Recommended Books
Search For Books
This form does not yet contain any fields.
    Tuesday
    Mar042014

    Motivational Interviewing and Guidance Practice by Peter Beven

    Motivational Interviewing and Guidance Practice

    This article introduces some ideas derived from Motivational Interviewing and suggests that the approach offers a supportive and constructive approach to clients in career guidance settings Motivational Interviewing is a method defined by Rollnick & Miller (2012) as a client-centred   intervention combined with directive elements that helps clients to explore and resolve their ambivalence about changing. It originates from research and practice undertaken in the addiction field in different countries.

    A varied caseload…

    Imagine the scenario: An adviser is undertaking interviews in an educational setting. The first client has requested a discussion so he can obtain some information about a possible career area he is interested in. The second client has requested a meeting because she is disappointed about her examination results and wonders about how her plans might have to change, she may be in two minds about whether to resit or not. Working with each of these clients might well require a range of guidance skills and there are many approaches that might be taken to be helpful. What they do have in common however is that both clients have requested a discussion and want to be there. Then let us suppose a third client appears who when asked what brought him to see you, just shrugs his shoulders and says “I don’t know… I was told I had to come and see you.” From there client number three shows no interest in your best efforts to engage with the process, uttering perhaps monosyllabic answers, making it clear through their body language that they are uncomfortable with the very fact of being there. Some advisers reading this article might see such behaviours relatively rarely. For many however it is the rule, not the exception, particularly for those with a caseload that is comprised of client groups often referred to as “harder to help.”

    For some advisers, such behaviours in interview settings may feel like a challenge to their competence. It can be tempting to react in ways that are unhelpful typified by the “fight or flight” approach. For example resorting to defensive statements like “I’m only trying to help you” or giving up prematurely saying things like “Well come back when you do want to talk about something!” Motivational Interviewing provides a helpful framework for understanding more constructive approaches to this sort of situation.

    Directing, Following or Guiding?

    In their book on motivational interviewing in health care settings (Miller, Rollnick and Butler, 2008), the authors describe three communication styles, that of directing, following and guiding. Directing or adopting a directive style involves the interviewer in taking control, implies an uneven relationship in terms of knowledge and expertise. The client is told what to do by the adviser, with all the possible consequent implications of lack of real ownership on the part of the client.

    Following is about being a good listener. This links directly with Rogerian notions of trying to understand the world view of the person in front of you, giving value to the client experiences. The message to the client is “what you say and how you see things is important” This approach is used strategically in motivational interviewing to encourage the client to amplify their feelings about their current situation but also to address any risk involved.

    The third style that of guiding, is about being able to offer approaches and options to help the client make decisions based upon where they want to get to. Motivational interviewing is described as a “refined form of this guiding style”. The purpose of this article is to introduce what that might mean for career guidance practice.

    Defining motivation as a state of readiness

    In this approach, motivation is defined as a state of readiness to take action. We need to move away from any stereotypical notions of individuals either being motivated or not motivated. It seems evident that motivation is always context specific, is changeable over time – sometimes quite a short period of time, and is influenced by perceived power relationships. It is context specific in that I may be, for example at the same time, highly unmotivated to do one thing, let’s say, for example to  move house, whereas at the same time be highly motivated in another area, for example supporting my local football team. It depends where we look where we find the motivating feature.

    It is changeable over time: For example Hodkinson and Sparkes (1997) research uncovered the way young people make decisions, in pragmatic, opportunistic ways at odds with the technically rational ways many guidance models espouse. The individual client leaving an interview with the stated intention of attending an interview may find as soon as they leave the interview place that other priorities take over.

    It is influenced by perceived power relationships. What is sometimes called “resistance” in interview sessions, clients not wanting to participate, being defensive and / or aggressive for example, might usefully be reframed as feedback, a reaction to some perceived threat. People appearing resistant are resisting something else; and that something else might sometimes be an interviewer pursuing an agenda the client does not share.

    Before discussing the communication skills linked with Motivational Interviewing in a little detail, it is probably useful to reflect upon a behaviour change model that has been influential in the evolution of Motivational Interviewing, although originally developed independently. Prochaska and DiClemente (1984, 1992, and 2002) described their transtheoretical “Wheel of Change” model as a result of their research in the addictions field. They noticed that individuals seemed to follow a pattern of change typified by certain statements and attitudes towards making changes in their lives. The “Wheel of Change” gives us a way of conceptualising change as consisting of a series of stages.

     

     

    Although the “wheel of change” behaviour change model derived from the addictions area of work, it also resonates strongly for individuals making changes in terms of their career or professional development. It is possible to indicate possible statements or attitudes that coincide with each of the stages indicated above derived from career guidance cases.

