Training Incoming Social Work Students in Motivational Interviewing Skills: An Experiential Lab Model for Advancing Social Work Education

Field practicum settings often do not have adequate resources, staff, and time to meet the extensive basic training and learning needs of master’s level social work students beginning their first year of field placement. An innovative, empiricallysupported motivational interviewing (MI) skills lab was created to provide students with supplemental skills training in preparation for field placement entry. The lab practice of MI strategies allows students to gain familiarity with effective methods for forming helping relationships, developing intervention goals, and understanding and resolving ambivalence about behavioral change. This paper describes the rationale for the experiential learning approach, addresses challenges encountered by students in learning MI skills, and demonstrates its potential effectiveness in addressing the learning needs of incoming social work students. We recommend that the MI lab be considered as a model for helping to prepare new students for agency practice.

Students entering a master's level social work program often come with little to no experience in effective engagement and communication skills that are central to forging collaborative client-practitioner relationships (Tham & Lynch, 2014). Many come directly from undergraduate programs without having majored in social work nor having prior experiences with clients in social service and health care settings. Concurrently, field placements are frequently understaffed and resourced, making it difficult to provide close mentorship and training in essential social work skills. This is especially relevant in agencies servicing high-risk or vulnerable populations.
To address this limitation, social work educators have advocated and implemented skills-based training within the school curriculum for social work students entering their field placement settings (Bogo, 2015;Jackson et al., 2020;Mumm, 2006). These skillsbased strategies have been necessary but not sufficient to address certain areas such as rapport-building with clients having difficulties in engaging in a helping relationship (Gockel & Burton, 2014). This paper describes the motivational interviewing (MI) skills-based lab program that was incorporated as part of first year MSW students' foundation curriculum. We present the rationale for the approach, address the challenges encountered by students in learning MI skills, and demonstrate its potential effectiveness in preparing students for entry into field placement settings. We present a limited number of exercises to illustrate how they can be used by students to develop and improve a MI skillset.

MI Training in Social Work Education
To better prepare social work students for entry into their placement settings, motivational interviewing (MI) training has been incorporated into school curricula to help students learn essential MI strategies linked with behavior change (Hohman, 2021;Iachini et al., 2018;Pecukonis et al., 2016). Students learn how to employ such techniques as open-ended questioning, affirming, reflective listening, and summarizing (O.A.R.S.) to forge a collaborative partnership for shared decision-making and enhancing a commitment to change (Hohman, 2021;Miller & Rollnick, 2013).
Studies of MI training with social work students have shown that the majority demonstrated an improved capacity in working with clients in their field settings (Hohman et al., 2015). Feedback on these programs has indicated that students have a deeper grasp of practical applications of core social work skills while opening up opportunities to expand their skillset in the field Hohman et al., 2015;Iachini et al., 2018;Pecukonis et al., 2016;Phillips et al., 2018).
The efficacy of MI with diverse, at-risk populations in a variety of contexts and settings is supported by an extensive literature (Lundahl et al., 2010). At the same time, there is now empirical evidence supporting MI training methods for improving the capacity of practitioners to learn and sustain MI skills in routine everyday practice (Schwalbe et al., 2014). What is most valuable about MI is that it can be adapted to various field placement opportunities. MI can be effectively employed as a stand-alone approach or in combination with other approaches such as cognitive behavioral therapy, case management, and pharmacotherapy to improve client outcomes (Miller et al., 2019;Zweben & Piepmeier, 2020).
For all of the stated reasons, we developed and implemented an innovative MI skillsbased lab program for first year master's level social work students. The skills-based lab training program has been adopted from an empirically-supported, experiential learning approach that has been recommended by educators interested in improving field education (Bogo, 2015;Cheung & Delavega, 2014;Huerta-Wong & Schoech, 2010) and motivational interviewing skills training (Madson et al., 2009;Martino et al., 2011;Miller et al., 2004;Schwalbe et al., 2014).
The lab model provides students an opportunity to try out new skills for forming helping relationships, developing intervention goals, and understanding and resolving ambivalence about behavior change (Lewis & Gibson, 1977). Students learn how to use MI strategies to navigate challenging dialogues, address roadblocks, and soften discord in their interactions with clients and others (Miller & Rollnick, 2013). The lab offers the added dimension of improving students' self-awareness and self-reflection in their communication with peers, faculty, field instructors, and clients. In other words, students are enabled to demonstrate a beginning familiarity with MI principles and practices, allowing them to implement a MI skillset into their field placements and educational settings.

