national child measurement programme | helpful conversations 1 helpful conversations talking with...

National Child Measurement Programme | Helpful Conversations 1

Helpful ConversationsTalking with disgruntled parents: lessons from motivational interviewing

A brief workshop considering guidelines for better practice, using motivational interviewing as the

reference style

Welcome!


Our workshop formatThree sections

1. The challenges and pitfalls of talking with parents2. A few simple messages from MI3. Guidelines for better practice


ObjectivesTo help you ...

• Better appreciate how conversation influences behaviour

• Exercise restraint when pressure mounts • Sharpen a few skills • Have more satisfactory conversations with parents• Achieve better outcomes• Anything else? Your suggestions ...

An enjoyable and stimulating workshop for all!


Your PresenterJeff Allison

20 years working in the UK addictions field as a specialist social worker, counsellor and service manager.

Since 1996, has run an international training consultancy and private practice, providing training and practice development/supervision for more than 200 commissioners in UK, throughout Europe and Scandinavia, and in Canada and South Africa.

Training events for the European Addiction Training Institute, the European Commission and for the United Nations Office on Drugs & Crime.

Visiting lecturer to Glasgow University, The North Trøndelag University College, Norway and past member of the guest faculty of INSEAD, Fontainebleau.

Member of the international Motivational Interviewing Network of Trainers (MINT Inc.)

Co-founder and a director of MiCampus BV, a new web-based training and certification initiative.


Your PresenterTim Anstiss

• insert


Your PresenterJudith Carpenter

• Registered Dietitian since 1987• 22 years NHS work experience – diabetes, obesity,

eating disorders• Freelance trainer since 2007, runs Optimal Change Ltd• MI trainer since 2000, trains nationally/internationally

in health and social care• Currently chairs the Board of Directors of motivational

Interviewing Network of Trainers (MINT)


So what is motivational interviewing anyway?Definitions

‘Motivational interviewing is a collaborative conversation to strengthen a person’s own motivation for and commitment to change.’‘People are generally better persuaded by their own arguments than by those of others - especially so-called experts. Our task is to help them decide to do things differently’.

Bill Miller & Steve Rollnick | 2010The psychologists who originated and developed MI during the last 30 years

www.motivationalinterview.org


Section 1 | The challenges and pitfalls of talking with parents


The challenges and pitfalls of talking with parents

A hypothetical conversation with a parent• Paper copies - circulate!• Let’s read it out loud - two volunteers, please!• Next, in small clusters, consider these questions ...

1. In which ways does this represent current practice?

2. What’s good and less good about this conversation?

3. How do you imagine both parties are feeling before, during and after the conversation?

4. What will be the likely consequences?5. What conclusions do you draw?

15 minutes of sharp, constructive critique


The challenges and pitfalls of talking with anyone Exercise: a demonstration of contrasts | Part 1 - persuade

•In pairs - one to talk, the other to respond•Talker: describe a necessary issue of change in your life, for example, more exercise, better diet or less alcohol - you’re just contemplating doing it•Responder: explain why the talker should make this change, suggest many specific benefits of changing, tell the talker how to do it, emphasize how important it is to do it as soon as possible, insist on all the negative consequences of not doing it, demand a commitment to change.5 minutes of robust conversation


The challenges and pitfalls of talking with anyone Exercise: a demonstration of contrasts | Part 2 - evoke

•Start again - as if the first conversation never happened•Talker: repeat your story•Responder: listen carefully with a goal of understanding the dilemma, but give no advice unless it’s requested. Offer listening statements and ask these questions:1.Why would you want to make this change?2.What are the three best reasons to do it?3.Why is it important for you to make this change? 4.How might you go about making these changes?5.How will you know when you’re succeeding?6.End with a summary and ask, What do you thing you’ll do?

10 minutes of thoughtful, collaborative exploration


The challenges and pitfalls of talking with anyone

•Persuade or evoke?•Wrestle or dance?

Your conclusions?


Section 2 | A few simple messages from MI


Why do conversations about ‘hot issues’ and change often turn sour?

