#healthpsych

Stop using motivational interviewing (MI) for clients in the action stage

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Experienced MI practitioners know that MI has little application when theyare working with an individual who is activated, motivated, has a goal and plan to achieve what they set out to do.  Despite MI not being a panacea for use across different motivational states, and having little evidence for its effectiveness with motivated individuals.  I notice the conversation about change becomes a default communication process for quite a few people working with clients.  I asked myself, why do well trained individuals default to focusing on eliciting change talk when the individual has already stated and signaled they have a goal and a plan?

In my supervisory work over the last five years I listened to over 150 recorded intake interviews and follow up coaching sessions.  I listened for the interviewer’s readiness assessment, understanding and direction setting with the client.  As the sessions progressed and the interviewer recognized the person they were working with was ready to act because they had set a goal and created a plan the conversation stalled.  It would then turn into a circular conversation going nowhere as the interviewer explored for other problems.  

I listened as the person being interviewed got quieter and quieter until I heard only the voice of the interviewer.  The person being interviewed withdrew because they were frustrated at having to retread what felt like an old path.  They wanted to move on and get on with things to improve their situation.  When I talked with the interviewer after the interview to learn from their point of view, what they thought went well, what was difficult and how they might have improved things given the same opportunity with the same person.  They often replied they were stuck when they felt there was nothing to fix and the person did not need them.  They felt they had nothing to add because MI did not seem to help them when the moment to coach came about.  Exactly!  MI is not for coaching for action, instruction, teaching and the like.  That is a different communication process assuming roles have shifted. 

The “fixing” mindset of the interviewer seems to be a standard approach at the outset of the work for novice practitioners.  Not surprising as so much of their experience before I work with them is being told what to do.  It comes from a good place and is well intended but is often not always well received or acted on quite in the way the person telling might have liked.  It seems many interviewers focus on fixing a person instead of listening and modifying their approach to the client.  They tell the person they are interviewing what to know and how to act but do not show or coach the person how to implement their improvement.  Telling is cheap and coaching is costly. 

Interviewers are often confused about how to make the shift from a conversation about change to a conversation about capability and commitment in action. Action requires commitment, having a conversation about what it is and how to establish it is critical for the client to take responsibility for their own effort toward their goal.  A person engaging in a behavior must draw on commitmentwhen things get tough, in doing so it helps preventrelapse and keeps an individual on track.  They often feel more powerful over their own change because they are the one who is in charge of their effort and focus.  

When interviewers get stuck I encourage themto be mindful and consider these questions (see below) when they are working with a person and the conversation is shifting from planning and preparation to action in their life.  I invite interviewers to have these questions listed in front of them when the moment arises the shift in readiness and commitment happens in the conversation about change. 

What does the person need to know to make progress?

What skills do they need to be able to use to stay on track?

What do they need to learn today, right now?

What is my role here?

By asking these questions the interviewer can shift from guiding a conversation about change and eliciting the intrinsic resources and motivation for change from a person, to a conversation geared towards coaching for capability and commitment.  The role of the interviewer subtly shifts to becoming an educator and a teacher, which means the interviewer needs to know what their client needs to know and what skills they need to show to able to build confidence and work towards their goal. 

The interviewer need to assess and evaluate the desire and needs of the person and act on them educating and teaching the person properly to build on their commitment to achieve their goal.  The interviewing relationship is still collaborative but it shifted because the interviewer had further value to bring to the conversation by showing their client how their commitment and desire might be channeled for the client’s own progress.  These behaviors are coaching behaviors they are different from MI consistent behaviors. 

The key point to take away from this is that MI is for a conversation about change.  A conversation about how to concentrate effort and intensity into behaviors that achieve client goals is for capability and commitment.  This conversation is characterized by an exchange of knowledge, the teaching of skills and the implementation of self-monitoring tracking progress to goal.  By knowing the difference in the conversations an interviewer might experience a client becoming even more engaged and less frustrated.  The communication process being smoother, the interviewer feelingless stuck and progress to goal more likely to occur sooner rather than later. 