Motivational Interviewing Skills Lab
The MI skills lab consists of weekly, two-hour sessions over a 7-week period. Sessions are led by certified lab instructors who are required to complete 14 hours of training on the lab teaching model and content. Lab instructors are comprised of faculty and advisors, field instructors, and social work practitioners from the community. The MI lab is offered to both residential and online MSW students. Since the Spring of 2020, the lab is only offered to students in a synchronous online platform due to the ongoing COVID-19 pandemic.
The lab was originally considered a field seminar for incoming students. Students were expected to participate in the lab during their field placement hours. This requirement was found to be impractical for many students. Consequently, the lab became a noncredit course incorporated into the foundation year curriculum. This includes students enrolled in the two-year, 16-month, and five term international programs. Full-time students in the two-year program have to complete two consecutive years of four semesters (fall and spring semesters). Sixteen-month students begin fulltime study in January (spring semester) and fulfill the requirements for the MSW degree in four consecutive terms by continuing through the summer. Five-term international students attend the program over the course of five terms with courses over the summer between their first and second year. Students who are advanced standing (hold a BSW degree) are not expected to participate in the lab given their one-year accelerated stay in the program.
Since 2018, approximately 1200 social work students and 61 certified lab instructors have participated in the lab program. The lab sections are generally comprised of 16-18 students. For example, in the fall 2020 semester, 403 students were assigned to 24 lab sections;. 67% of the labs were comprised of 18 students, 25% of the labs included 17 students; and 7% of the labs involved 15-16 students..
As part of the program, we have developed a comprehensive and detailed training manual which can be adopted by other institutions interested in developing a MI skillsbased training lab program. The training manual includes innovative instructional videos, interactive exercises, role-play scenarios, as well as coding sheets and other tools to measure student performance. The content covered has been drawn from the review of the literature on MI training (e.g., Schwalbe et al., 2014) and our experiences in training professionals working in different organizational contexts. Finally, two of the authors (AZ and MP) regularly meet with lab instructors to review student progress in the labs and obtain feedback on how to improve the program. This has helped to modify the content and exercises covered in the lab.

Experiential Learning Approach for Skills-Based Training.
The MI skills-based lab is designed as a highly interactive training in an experiential learning environment. Experiential learning is a "hands-on" approach toward knowledge and skill acquisition in which the focus is placed on students learning by doing. This is in contrast to a didactic method in which students passively take in information through lecture-based teaching. Research has supported experiential learning as a well-grounded method in social work field education (Bogo, 2015;Cheung & Delavega, 2014;Huerta-Wong & Schoech, 2010) and in motivational interviewing trainings (Madson et al., 2009;Martino et al., 2011;Miller et al., 2004).
There are three distinct components to the experiential learning process in the MI Lab (see Figure 1): (1) practice exercises (role playing), (2) debriefing (self-reflection), (3) observational feedback, and (4) conceptualization (connecting experience to MI principles/terminology). These components are a reiterative process as each new skill is introduced over the course of the seven sessions.
Practice Exercises. Practice exercises can range in style and in format. The majority of exercises are performed as "real" plays where students perform scenarios from their own personal lives (e.g., "I need to find a balance between school and family obligations"). There are many advantages to real plays: practicality-wise, they are easier to implement, can be spontaneous, and give students a chance to be on the "receiving" end to understand the effects of the skills on interactions. Furthermore, the speaker is able to provide an honest assessment of the impact of the exchange with the listener: did the speaker truly experience a sense of movement or change in a positive direction based on the listener's behavior? Students also perform "role" plays based on real client encounters derived from their field placement experiences. This gives students an opportunity to practice and reflect on what strategies and skills would be most useful and effective with the various populations with whom they are working. Students can also consider what they could have done in past situations where they would have found MI skills to produce a better outcome.
Sessions are structured in such a way so that with each new skill, students must first experience the "feeling" of how to apply the skill effectively. Most students come into the session with little to no familiarity with underlying technicalities of MI. As opposed to the instructor lecturing or modeling for the students why and how a skill may be used, students engage in a form of experimentation first by "testing" how they think this particular skill would be most useful and helpful in a situation and why.
Additional exercises that take on a different form of role/real playing are interactive videos that simulate an encounter with a hypothetical client. Students are given a brief background on a particular client and their case. In all simulated exercises, the scenario takes place as their first encounter with the client. Subsequently, the students watch and listen to the client provide a statement as if they were talking to them; the students are then prompted to generate a response using one or more of the micro-skills (open-ended questions, affirmations, reflections, or summaries). The exercise continues with each successive statement given by the client. Interactive video exercises provide a standardized form of practice with a "realistic" component in the context of a clinical setting. Skills can be practiced and applied toward problems or issues that may not arise in a peer-to-peer real play.
Reflection/Observation/Feedback. After each practice exercise, students participate in a debriefing phase during which they are asked to reflect on their experience and observations post-exercise. This debriefing encourages two forms of critical assessment: a self-awareness of one's own growth and an ability to provide constructive feedback from observations of others engaging in practice. This helps students internalize the purpose, function, and impact of the skills. The instructor plays a facilitative role in the discussion and feedback phase. Feedback is empirically supported as important not only for skill development, but also for the sustainability of proficiency and adherence of skills in trainees (Kourgiantakis et al., 2019;Roulston et al., 2018;Schwalbe et al., 2014).

