Motivational interviewing: “Now I listen more before jumping in with a possible solution”

“You are the first person to really listen and not criticise me”

This is a comment a social worker halfway through a motivational interviewing programme received from a young person in Merton.

Motivational interviewing (MI) is a structured approach to direct work that can help individuals to want to change behaviour. It is shaped by an understanding of what triggers change and is designed to be a non-confrontational way of helping someone to recognise and do something about their present or potential behaviour concerns.

Behaviour change can feel ‘hit and miss’ at times…a young person can seem to be doing really well and all of a sudden revert back to unwanted behaviour. Motivational interviewing addresses the factors that frequently underlie this – ambivalence about wanting to change, resistance and the idea of ‘learned helplessness’.

Building resilience and autonomy

It can be particularly effective when working with young people as the focus on their personal motivation and commitment to specific goals helps develop a stronger sense of identity and decision-making capacity. The confidence gained from making small steps towards change builds resilience which supports young people move towards greater autonomy.

Merton, a south London borough, is training 70 practitioners on a programme which links evidence-based motivational interviewing techniques to an understanding of adolescent brain development and attachment theory.

Staff from the 14+ team, youth justice, Transforming Families (Merton’s troubled families service) and education, training and employment team who all work with young people who are at a risk and/or present as a risk to others are taking part in the programme.

Embedding learning into practice

Many social workers will recognise the feeling that training courses do not always translate to changes in their practice. We are combatting this with a programme of clinical group supervision and action learning discussions alongside learning the techniques, as well as ensuring individual supervision reviews the MI-based work.

The approach is becoming embedded in practitioners’ whole approach to work and their workflow. Reflective learning logs enable reflection on using the approach and planning ahead.

The spirit of working in partnership is brought to all assessments and case recording as well as direct contact, ensuring the young person’s voice and perceptions are kept central.

I am able to better record and evidence professional judgements in my case notes when using MI with young people

Analytical skills can also be underpinned by the principles we use to look at change, for example identifying and affirming strengths, seeking exceptions to problems, reframing problems, deconstructing problems, setting goals and incremental small steps towards goals which use the young person or family’s skills.

Impact on practitioners

Motivational interviewing also encourages self awareness (sometimes referred to as reflexivity) – looking at how the social worker is perceived by young people and how this impacts on the way they engage. Practitioners then develop strategies to work with this.

A full evaluation of the Merton programme will be carried out on completion but the impact of the techniques and how they link together is already valued by staff for how it has improved relationships with people using services. So far staff have said things like:

“Allowing more time to identify young people’s views on their situation gives me a greater understanding of how they see their situation.”

and

 “Using some of the skills around empathy building and reflective listening seem to build up a better connection with the young person.”

One practitioner felt that using some of the motivational interviewing skills had led to safeguarding disclosures by a young person which had never been mentioned to other professionals.

Looking ahead

A key part of the programme is training a small cohort of social workers to be motivational interviewing ‘champions’; they will develop further specialist skills and knowledge in order to support other practitioners and deliver training for more groups in future.

Merton were keen to implement motivational interviewing for a number of reasons, including Munro and government recommendations to increase focus on relationships and direct work with service users and Ofsted feedback to local authorities to use more evidence-based practice.

Practitioners in some of the teams have identified how the techniques can be useful in other scenarios – for example, one said the skills means she is able to teach parents to better communicate with their children. The aim is that the champions will make the programme self-sustaining and enable it to spread to other parts of children’s services.

T Daszkiewicz Associates incorporates the Centre for Training, Education and Development which focuses on skills-based learning for children & families workforce development.