hassan (43:29):
And I've been a part of some MI communities before where people just get together and practice and discuss what comes up and it's so supportive and it, it can be so fun too. I mean I, I love having conversations about conversations, you know, about these interactions. I just think it's fascinating. It never gets old cause every interaction is gonna be so different. You know, you think you know how to do something and then years later you have a new experience and you know, you run into your roadblock and having other people to consult with can be so helpful in keeping these skills fresh and strong. And there's so much rich research going on internationally. It's taught in over 50 languages. It's taught, I mean so many different countries at this point. It's been, the founders made it, it was a really important value of theirs that this is brought to people who most need it.
Ryan Hassan (44:24):
And so it's been taught around the world and there's always something coming out. MI has changed over time. It's changed significantly I wanna say in the last 15 years too. I mean, people who went to trainings, you know, 20 years ago, it's gonna be pretty different when they go to a training, you know, in the next year or two because so much has changed. And so whether somebody goes to a training with Boost or you know, if, if they seek out a training elsewhere, I would just make sure it's somebody who is staying up to date with current research and motivational interviewing. Cuz new things are always coming out. I mean, I'm always updating the information I'm sharing and how I'm teaching it in trainings and, and so it's, that's something that's really exciting. It's, it's a living thing and so it's adjusting over time as people figure out more and more about what is most effective, what effect, you know, what is most important in these conversations. What do we really need to make sure we do and not do in order to have effective conversations.
Carrie Bader (45:26):
Yeah, I would say for me, I would agree with all that. I would love to see this work, get some more robust data on outcomes to support, you know, what we're doing. I know that it feels way better to take this approach and my patients feel way better and more empowered and it helps all of us to be more confident in navigating this very challenging issue. But I would love to see some studies that we can prove how effective it is and, and know for ourselves and hopefully spread the word to other people and hopefully that's on the horizon for Boost. What I think the long term goal for me is, which I don't anticipate I'll see in my lifetime, but is that, that we can just repair the trust that has been just so eroded between, between ourselves and and between people in the institutions that are binding us and for good reason.
Carrie Bader (46:21):
I mean we should have a health mistrust of many of our institutions right now cause they're not entirely trustworthy. But I think finding ways where we can, you know, know when we can trust people and the extent to which we can trust our institutions specifically around vaccines and making a world where people can be comfortable having conversations and feeling heard and listening to one another where we can feel like we actually are connected and remember the ways that we are more alike than different. And one day be a hundred percent vaccinated against all vaccine preventable diseases and one day have vaccines for every disease and never get diseases anymore. I mean I think that's really the end goal. Be fantastic.
Ari O’Donovan (47:07):
Absolutely. I think that all of those are amazing goals for Boost and beyond. There's just so much we can do and I'd love to see us collect some data or get a study going within Boost Oregon. I think we kind of talked about this a little bit in past interactions. I'd love to see that maybe that's possible.
Ryan Hassan (47:29):
It's so important cuz I think there's so many good efforts out there and you know, we just need to see, I think that data can also tell you where you need to shift your efforts. Maybe certain things are working better than others and things need to be adjusted. You know, maybe we start doing trainings and we realize, gosh, maybe there is an abbreviated version that can focus more on one specific aspect that might be helpful to people. There's so many different directions to go in, but I think when you, when you actually look at your outcomes, that can provide some guidance on how to, you know, best use your energies, how to shift courses whenever appropriate. It's
Ari O’Donovan (48:08):
All possible. I am very excited for the future of Boost and how we use MI in working with you both so much. Thank you guys for being here.
Ryan Hassan (48:19):
Oh, it's been fun. Yeah, it's a pleasure. Thank you so much. Wonderful. And
Ari O’Donovan (48:24):
Until next time, don't be a stranger. Email us or send us a voice memo at boosting our voices gmail.com with your health related questions. Your questions may even be featured on an upcoming podcast episode. Follow Boost Oregon on Instagram, Facebook, Twitter, and TikTok. You can find all of our social media and our website information in the show description below. Until next time, thank you for listening and be well.