Welcome to the April/May edition of Tips and Topics. Welcome to the combined April/May edition of Tips and Topics. This edition starts the 24th year of publishing Tips and Topics. Why a combined April/May edition?

• Firstly, guest writer Kristin Dempsey has presented a lot of important information that deserves your thoughtful attention.

• She agreed to step in since I was returning from three weeks away in Japan and it would have been a squeeze for me to rustle up the April edition.

• Then I realized I am off to the Greek Islands in just over two weeks, leaving a short window to get out the May edition.

So it is fitting that we all “win” to allow you time to digest Kristin’s comprehensive information and for me to ease into the next joyful event of living the life of retirement.

In SAVVY, Kristin shares tips on the constant construction of Motivational Interviewing (MI) skills so she talks of Advancing MI, not Advanced MI; the usefulness of the Four Tasks of MI as a map; and if the session is not going well, first check your own agenda.

In SKILLS, Kristin writes about the importance of creating psychological safety for clients; of changing our perspective as helpers that can make a difference in how we approach our work; and getting curious about what creates a client’s stuckness.

In SOUL, Kristin selected one of her favorite attitudes that support MI, and her choice was curiosity. She defines curiosity as the wonder that comes from an ongoing desire to learn, which typically requires that we are open and flexible.

In my SOUL section, I remind myself and you as to why I started Tips and Topics 23 years ago. Whether you are a longtime reader or new to Tips and Topics, the mission hasn’t changed. I remain a resource for your questions or comments on person-centered services.

When Kristin L. Dempsey, EdD, LMFT, LPCC, released her book The Harm Reduction Workbook for Addiction on January 2, 2024, she summarized some of the main points as a guest writer for the January 2024 edition of Tips and Topics.

Her latest book, Advancing Motivational Interviewing, she co-wrote with colleague and friend, Ali Hall. It was just released on April 7, 2026 and I have asked Kristin to share some SAVVY and SKILLS tips for this April edition of Tips and Topics.

Here’s what she wrote:

As always, I am grateful to have the opportunity to write for Tips and Topics. Tips and Topics is one of the few resources I have returned to year after year that is consistently relevant and meaningful. I hope the tips and skills are helpful for you and contribute to the Tips and Topics legacy. Let me know what you think by connecting and staying in touch; my contact information as at the end of the newsletter. -kld

To begin, I wanted to spend a moment in Tip 1 discussing why we wrote this book.

Tip 1

We called the book Advancing Motivational Interviewing instead of Advanced Motivational Interviewing for a reason.

Miller and Rollnick (2023) define Motivational Interviewing (MI) as “a particular way of talking with people about change and growth to strengthen their own motivation and commitment" (p.3). This definition is intentionally basic in order to speak to the foundational nature of this set of skills and attitudes and the way they are used to reinforce and promote language of change (change talk). But the successful application of Motivational Interviewing is not always so simple and competence in Motivational Interviewing typically requires focused practice and attention to refining skills. Specifically, competence in MI is obtained and maintained through a practice that allows for feedback (what needs to change) and coaching (here is what you can do instead) (Miller et al., 2004; Miller, 2023). Given the nature of how skills are built and maintained, we wanted to speak to the process of how MI skills development is constantly under construction; we do not become advanced practitioners, but increasingly skilled and these skills are always under construction, thus the idea of “advancing” vs. “advanced” Motivational Interviewing.
 
That means:

• One Motivational Interviewing workshop will not make you competent in the practice of Motivational Interviewing.

• Practice and application are how we develop and refine our skills and sort out how we want to apply Motivational Interviewing in our specific work. MI will be applied somewhat differently depending on our client characteristics (age, culture, needs) and the nature of our services (individual and group therapy, medication provision, case management).

• It is preferable if MI learners can obtain coaching and feedback and having workbooks with structured activity can offer low fee options for guiding and increasing practice.
  
  

Tip 2

Motivational Interviewing is simple, but not easy, at least not when you first learn it. Use the tasks of MI as a map and remain flexible.