Figure 1. Experiential Learning Model
Bridging practice and theory/concepts. A comprehensive training on skills-building connects the experiential component to established knowledge and understanding of the fundamental concepts and principles of MI. In similar fashion to MI, facilitators guide the students to articulate an abstraction of their experience in the previous phases (role/real playing and debriefing) to connect to broader themes of what it means to effectively communicate. This experience ultimately forms a summary or "take-home message" of what the students have expressed and learned from their debriefing.

Reflect
What did I experience?
Feedback What did I observe happen?

Conceptualization
How would I define the experience?
Log assignments. An additional component of the experiential approach is the introduction of a weekly log assignment. Students maintain a weekly log to reflect on their experiences in exercises from the sessions and to record instances of practicing specific skills in their daily life and/or field practicum over the past week. The weekly logs are multi-purposeful: they allow the instructor to receive feedback on the course exercises and, in general, become more familiar with the student experiences in the lab. The logs inform the instructor on which skills and concepts students have grasped and which require more practice and instruction. Instructors also learn what exercises have been most and least helpful. Another purpose of the logs is to give students continuity in their practice outside of the lab; students are prompted to practice specific skills (e.g., reflections or open-ended questions) in-between sessions and then to reflect on the effectiveness and outcome of those skills. Additionally, it provides students a chance to hone skilled, active listeningobserving moments and exchanges relevant to motivational interviewing.

Engaging: Understanding and Forming a Helping Relationship
Most students who enter a social work program come without having a clear understanding of what it means to be involved in a helping relationship. Many have limited knowledge and/or practice in employing skills required to foster a working alliance. Forging a helping relationship is essential (but not always sufficient) to facilitate a person's readiness and commitment to change (Miller & Moyers, 2021). MI spirit is the foundational component of effective MI practice (Miller & Rollnick, 2013). MI spirit gives a broader meaning/sense to the lab for all areas of specialization (e.g., substance use, mental health, and criminal justice). MI spirit is defined by four pillars of practice: (1) collaboration (working in partnership); (2) evocation (supporting and eliciting a client's commitment to change); (3) acceptance (recognizing absolute worth); (4) and compassion (communicating genuine interest and concern). Students are first introduced to MI spirit with an exercise in which they reflect on personal experiences with, and characterize the primary features of, what it means to be in a helping relationship (Table  1-Dilemma exercise).
Reflections vs. questions. Reflections are considered the most fundamental and challenging tool in forming a constructive relationship between practitioner and client. Reflections are more useful than questions for gathering relevant information about the client and guiding the client toward a deeper contemplation and exploration of their thoughts about behavioral change (Miller & Rollnick, 2013). Asking too many questions can cause the client to feel burdened, defensive, exposed, and vulnerable which in turn can interfere or disrupt efforts toward establishing a working relationship. Excessive questioning can inhibit a conversation from moving forward in the direction of exploring a client's thoughts, feelings, and perspectives on their motivation for positive change. Identify key rapport building skills & define MI spirit.
Students list characteristics of ideal person & non-ideal person to address personal dilemma.