    For example:

    Precontemplation: The individual is not even thinking about the possibility of change. They may have been referred from another agency, they might report “I haven’t got a problem” or might express surprise or unhappiness at having to attend and interview. They might be defensive too “I’m only here because they force me to come here” (e.g. to avoid losing a benefit or funding).

    Contemplation: this is where there is some awareness that there might be an issue to be addressed. Often it is characterised by ambivalence - feeling two ways about change. An example might be “Yes I suppose I could go for that interview but there’s no point really because I never do well”

    Determination / Preparation stage: this is where the balance shifts to intention to act. For example the client might start to say things like, “I‘ve got to do something about this” or “I really need to get a job to bring in some money.”

    Action Stage: This is where the client is taking positive steps to achieve change; for example applying for courses or vacancies, taking advantage of additional support to improve literacy or numeracy, undertaking a drug treatment programme, etc. etc. – in other words doing something constructive to make a change happen.

    Maintenance is basically keeping going with the plan for change; reviewing progress and hopefully not giving up if at first things don’t work out immediately. E.g. this would involve the individual keeping going with fallback strategies if rejected by the first choice job or college course.

    Relapse: Relapse is when an individual, having made some attempt to change “reverts back” to problematic behaviour. Many advisers will be familiar with the person saying “well I applied everywhere for that type of work but I got turned down every time. There’s no point in going for anything now”

    Taking cognisance of the wheel of change would appear to be significant for career guidance work in many respects. It seems self evident that different strategies and tactics are needed for working with a client at the pre-contemplation stage compared to, say, the action stage of readiness. The tentative suggestion might be put made that one possible reason for dissatisfaction (on both sides) of some interviews may be due to the adviser operating in the action stage when the client is not yet ready to engage with that. It feels helpful sometimes to talk about action strategies (giving information about options, tactics and so on) in an enthusiastic way, but if the client is feeling in two minds about the whole process, the risk is that resistance to contemplating change is reinforced, not eased.

    Motivational Interviewing: The approach in practice

    Miller and Rollnick (2010) are at pains to reinforce the fact that Motivational Interviewing is much more than a series of tactics. The ‘spirit’ of MI is crucial to its effectiveness in practice. The overall engagement with clients is characterised as one of collaboration, a sharing of resources. A positive partnership which emphasises client autonomy is important. It is after all the client who ultimately will decide what they will or will not do. The job of the interviewer here is to try and evoke whatever motivation for change that resides within the client.

    Four Principles

    Four general principles evolve from this stance; firstly expressing empathy, that is trying to understand the client’s feelings and points of view without attaching judgements or blame. Secondly, where appropriate to develop discrepancy. This means establishing with the client where they would like to get to and to encourage the client to reflect upon how far current behaviour is helping them to get there. The idea is to encourage the client to talk about the possibility of change rather than the adviser doing so. The third principle is termed “rolling with resistance” This is about avoiding getting into arguments with clients, respecting the individual’s right to make their own decisions. As mentioned above it is helpful to regard resistance as feedback, which when we encounter it is probably a sign to change what we are doing as interviewers. The fourth principle is in supporting self efficacy. This refers to a person’s belief that they can accomplish change. An aim of this approach is to encourage the belief that some change is possible.

    Tactics

    Some specific tactics are suggested for encouraging clients to talk about the possibility of change. For individuals at the precontemplation and contemplation stages reflective approaches may be helpful to support the client in talking about their own view of the current situation. The idea is to provide space for the client to explore what they like about their current situation as well as encouraging clients to explore potential risks in staying as they are.

    The objective is to evoke what Miller and Rollnick originally called “self motivational statements” or talking about change. Depending on where the client is in terms of the stages of change model ‘change talk’ statements can be evoked by strategic questioning. Important areas to address might be problem recognition, concern, intention to change and optimism for change.

    Summaries are used which incorporate a client’s self motivational statements which can then lead to the “key question” the essence of which is saying to the client “In the light of all we’ve discussed what do you think your next move should be?” The emphasis reinforces the ownership of the next move being the client’s.

    A word about the nature of directiveness

    It is clear from the literature that the terms “directive” and “non directive” are not used in consistent ways. Directive can mean giving advice, direct confrontation, or in the case of traditional career guidance models, “expert” models of matching. These “expert “ models are still much in evidence (Bimrose 2006, Hambly 2007) despite serious questions being asked about their effectiveness (see for example, Cochran 1997, Sharf 2006, Reid and Bimrose, 2006). Work has been conducted on conflicting discourses about the role of counsellor influence, e.g. Spong, (2007). In the case of Motivational Interviewing “strategic questioning” is perhaps a better term, one that also fits well with aspects of constructivist and narrative approaches. The idea is to help the client reflect upon specific aspects of their story, and certainly not directiveness in terms of telling the client what to do.