Stop talking about change.  Shift.  Start talking about how to make it happen. 

Register for your upcoming MI Training Workshop on May 18th, 2019 in Chicago.

Find a trainer and MI resources at Motivational Interviewing Network of Trainers

 

 

Measuring Up

A blog on the pressures of being "good enough"

Written by Ryan Shuda

This painting was done by Polish contemporary artist Igor Morski.

There is a secret hiding in this photo, a secret that a growing number of teenagers and young adults can relate to. Even though they can relate to the secret, few people want to acknowledge it. Can you figure out what I am talking about yet? The secret lies in a constant feeling of being unable to “measure up” and questioning “Can I even do this?” These perceived expectations come [somewhat unconsciously] from a child’s parents or siblings, teachers, coaches, peers, and images and messages in society as a whole. What we don’t always recognize as parents, grandparents, friends, coaches, peers, and members of the community is, the message and standards we are communicating are leading to extreme pressures on the next generation leading to extreme measures to be “good enough.”

 

As adults, most of us take technology for granted, whereas for most teens, technology is their life and social realm. “Do your homework,” now means “Get your Ipad/laptop.” “Call your friends to see what they are up to” is now “I’ll text them and start a group chat.” “Spending time” with friends is now messaging them on Facebook, Skyping with them, or playing video games online together. In this case technology, right or wrong, can help people who are shy open up and make friends easier. Unfortunately though, young kids use technology so extensively that they may receive mixed messages from major support figures in their life like parents, coaches, and even loved ones. The teenager may hear the suggestions and turn them into “rules” or “expectations” of how they should act or be acting. Today’s teens though have a drastically different skill and comfort level than we do. Inadvertently, these well intended suggestions frequently end up turning into more thoughts that the teen is not “measuring up” or doing what is expected of them.

 

Personally, I see a number of teenagers and young adults being treated more and more like adults. No longer is it good enough for children to just go to school, get good grades, and maybe participate in a sport or club. Instead, teens are put into multiple sports or extracurricular activities which take away significant time from their academics and overall social growth and development. Children are also being asked to do more and more to get into a “good” high school, and even middle school. The application process for some high schools require teens to go through an interview, application, essay, and even an orientation. That was required for me to get into college, not high school. More and more children are pushed to do more to get into a school only to still have the risk of saying “We regret to inform you but our enrollment has met its capacity,” but what children read and hear is “You weren’t good enough.” Children are no longer just allowed to participate, but they have to “succeed” and “measure up” to others, when the reality is that everyone has their own strengths and weaknesses.

 

On top of using technology to build relationships, having extremely busy schedules, being exposed to a lot of high pressure situations, consider another role technology plays today.  Not only is the constant exposure to be “cool” plastered all over Twitter, Instagram, Snapchat, Youtube, and Facebook but these “cool” things get put next ads that are sexually suggestive, promoting the use of drugs and/or alcohol, and even sometimes extensive ridicule from other people.  Again, this sends mixed messages that reinforce the idea of not “measuring up” to what other people their age are saying and doing.
 

So, adults, specifically parents, coaches, grandparents and loved ones, what can you do to help the teens and young adults in your life? The first suggestion I have is for you to understand and recognize how your teens world is different from the world you grew up in. Next, I want you to take a look at your child’s schedule and find your child’s “downtime.” If you can not find any time where they are not involved in extracurriculars, doing homework, or any other type of “work” then your child needs some! Downtime is supposed to be just that, time that they can do something that THEY enjoy (age appropriate of course). An additional suggestion I have is to help your child identify his/her values by asking them about situations they see on social media regarding the people or pop icons they follow. Lastly, and most importantly admit to making mistakes. Everyone, yes I mean everyone, has their own strengths and weaknesses and admitting our own mistakes will help shrink those thoughts of being “unable to measure up.”