• Motivational Interviewing is a guiding approach and when we use the Tasks of MI as a map, we will be brought into the guiding process. We follow to help learn about someone’s dilemmas (engaging), and we then guide them to choose a direction (focusing). Once we have a focus, we can then guide their movement toward change by eliciting and reinforcing their own change talk. When we have gathered enough change talk, we will move into planning through a curious exploration of the gathered change talk and then ask what they might do next (key question). If we stick to the map, we will more than likely head down this path toward change.

• We teach the four tasks of Motivational Interviewing – engaging, focusing, evoking and planning – as it provides a usable and logical structure to guide individuals as they move from engaging in conversations about change to considering and possibly planning for change. When learning and practicing MI, identify what task you are addressing during each session with every client. You can then use the tasks of MI as a map that provides direction regarding when to stage your interventions. For instance, asking somewhat how they plan to address their cannabis use (planning) doesn’t make sense when they have just started to engage in a conversation – they aren’t ready! Make learning, practicing, and using MI easier on yourself – use the map (the four tasks)!

• If you have used a navigation program or an old-school paper map, you know that a map is helpful, but it cannot anticipate all the possible challenges along the way – how do you get around a closed road, a new onramp, or a flooded intersection? You have to pivot. When having an MI conversation, you might need to do the same thing – a client can decide they want to refocus, or they might need some time to build trust before they identify a topic (focus), or they might identify many good reasons and desires around change (evocation), but they are just not ready to change, yet.

Tip 3

Problem with the session? Check your own agenda first.

• It seems to be human nature to push back and when someone is trying to “get us” to do something. Reactance is what we call our desire to gain back autonomy when we perceive it is being taken from us (Brehm, 1966). It can show up as rebellious, resistant, aggressive or passive-aggressive behavior. If you find yourself experiencing some of this pushback in session and feel like you are wrestling vs. dancing with a client (Miller & Rollnick, 2023), it’s likely you have activated some reactance. Notice your inner language. Are you telling yourself that you “need to get someone to do something”? If so, stop. I recommend using STOP skills from the Dialectical Behavior Therapy (DBT) curriculum (Linehan, 2025) to get back in sync with the client:

• S – Stop what you are doing, which might be trying to persuade or lead in a certain direction.

• T – Take a step back. Pause for a moment and take a breath.

• O – Observe. What is happening here? Try to observe your own agenda. Ask yourself: What am I trying to get to happen here?

• P – Proceed Mindfully. I recommend after observing, the next step in such a situation is to provide a reflection on what is going on. Simply noticing the dynamic can be very helpful.

• “I am noticing now that we have been talking about your drinking and these ideas I have about rehabilitation programs don’t seem to be landing for you. I think I need to listen to some other ideas or concerns you might have right now.

• I am a Bruce Lee fan, and I encourage MI learners to “be like water, my friend” when learning Motivational Interviewing (Lee, 2021). Mr. Lee first spoke about his fluid approach to martial arts in which he thought of himself as being formless like fluid in a container, allowing him to flexibly respond to any situation that occurred during practice. Similarly, the Motivational Interviewing provider, in the pre-action stages of change, can flexibly respond to what the client needs when they need it and not try to force or over-direct the change process. Although the Tasks of MI offer an excellent map, we can benefit from “being like water” as we flow among the tasks and avoid getting too rigid and controlling in our responses to the client.

SKILLS

My favorite part of co-writing Advancing Motivational Interviewing was sorting out what we should cover in the book. Motivational Interviewing continues to evolve and individuals using MI continue to emerge from different practices. Each of the 12 chapters features addressing trainee and clinician challenges presented to us over the years as they make their way through the tasks of MI. Perhaps you recognize some of these challenges in your own work. 

Tip 1

The Spirit of MI is a framework for the values and attitudes that the practitioner brings to the session that helps create psychological safety.

That safety is necessary for individuals to explore their ambivalence and thoughts about change and growth (Miller & Rollnick, 2023). The Spirit includes seeking collaboration in our work together, accepting individuals for who they are when they show up, valuing the individual’s needs above all else, and finding ways to help participants connect with their own power so they can experience their own empowerment. In Advancing Motivational Interviewing, we included some additional attitudes and behaviors that help create this environment of openness and support.

• Hope – Hope is about believing that the future has some promise to be better than today. It might be challenging to think through change and growth if someone doesn’t believe that anything will change in the future. Having conversations about hope can be an important activity during the engaging task and some structured open-ended questions can help:

• “What do you hope will happen in our work together?” is a helpful conversation to have, especially as we start the engagement task.