     

     

    Motivational Dialogue

    One feature of the collaborative nature of the approach is the use of language; in particular the use of words that join the client to the issue being discussed. For example if a client were to say something like:

    “I really couldn’t stand that training course” one reflection might be “so it wasn’t for you…” Within motivational interviewing there might be the possibly more productive “What concerns did you have about it?” or “what bothered you about it?” The idea is that ‘trouble’ and ‘bother’ are both words that join the client to the issue being discussed.

    A further range of strategies are suggested with the goal of encouraging the client to talk about the issue of change

     

    Information Handling  

    Some guidance interviews undertaken by experienced practitioners I have observed are like two act plays. The first act consists of very engaging use of listening and questioning tactics to establish the  purpose of the interview, developing a shared agenda and finding out about the client’s interests or ideas about the issue at hand. The second act is when, in the light of what has been found out, the adviser resorts to “expert mode” and takes over the discussion to talk about options and possible ways forward. It may feel like we are being helpful and informative, but questions must be asked about whether there are more effective ways of working with information, ways that involve the client more effectively.

    Miller and Rollnick describe a simple yet effective way of working with information. The idea is to maximise client involvement in the process, avoiding the danger of going into “expert” mode.

    The Model is summarised as Elicit, Inform, and Elicit

    First Stage

    1. Elicit: Find out what the individual knows already about the initiative, resource, opportunity, and facility, whatever

    For example: “You say you are interested in getting some more help with your spelling. Could you tell me what you know already about what you could do?”

    Or “Perhaps you could tell me what you know about this drug treatment programme...”

     Establish also what the individual thinks they need to know. What would be helpful to him or her?

    Second Stage

    Inform: Try to help fill the gaps in knowledge, based upon individual information needs. Think about being tentative rather than directive about using information. For example, use phrases like “What some people find helpful….” Or “Probably the usual way people do this…” The objective here is to make it clear that the client has the responsibility for choice.

    Third Stage

     Elicit: find out what this information means for the client and what this means for the next step. “So what do you make of this...?” “What do you think this means your next move should be?

     

    The MI style is a collaborative method using distinct principles and techniques. Its emphasis on client autonomy in decision making fits well with principles associated with career education and guidance. It is not possible in this short space to do justice to the full range of strategies suggested by the approach. It is hoped that readers may be encouraged to investigate further to explore the potential for guidance practice.

    Further Reading

    Bimrose, J. (2006). What is the impact of guidance on clients one year on?  Evidence from a longitudinal case study in England, in Reid, H. Re-Positioning Careers Education and Guidance, Canterbury Christ Church University, Canterbury, pp9-14

    Cochran, L. (1997) Career Counselling A Narrative Approach London: Sage Publications

    Egan, G. (2013) The Skilled Helper, 10th edition Pacific Grove: Brooks Cole

    Hambly, L. (2007) New Theory: Implications for Guidance Practice Careers Guidance Today Volume 15.3 October 2007 pages 30 -33

    Miller, W. R. and Rollnick, S. (2012) Motivational Interviewing 3rd Edition New York: The Guilford Press

    Miller, W.R., Rollnick, S.  & Butler, C. C. (2008), Motivational Interviewing in Health Care New York: The Guilford Press

    Nathan R. & Hill L. (1992) Career Counselling 2nd ed. London: Sage Publications

    Prochaska, J. O.  & DiClemente, C. C. (1984) The transtheoretical approach: crossing the traditional boundaries of therapy Malabar, Florida: Krieger

    Prochaska, J. O., DiClemente, C. C. & Norcross, J. C. (1992) In search of how people change: applications to the addictive behaviors American Psychologist, 47, 1102 - 1114

    Reid, H. and Bimrose (eds.) (2006) Constructing the Future: Stourbridge: ICG

    Sharf, R. S. (2006) Applying Career Development Theory to Counseling: 4th edn Pacific Grove: Brooks / Cole

    Spong, S. (2007) Ideas of Influence: counsellors’ talk about influencing clients British Journal of Guidance and Counselling Volume 35:3 August 2007 pp 331 -345

    Tober, G. and Raistrick, D. (eds.) (2007) Motivational Dialogue Hove: Routledge

     

     

     

     

     

     

    © Peter Beven 2014 All Rights Reserved