Reflections vs. Questions
What is the function & importance of reflecting?
Practice accuracy & hypothesizing meaning behind a person's words in giving reflections.
In dyads, listener must give 3 reflections for every 1 question in discussing speaker's desire for behavior change.

Open-Ended Questions
What makes an openended question effective?
Practice creativity in formulating a question to evoke more information; to experience the effect of asking open-ended questions. In a "round robin," students take turns responding to a speaker's sustain talk statements, using strategies that will help soften sustain talk & elicit positive speech about change.
The rest of the group provides constructive feedback on what was effective/helpful at minimizing sustain talk.

Discord
How do we address dissonance in a working relationship?
Employ strategies that reduce or do not invite further discord on the part of the client. Learn how to demonstrate an acceptance of person's perspective of their situation & support a person's autonomy in the process.
Students are presented with hypothetical client statements that express discord with the working relationship. Students come up with responses to each statement that are MI consistent with reducing or softening discord.

Planning
How do we preemptively address obstacles to the planning process?
Develop fluency in employing elicitation & reflective skills as means for reducing or removing obstacles to the planning process.
In dyads, listener guides the speaker to discuss their planning process as well as explore & address potential obstacles that could interfere with meeting behavior change goals.
In typical daily conversations, it is very common for students to rely on asking questions when forming relationships and getting to know someone. As part of the lab learning process, students gain a deeper understanding of this concept by actually experiencing and observing the downside of being caught in the "q&a trap"-a cycle of repetitive questions and answers with no specific direction for the conversation (Miller & Rollnick, 2013, p.61). Practice exercises include having students role/real play a scenario in which they can only ask questions, then repeat the scenario but using only reflections. A more direct skills-based exercise has students follow the 3:1 rule in which they are only allowed to ask one question for every 3 reflections during a 5-minute role/real play (Miller & Rollnick, 2013). Students debrief post-exercise to reflect on their experience to illustrate the effectiveness of reflections over questions in facilitating the rapport building process (Zweben & Piepmeier, 2020  We also expend some time highlighting the importance of having a proper tone in clarifying the difference between reflecting and asking questions. Students quickly learn that merely raising their voice at the end of the statement changes a reflection into a question thereby instilling a sense of distrust rather than support in the relationship. You are communicating to the other person that you are listening thereby strengthening confidence in the relationship. The example below demonstrates the difference: • "You didn't want to come to our meeting today?" vs. • "You didn't want to come to our meeting today." We also spend some time demonstrating how a reflection can lead to a more meaningful response than a close-ended question. Here is an example using the same content as the above.
• Closed-ended question: "You didn't want to come to our meeting today?" • Limited response: "No" vs. • Reflection: "You didn't want to come to our meeting today." • Elicited response: "Right, because I don't know if I am ready to talk about my drinking." For many students, this is their first exposure to the reflecting strategy. As a result, students often feel intimidated or hesitant to give reflections thinking that they are making unsupported "assumptions" about the person. Consequently, students need to exercise their listening "muscle" which often leads to accurately reflecting the person's feelings, perspectives, and experiences in order to build trust and rapport in the professional relationship.
As beginners to MI, students must first grasp the practice of simple reflections before building up to complex reflections. Real/role plays in which students can give only simple reflections as the listener (meaning they cannot ask any questions at any point during the exchange), can help increase their ability to instinctively listen with purpose so they can accurately reflect on what the speaker is saying. Eventually, students move on to practicing complex reflections which do not simply repeat what the person says, but offer hypotheses that capture a deeper meaning behind their words: • Statement: "After a stressful day, I always end up drinking more than I should." • Simple reflection: "Stress leads to excessive drinking." • Complex reflection: "You are concerned about how you are managing stress with alcohol." Effective questioning. Students learn how to ask effective questions by distinguishing between open-ended and close-ended questioning. (Table 1-Open-ended questions exercise). Close-ended questions do not require as much attention as open-ended questions since they require "yes" or "no" answers (e.g., requesting factual information).
In contrast, open-ended questions require more attention (i.e., active listening) since the objective is to elicit as much information (e.g., feelings, thoughts, concerns and related matters) as possible from the person-giving them more flexibility to expand on the conversation.
Students often encounter difficulty in recognizing that a question will be effectively evocative. In training, easily identifiable open-ended questions are helpful in enabling the person to think about change: "Tell me more about…" or "What would life be like if…?" Students learn that common close-ended questions such as "Have you ever…?" or "Do you think…?"do not have the same impact.

