The Four Processes: Focusing

By Mia Croyle, MA

In the third edition of Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013), we are introduced to the four processes. In our newsletter, we discussed the first of these, engaging. The second of the four processes is focusing. Our objective in this process is the collaborative, ongoing process of seeking and maintaining direction. 

In Motivational Interviewing. there are three main sources of focus, and in almost every instance. we rely on some combination of them all:

01. The other person (the “patient”): people generally have concerns, preferences, ideas, and values that influence our focusing process. For example, in BSI, if a patient screens positive for potential risk in the areas of tobacco use and depression, the patient will have some ideas about where he or she would like to start, and we certainly give priority to those ideas.

02. The setting: in BSI, we are in a healthcare context and generally, our health educators have a pre-established list of behaviors that they are trained and sanctioned to address. If patients have concerns that fall outside these areas, the health educator can refer patients to other resources.

03. The helping professional’s clinical expertise: in BSI, this is informed by the results of the screen and brief assessment. Other members of the healthcare team, such as the physician, may also have clinical expertise that informs our focusing process.

Like each of the four processes, focusing is an ongoing process. Once we have established a focus, we continue to attend to focusing throughout our interaction. We may need to revisit our focus at times to make sure we are still on the same page with the other person.

WIPHL/WCHQ Symposium Planned on Spreading BSI


By Richard L. Brown, MD, MPH

I’m pleased to announce that WIPHL and the Wisconsin Collaborative for Healthcare Quality (WCHQ) will host a day-long symposium on behavioral screening and intervention (BSI) in Madison this upcoming September 17.

The goals of the meeting are to discuss the documented improvements in health and cost savings of BSI, the current state of BSI delivery in Wisconsin healthcare settings and together, plan how to accelerate the spread of BSI all across our state.

The conference is targeted at a diverse array of audiences, including individuals and representatives of organizations in both the private and public sectors, that:

  • Purchase healthcare
  • Pay or help contract for healthcare
  • Provide healthcare
  • Influence healthcare policy – or would like to do so
  • Advocate for the health and well-being of Wisconsinites

Our keynote speaker will be John Torinus, Chairman of the Board of Serigraph, Inc., and author of The Company That Solved Healthcare. Mr. Torinus will discuss why mainstream healthcare payers and providers are losing market share among large- and medium-sized US corporations, and what can be done to win back those customers.

I will discuss BSI, its health and economic benefits, and a model for delivering BSI that has worked well in dozens of Wisconsin healthcare settings. Kevin Moore, Deputy Secretary of Wisconsin’s Department of Health Services, will provide commentary on the prior sessions.

Mia Croyle, MA, WIPHL’s Director of Operations, will facilitate a panel of healthcare professionals who will discuss their personal experiences in delivering BSI.

Throughout the rest of the day, there will be additional sessions designed to foster a rich exchange of information, experience and new ideas on various aspects of BSI, including:

  • Delivering BSI in primary care settings
  • BSI and the business case for employers
  • BSI and other models of primary care/mental health integration
  • BSI-related national and state health policy
  • BSI and the prevention of heart disease
  • BSI in schools and colleges
  • BSI and federally qualified health centers

At the end of the day, there will be a plenary discussion of ideas that came out of each session, how to move BSI forward in Wisconsin and the various roles that participants can play. There will be ample opportunities to participate in discussions in the large groups and small groups as well at network throughout the day.

This symposium is sure to be an exciting and enriching experience, so be sure to save Tuesday, September 17 on your calendar. It will take place at the Monona Terrace. Lunch and refreshments will be provided. All symposium expenses will be funded by WIPHL and WCHQ’s current grant from the US Agency for Healthcare Research and Quality (AHRQ).

There is no fee to attend the symposium but registration is required, and there will be a registration cap. Be sure to register at, and tell your friends and colleagues.

We hope to see you there!