Motivational Interviewing (MI) stance, as described by
Naar-King and Suarez, (2011), has helped shape some of my thoughts and feelings
about difficult behavior such as resistance and defiance in adolescents.
In MI understanding Autonomy, Collaboration, and Evocation
(ACE) are important to the therapeutic process of the therapist and the
adolescent. Autonomy and collaboration
seem to be more relevant and helpful to the group work I do with children and
adolescents in my internship. Naar-King and Suarez, (2011) describe autonomy as
an important developmental stage that can be positively encouraged, not
controlled. Collaboration can help set healthy parameters from where the young
person can explore his or her potential and gain self-efficacy. Empathy and collaboration are important
because they can help build a “working for change” relationship with the young
person. Failing to collaborate and empathize creates resistance to change,
especially in adolescents with behavior disorders. In a “working for change”
collaborative relationship a social worker does not have to “fix” the client,
but serve as a guide using the client’s own values and goals.
It is a relief to not feel that it is not my responsibility
to change young person antisocial behaviors.
MI principles have made it easier for me to reflect on how I handle
difficult behavior in my internship. I often find myself rethinking how I
handled a situation. I asked myself was I respectful to autonomy? Did I
collaborate or did I dictate? Naar-King and Suarez, (2011) also explain that it is important to "roll with resistance." This requires the therapist to recognize that he or she has influence in creating resistance in the client and must be able to stop in the moment to identify what is causing resistance. I describe a scenario bellow where I encounter resistance in my internship.
Three weeks ago, I gave rubber bands to
children and adolescents for participating in group activities. At the end of
the day I gave prizes to students who had rubber bands. Three students, who did
not have rubbers bands, stood there complaining and watching as everyone else
got their prizes. They gave me reasons to why they did not have rubber bands. I
walked away without giving them a prizes and did not listening to their
explanations. One of them said, “Screw you!” I decided to ignore. After further reflection over the week, I
realized that their explanations for not having rubber bands were right. The
following week I spoke with them about what happened. I told them that I did
make a mistake giving rubber bands, and I apologized. Their faces looked
surprised as I did this. I got the feeling they do not normally receive
apologies from an adults. They were very
nice and said it was okay. I also told them that it was not okay for them to
tell me, “Screw you!” They apologized. This made me very happy. I asked them if
we could start over. They said yes.
While I was not able to recognize in the moment how my behavior caused resistance, I was still able to reflect and recognize what I needed to do. After this experience I make sure I listen
and have noticed that we are more relaxed around each other. They also talk to
me more and pick me to be in their team when we play games.
Thank you for your thoughtful reflection and the example from your field placement to help illustrate these MI principles. I also really enjoyed learning about this approach and think it really reflects social work values well. It can be difficult at times to meet the client where they are when problems seem so clear, but they are unwilling to recognize them. By remembering and reflecting on the ideas of autonomy and collaboration it can become easier to build an alliance and help the client to feel heard.
ReplyDeleteI had some previous experience working with adults that came to mind when learning about MI. I often had to confront individuals about substance use and heard a more abrasive form of "screw you" almost as regularly. As time went on, I developed more tact in how I approached such situations and really collaborated with those clients to explore what was going on/what led to the substance use/was that the best strategy? While I didn't know anything about MI at the time, I was more or less using the technique. By acknowledging the substance use without judging it and working with the clients to reflect on it I was able to improve rapport, avoid the escalation/aggression that occurred with the more authoritative approach, and was able to help the clients work toward better (far better) outcomes.
Esmi -
ReplyDeleteI love how willing you were to reflect on yourself and admit your mistake. We all make them and it says a lot that you continue to think about your work even after going home for the day and acknowledge when you were wrong.
Thanks for highlighting how therapists can actually create resistance in their clients. When I first learned about this, it was new to me as well. I think our instinct is to try to convince people to change, when we see they're heading towards danger. Within the framework of motivational interviewing, however, it makes sense that we can engender more resistance to change when we don't recognize which stage of change they are in and meet clients where they are. It's a tricky balance between, however, between meeting them where they are and gently directing clients towards change. This is where I tend to get stuck. In my own practice, I am trying to remember to help elicit reasons for change by highlighting discrepancies between the client's values and goals and actual behaviors.