MI-consistent vs. MI-inconsistent affirmations.
Affirmations are reflections that build upon a client's statements to emphasize their qualities, strengths, and/or accomplishments. They function as a way to strengthen autonomy and reinforce confidence and selfesteem/self-efficacy to enhance the client-practitioner relationship (Magill et al., 2018). A major challenge is to have students distinguish between "MI-consistent" and "MIinconsistent" affirmations. MI-consistent affirmations are accurate and specific reflective statements that are compatible with MI spirit (evocative, supporting autonomy and absolute worth, and demonstrating compassionate and genuine interest). Evidence of MIinconsistent affirmations are those that undermine the self-worth and confidence of the individual. These are characterized as conditional ("If you continue to show up on time you might really benefit from the program."); patronizing ("I am surprised you made it thus far."); or judgmental ("I believe you could do a good job if you put your mind to it."). Some affirmations are too vague or superficial ("Sounds interesting") to be of benefit to the person. MI-inconsistent affirmations are often associated with poor listening skills on the part of the practitioner and are counter-productive to rapport-building.
Another challenge for students is to employ affirmations that extrapolate positive qualities that go beyond what is explicitly shared by the client. These affirmations shed light on positive aspects of the client that lie just beneath the surface (i.e., "hidden strengths") or are not immediately noticed, evident, or considered by the client. Such affirmations are often described as having the client feel prized or celebrated (Kirschenbaum, 2009).
There are several activities that can be used to help students experience what it means to affirm "hidden strengths." One activity involves students giving affirmations based on client vignettes (Table 1 -Affirmations exercise). Some of the vignettes are clearer in highlighting positives (e.g., client who was homeless found housing); other vignettes are more challenging in that they do not include information that is immediately obvious as positive. This activity has students expand their perspective on how we can validate a person's absolute worth.
Based on our experiences in the labs, affirmations are often perceived differently among individuals coming from diverse backgrounds and experiences. Students are encouraged to explore the implications of how cultural and other factors play a significant role in how we choose to apply skills to be helpful to the person. It is important therefore, to help students understand the considerations involved in making effective use of affirmations to facilitate behavioral change.

Focusing: Identifying the Target Behavior and Change Goal
In motivational interviewing it is necessary to identify a target behavior and a related goal to establish a direction for positive change. The goal must be a behavioral change the client is interested in pursuing that is specific and realistic and is consistent with the values of the client and the social work profession (e.g., becoming a better parent, becoming drug-free, having a healthier lifestyle, improving self-esteem, and related issues). Focusing is the process of narrowing down from multiple areas of concern to a single behavior for which change is intrinsic to the client's self-improvement/best interest and motivation. Focusing occurs after a trusting relationship has been established between client and practitioner.
The challenge for students is to set an agenda when there is little agreement between client and practitioner about the issues associated with the presenting problem and/or strategies needed to resolve these problems. For example, in discussing the presenting areas of concern such as marital or family conflict, other problems not initially recognized by clients may emerge, such as excessive alcohol use. In such situations, alcohol use may need to be addressed either concomitantly or sequentially in order to resolve the presenting problem.
It is helpful to employ MI strategies such as open-ended questions, reflections, affirmations, and summaries to help clarify uncertainties and misunderstandings in order to establish clinically meaningful goals. For example, some students may be placed in settings where the supervisor tasks them to address the client's substance use when the client is still uncertain, reluctant, or ambivalent about discussing the substance use. This is where the lab training is so pivotal for the student's development in the field. The student now possesses a skillset to guide and elicit the client to explore priorities and concerns eventually opening up the opportunity for them to recognize and accept the need to address their substance use problems. Using MI skills such as reflections, affirmations, and summaries, the student works collaboratively with the client to better prepare them to engage effectively in a helping relationship.