• Later in the session, after a client chooses a topic to focus on together, we can ask, “What do you hope might happen if a behavior is changed: Imagine you did cut back on using methamphetamine, what would you hope might occur as a result?” Hope can thus be an important motivator for change.
  

• Empowerment – Everyone we see is a survivor. How can we step away from the problems to help them notice their strengths? Look inside the problem itself:

• The person struggling with depression has the determination to get out of the house and visit us.

• The client recently discharged from the hospital was able to find the ability to focus and follow up on numerous discharge requirements in order to be released.

You might recognize the skill of affirmation in these examples, and here we are able to locate strength even within the darkest aspects of their struggles.

Tip 2

Our ability to change perspective, even slightly, can make a difference in how we approach our work.

One challenge we talk about in the book addresses people who are mandated to care. We do not have control over how someone is referred, but we can connect with the goals of engaging to move out of the stuckness that we can feel as providers when working in situations where we feel less control.

• I am often asked how I manage mandated clients. First, I have a way of framing this for myself: most people are “mandated” to treatment. If not by the judge, social services agency, or the principal, then by a partner or another family member, or by grief, or by trauma. I notice such a reframe keeps me from seeing individuals in fundamentally different categories and in doing so, I can be more open in my acceptance of everyone who shows up instead of holding some secret (or not so secret) judgments based on how someone walked through the door. My job when engaging is to hear their story and find a way to help them focus on what is meaningful to them so we can explore change and growth. It is a good process, and good process leads to good outcome (Godin, 2020). Adopting such a reframe takes practice, and it’s a worthy effort as our judgments can influence how we see someone, which can result in poor practice. The benefit of not being focused on mandates is that I am more open and there is less pushback from clients who are not reacting to having their autonomy threatened and who will often open up more in session.

• Having a mandate does not mean that we ignore context. I might still have a probation officer who wants to know if my client has shown up, and the client will likely have a court review, so, in collaboration with the client, I need to build a relationship with the officer. I will also oversee the release of information when I receive a message from family members requesting a consultation. I respond as the context demands, and I am still not overly focused on how they got to my door. The point is that they are in the door, and we are working on the tasks of MI together!

• Honor and respect ambivalence. It is common to identify someone who has been compelled to treatment as being “difficult,” “resistant,” or “in denial,” but what if we see the person arriving as ambivalent? “They don’t want to be here, so they must not want to change” might be an inaccurate statement. Why? Because they are here. I like to remember that there is always something meaningful in their showing up; it might not feel like a great choice for them, but they are ultimately there to get something – freedom, support, clarity. I remember in the evoking stage that my job is just to be curious and help them unload their story. When I see my job as being a good person to talk to, and someone who can accept their stuckness, frustration, fear, and all the other difficult emotions that emerge, the tension often decreases.

Tip 3

Our individual behaviors are shaped by the environment. Get curious about what seems to create stuckness.

In Motivational Interviewing, we are having conversations that ultimately help guide others toward change and growth. It appears our ability to reinforce a client’s change talk helps to generate more change talk, including mobilizing change talk that often leads to change behavior (Miller & Rollnick, 2023). We also know that someone can want to change and feel confident about change, but might not seem ready to change. Continued evocation seems to help with internal ambivalence, but what if the issue is not an individual’s motivation, but a real response to external pressures that maintain the status quo? Consider the following:

• You discover someone that is “hard to engage” and will not return to the clinic is unhoused. When they come to the center, someone tells him that they cannot bring “all their stuff” into the waiting room. They have nowhere to keep their belongings, and they are afraid they will be stolen or thrown away if left outside. That’s why they don’t come to their appointments.

• A client tells you they have to leave treatment early to care for their kids. Is it because they don’t want to continue being in a rigorous program structure and are unmotivated to maintain their agreed upon program goals or is it because the family members caring for their children texted them and said they have to leave and come pick up their kids?

• You are working with a new client who is asking about seeing a doctor to obtain medications for attention deficit hyperactivity disorder (ADHD). There is a concern among staff that they might be seeking a stimulant medication and doing so would impact their recovery goals. After some inquiry, a counselor discovers they have been told they should have a medical evaluation as a youth, and it was never arranged because they had no access to care. As an adult, they continue to wonder if an untreated neurological issue is part of why they have always had difficulty with focus.