Understanding and Resolving Ambivalence about Change
Resolving or reducing ambivalence is viewed as overcoming a struggle between two opposing sides that are associated with balancing the decision for making a behavioral change. Ambivalence is expressed by change talk, speech that is in favor of resolving the ambivalence by moving in the direction of positive change and sustain talk, speech that is not in favor of moving in the direction of positive change or maintaining the status quo (Miller & Rollnick, 2013). One side of the dilemma represents a desire to change the target behavior: "I need to cut down on my drinking to maintain my job." The other side represents no desire to change the behavior or a just wants to maintain the status quo: "I could cut down my drinking if I really had to, but I don't see a reason to right now." The goal here is to increase change talk and to reduce sustain talk to resolve ambivalence and achieve the behavioral goal. Simply put, the more one talks about changing, the less likely one will talk about not changing (Apodaca et al., 2016). Research has shown that such a process leads to positive behavioral change (Magill et al., 2018).

Importance and Confidence in Facilitating Change Talk
Importance and confidence. There are two issues that need to be considered in increasing change talk: (1) The perceived level of importance of changing a particular behavior (i.e., asking what matters) and (2) the perceived level of confidence in changing a particular behavior (i.e., doing what matters). Increasing both perceived importance and confidence levels enhances the probability of changing the target behavior. The challenge for students is to learn and practice strategies that will increase levels of importance and confidence to facilitate behavioral change. Students absorb these strategies by experimenting with them in dyadic exercises ( Evoking and responding to change talk. Once students hear change talk, it is important to reflect back what they hear and experience about the client's change statements. Other effective techniques include elaboration ("Tell me more.") and affirmations ("It is exciting to see how positive you have become" or "Your hard work demonstrates a strong commitment to your family."). The idea here is that students do not miss the opportunity for encouraging and reinforcing positive behavioral change speech. In short, students learn that they become the mirror for change talk which in turn helps reinforce and support more change speech.
Reducing sustain talk. In reducing sustain talk, it is important to have students demonstrate an understanding and acceptance of the client's ambivalence to change the status quo. Students practice slowing down the conversation to enable the client to contemplate their thoughts, ideas, perspectives, and experiences about the target behavior. Persons struggling with an aversive task may be better prepared to make a positive decision over time (Miller et al., 1992). Having more time enables them to process the information and a greater opportunity to receive support from concerned significant others resulting in more openness to change (Zweben & Zuckoff, 2002). Students can do this by listening intensely, using open-ended questions to slow down the process, and reflecting back the essence and meaning of what is being said (e.g., "Let's slow down the conversation and take a step back. You are not really sure why you need to be here today. What is your understanding of the situation?") In accordance with experiential learning, students exercise these strategies in the lab sessions before being introduced to the rationale for their use in MI.
A major difficulty encountered by students is dealing with situations in which there is a lot of sustain talk. Higher levels of sustain talk may be related to a disparity between practitioner and client with respect to understanding and accepting of the client's readiness for change (Prochaska & DiClemente, 1992). Students may try to implement some action steps when the client is still considering whether they are ready to take these next steps. In other words, the student may be too far ahead of "where the client is at" with respect to level of readiness for change. Students can become frustrated with clients who are not clearly open or ready for change which often leads to their attempting to persuade or convince the client to make the change.
In the above circumstances, it is important that students understand that their role as practitioner is not to persuade or convince the client to change. The person seeking help must be the one verbalizing the reasons, needs, commitment, and steps for change. One way in which students can visualize their roles is to have the group observe a real play between two classmates (i.e., listener and speaker) and then have the observing group provide feedback to their classmates (Table 1-Reducing sustain talk exercise). For example, students are asked to comment on whether the listener (practitioner) was employing a MI effective strategy such as "remaining alongside" (accepting and collaborating) with the speaker (client) during the exchange or was moving too far ahead (Miller & Rollnick, 2013). Another approach is to help students take a step back from the evoking process and return to one of the previous MI processes such as engaging (strengthening the client/practitioner relationship and supporting a safe and comfortable environment) or focusing (identifying, clarifying, modifying, or confirming the target behavior or goal). In some cases, it may ultimately be necessary to shift focus to another topic rather than continuing the difficult conversation ("What else can we talk about today that might be helpful?").
Discord. Discord in the professional relationship is indicative of a high level of negative reactivity toward the practitioner on the part of the client typically resulting in poor outcomes (Miller & Rollnick, 2013). In this context, the dissonance pertains to the client's overall feelings that the practitioner is unable to (lacks competence), and/or unwilling (not motivated) to help them effectively address problematic issues. Frequent use of MI-inconsistent responses to sustain talk including confronting, blaming, shaming, or sarcasm often lead to discord.
Students practice different strategies that reduce or do not invite further discord or defensiveness on the part of the client. For example, students are presented with statements by clients expressing discord and then are asked to generate their own MIconsistent responses that they think would be most helpful in the situation (Table 1-Discord exercise). This is accomplished by learning how to meet the person "where they are at" (acceptance) to encourage and support the person's own ideas for change (supporting autonomy) and/or exploring options if the client is feeling stuck. Students are reminded not to tell or persuade the person to change themselves. In this way, students are able to help the client avoid withdrawing precipitously from the sessions and move further away from sustaining the status quo (Zweben & Zuckoff, 2002).
Client: "These sessions are just a waste of time, they are going nowhere." Practitioner: "You are frustrated that we are not progressing at the same pace that you were hoping (reflecting). Let's work together on re-evaluating your options right now (options). Ultimately, the decision to change is up to you." (supporting autonomy) or -"I am sorry if I am not hearing you correctly (accepting). You have a number of options that you might want to consider (exploring options). One option is to give the process more time. Another might be to move to another topic that might be helpful to discuss. Which do you prefer?." (supporting autonomy)

Moving to Planning
Students practice being attentive to clients who are ready to work collaboratively on a change plan. Signs of readiness to plan include a significant increase in the frequency and intensity of change talk and a reduction or softening of sustain talk. Listening for mobilizing statements signaling commitment, activation, and taking steps toward changing the status quo are all indicative of a high level of readiness to change ("I will graduate from high school despite the lack of support I am receiving from my family." "I am ready to take these next steps so I can graduate.") Clients who are not ready to implement a change plan demonstrate increased levels of sustain talk or discord often resulting in canceled appointments without rebooking, no shows, tardiness, and/or guardedness in the sessions. Any improvement in change talk is balanced by equal levels of sustain talk indicating that the person is still in an ambivalent state about change, and as a result, may likely raise questions about the timeliness of planning. Persons exhibiting low levels of readiness about the change plan are more likely to exhibit poorer outcomes (Zweben & Piepmeier, 2020).
Consequently, students practice reflective and listening skills to hear and reduce ambivalence about the change plan. No plan toward change will play out perfectly and consequently, students are instructed to explore the feasibility of the change plan. In dyadic exercises, students work together as speaker and listener to address unanticipated events or circumstances that might get in the way of an action plan (Table 1-Planning exercise). This will help prepare students to address setbacks if or when they occur. This approach is similar to a physician pre-emptively discussing potential side effects of a medication prior to the patient starting the prescription. In some cases, it may be more feasible to stay with the process of evoking change talk until the person meets the criteria for moving on to the planning stage.
If the ultimate goal appears to be overwhelming for the individual, students can identify and practice incremental steps to pursue. Consider the following examples: A person who is considering changing their drinking may be ready to set a goal of undertaking a brief period of abstinence (one week) before making a commitment to permanent abstinence; another person may decide to cut down on the amount of drinking before undergoing a sustained period of abstinence; and another individual may decide to drink at the local tavern rather than at home to avoid serious conflicts with family members -which in many cases will exacerbate the drinking. In other words, goals and strategies need to be client-centered, i.e., continuously modified and affirmed to facilitate movement in a positive direction of change.