Each of these examples provides opportunities for the practitioner to assume good intent and explore options with the client. When addressing these external factors, we use the micro-skills of Motivational Interviewing – open ended questions, affirmations, reflections, and summaries – and we also recognize the importance of advocacy, linkage, and policy change. A key to understanding individual change is to have a larger picture of a person’s history as it shapes the current behavior. Collecting history as an information gathering exercise is not useful. Thoughtfully collecting history over time and understanding how history and current events impact a person’s behavior is a critical part of effectively working with a change process. Not understanding why anyone behaves how they do can lead to inaccurate and misleading assumptions. Tapping into our own curiosity helps us see how someone fits into their world, which leads me to SOUL.

SOUL (KRISTIN) 

Guiding someone toward change and growth is both challenging and rewarding work. I have touched on only a few items we discuss in the book and there is so much more that we explore in a Motivational Interviewing workshop or coaching sessions. If I had to select one of my favorite attitudes that support MI, my personal choice would be curiosity. I define curiosity as the wonder that comes from an ongoing desire to learn, which typically requires that we are open and flexible. When we wonder and explore, right vs. wrong answers are not always relevant. We can accept that which we see and find ways to take the next step.

Among the many ways to engage in a curious mindset is to travel, which I love to do – so much to learn and experience. But…we can’t always travel. We have to work and take care of families. Expensive flights and world disorder also make long-distance travel less attractive. I learned during the pandemic about traveling where you are, and I still engage in this often. Travel where you are is a process of momentarily suspending reality and pretending you have never seen your street or neighborhood and walking through it as if you are a tourist visiting for the first time. I have discovered beekeeping neighbors, random art installations, and historic homes in my neighborhood where I have lived for decades. Cultivating curiosity on a walk helps me build my “wonder skill,” and it also serves as an accessible mindfulness activity that I use to decrease fatigue and stress during my workday.

I would love to hear your curiosity stories and anything else you would like to share about this Tips and Topics and any other content I share. Feel free to follow and connect with me at my site: https://www.kristindempseycounseling.com/

References

Brehm, J. W. (1966). A theory of psychological reactance. Academic Press.

Godin, S. (2020). The practice: Shipping creative work. Penguin.

Lee, S. (2021). Be water, my friend. Guy Trédaniel éditeur.

Linehan, M. M. (2025). DBT skills training manual. Guilford Publications.

Miller, W. R. (2023). The evolution of motivational interviewing. Behavioural and Cognitive Psychotherapy, 51(6), 616–632.

Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of consulting and clinical psychology, 72(6), 1050–1062.

SOUL (David) 

Twenty-three years ago, I published the first edition of Tips and Topics. Little did I imagine then that I would be still writing to start my 24^th year. Here’s what I said back then about the why of Tips and Topics:

1. I get repeated requests about questions on the American Society of Addiction Medicine (ASAM) Criteria and other topics; inquiries about any books, videos and audio learning materials; and help to implement and apply knowledge and skills presented in one or two-day workshops. This is a way to more efficiently answer those questions and requests.

2. Knowledge application cannot be implemented without some ongoing prompting, supervision or assistance. This will be a vehicle to help provide ongoing support to those who have attended a workshop before, or who cannot yet get to an on-site training.

3. I want the training and consulting I do to make a difference in providing, managing and funding person-centered services. This is a way to feed a few tips and topics to those interested in applying the concepts and skills to change the way we serve people in behavioral health.

The mission of Tips and Topics hasn’t changed. What has changed is that in my retirement this remains as the only ongoing tangible contact I have with you who are on the frontlines of services. Whether you are a longtime reader or new to Tips and Topics, I remain a resource for your questions or comments on person-centered services.

I don’t know if they will carry me out as I am mumbling that I need to write the next edition of Tips and Topics. Or if it will come to a graceful end before entering a Memory Care facility.

What I do know is that I still enjoy joining you every month. So I will keep at it until it isn’t fun anymore.

UNTIL NEXT TIME:

Thank you for joining us this month. See you in June.

David