Evaluation
Dyadic interview recordings. At the end of the 7-week lab, all students are required to submit a 5-10-minute recording of themselves conducting a dyadic MI interview conducted with another student in the lab. Each student takes a turn playing both the speaker and listener during the real play interviews. The speaker identifies a problem or concerning behavior that is interfering or in direct conflict with something they value and that they are considering changing while feeling ambivalent about making the behavioral change. For example, the target behavior may be poor sleeping habits that are interfering with school performance or struggling with balancing work and school obligations. The listener is responsible for strategically using MI strategies to facilitate and elicit readiness and commitment language from the speaker about the behavioral change. Lab instructors assess students' consistent use of MI strategies in the listener role using a Dyadic Recording Coding Scheme (DRCS). The DRCS applies a 3-point rating scale (MI-inconsistent, MI-somewhat consistent, and MI-consistent) to each of the following domains: (a) MI spirit, (b) emphasizing autonomy, (c) open-ended questioning, (d) affirming, (e) reflecting, (f) evoking/responding to change talk, and (g) reducing sustain talk. The coding scheme was adapted from the Motivational Interviewing Skills Code (MISC; Miller et al., 2003). Final scores on the DRCS are determined by summing the score on each rated item and calculating a percent average. The purpose of this assessment is to serve as a marker of a student's progress in the lab. Higher scores on DRCS are indicative of greater adherence to the accurate and suitable use of MI strategies. The DRCS codebook offers comprehensive definitions of the domain items. A minimum score of 80% is required to receive a Certificate of Completion in the lab. In addition to the scores, students receive written feedback on the items from the instructor to provide more detail on student strengths and areas of improvement.
We received data on dyadic interview recording scores from 13 out of 14 lab sections held in the fall semester, 2021. Of the 218 students participating in the 13 lab sections, only 1 student failed to meet the minimum required score. For students who met the minimum requirement on the DRCS, scores ranged from 80-100%. The average score on the DRCS was 92.4%, with a median score of 95%.
Student evaluations. All students complete a course evaluation at the end of each semester in which they rate the course and instructor performance. With regard to student ratings on the MI lab evaluations, we received data on 101 student responses from the spring semester 2020 course evaluations. Across all lab sections 96% of the students "agreed" or "strongly agreed" that the labs have improved their "social work knowledge and/or skills" and 84% of the students rated the labs as "better than average" or "outstanding". Similarly, we received data on 323 student responses in the fall 2020 semester course evaluations; 95% of the students "agreed" or "strongly agreed" that the labs have improved their "social work knowledge and/skills" and 80% rated the course as "better than average" or "outstanding." To obtain a better understanding of the impact of the labs on student learning, illustrative comments on the MI lab evaluations (spring and fall semesters 2020) are provided below: The lab forced me to zero-in on my speech and how to frame my questions.
MI is important to anyone in the field that requires a dialogue with a client.
Super important for me to learn practical skills in order to apply in future counseling.
Most important class that I've probably ever taken.
Helpful for the foundation class especially for role plays.
So useful for field work.
Finding this lab to be incredibly instrumental in my learning and I honestly wish that the class times and course duration through the semester were longer. This is especially true for those of us that didn't get a field placement on time. (Note: this situation occurred during the pandemic).
Feedback from faculty and field instructors. The MI labs have also received a favorable response from academic faculty and field instructors. Faculty teaching the foundation year courses report that students are more confident in conducting role/real plays and clearer in providing feedback on role/realplay assignments and video exercises using MI language (e.g., OARS) to communicate their concerns and support to instructors and classmates. Faculty also report that the MI labs have served as a "bridge" that connects field practice with classroom learning. Field instructors indicate that MI labs have helped students to work more effectively with diverse, vulnerable populations seen in their field placement settings. Students are better prepared to navigate challenging dialogues and cultivate working alliances with clients.

Implications and Conclusions
We have developed and implemented an innovative, comprehensive MI skills-based training program for students entering an MSW degree program. Preliminary data derived on the DRCS reveal high ratings on the consistent use of MI skills to facilitate readiness and commitment to change. Ratings and comments on the MI course evaluations along with the feedback on the log assignments suggest that students were highly satisfied with the way in which the labs were conducted, helped to expand their repertoire of skill-building activities, and enabled them to become more confident, satisfied, and effective in addressing the needs of at-risk individuals seen in agency settings.
Both academic and field faculty affirm that the lab program has had a positive impact on student performance in their field placement opportunities and in their foundation year courses. Students have learned how to address roadblocks and other challenges (e.g., discord) encountered in working with clients in agency practice. Together, these preliminary findings show the labs to be an acceptable, feasible and valuable offering to incoming students and have a strong potential for improving the learning opportunities of social work students. We therefore recommend that the MI lab be considered a model for other schools of social work-many of whom are confronted with the challenges of preparing new students for agency practice.