But that’s our job•We often think we know what’s best for other people - and we tell them so!•But no one likes being told what to do and how to do it - especially if they didn’t ask for help•Conversations about change are minefields - tread with care! Skilful persistence tempered with respectfulness and delicacy of manner will win the game



Insistence causes resistance•concerned confrontation is rarely helpful•Your behaviour will influence the parent’s behaviour - for better or worse•Don’t argue or cajole parents – even if you feel it justifiedThe pummelled parent is never a happy parent



Wrestling with parents isn’t helpful •Professional ‘logic’ rarely wins arguments when there’s a lot at stake•The ‘winning argument’ approach to promoting change is a cause of frustration and miseryOverwhelming with science? Stop it!



Psychology isn’t Physics•Changing a person’s attitudes isn’t like moving a washing machine stuck to the linoleum - applying additional force until there’s movement just doesn’t work with people•Attitudes entrench and harden when faced with brutal logic - poor outcomes follow behind



Helpfulness is a matter of perspective•It’s the parent’s perspective that matters•Parents must change their own beliefs, attitudes and behaviour - we can only guide and support the process•Helpfulness is hearing yourself explaining the why and how of changing•Drawing water from the well, rather than pumping petrol - evoking is all!



Changing is rarely easy•Even when desired, changing can require sustained hard effort and may be daunting•Compassion for the struggles of others is never wasted and never slows the process of change•There’re always reasons to leave it for another day - annoying parents may make it more likely•Stay in step - patience pays dividends



Practice is full of surprises•We can’t anticipate the causes of positive change - curiosity, humility and optimism are good for everyone’s mental heath•Information and advice-given are only a part of the helpfulness package - the foundation is understanding, thoughtful appreciation and a spirit of acceptance



The take-home message!•Unsatisfactory results will commonly follow when you are perceived by the parent as being judgmental and unsympathetic •The converse is also true - you can make it so


What’s the challenge?

•How might you use your knowledge, skills, experience and authority to best guide the parent to a good outcome without triggering or increasing resistance?•And what is a satisfactory outcome anyway?



We’re all members of the ‘awkward squad’!•Hands up if you’ve ever done the opposite of what someone has suggested or told you to do - even when you knew it made sense•Why would you do that?•Everyone prefers to feel in charge of their own life - perceived threats evoke a counterblast!


What is resistance and what causes it?

Reactance leads to Dissonance leads to Resistance•It all signals trouble ahead and poor outcomes•‘Push me and I’ll push back. Even if I lose, I’ll feel better for trying!’•It’s normal, not pathological behaviour•It fluctuates in response to your behaviour - take away control and it gets worse!



Reactance leads to Dissonance leads to Resistance •People would rather assert their freedom of will than comply with an external requirement or constraint•In the face of ‘onslaught’, maintaining self-esteem may become, for the moment, more important than anything else - including the wellbeing of one’s family



Reactance leads to Dissonance leads to Resistance •When independence is threatened, people attempt to re-establish their capacity to be self-directing, often through symbolic behaviour - like arguing with you • Proscription makes the object all the more attractive - smoking and the chocolate éclair - naughty but nice!



Reactance leads to Dissonance leads to Resistance •An ‘atmosphere’ of distrust, conflict, discord, friction, fear, anger or non-cooperation - tension is mounting, dissent is following behind •It’s a signal of things falling apart•We all recognise this - and the thoughts and feelings it evokes in us - it’s exhausting!



Reactance leads to Dissonance leads to Resistance •Opposition in thought, feeling, speech and behaviour towards you and your organisation•It’s a signal of things falling apart•We all recognise this – and the thoughts and feelings it evokes in us – it’s exhausting!



Resistance - typical ‘bad news’ behaviours•missed appointments, arguing and interrupting, ignoring guidance and advice, false agreement, blaming, denying, excusing, sidetracking, poor compliance and aggression - disengagement!•What else have you noticed?



We may cause it - but we can change our behaviour•The practitioners as ‘campaigner’- not helpful•Arguing the case for change: directly and persistently, trying really hard to convince the parent - ‘arm-twisting’•Some examples would be? •Communication breakdown!•The solution is to stop wrestling and dance!



We may cause it - but we can change our behaviour•The practitioners as ‘campaigner’- not helpful•Assuming the role of expert: conveying a singular message, ‘I know what’s best for you and I have the answers you need.’•Some examples would be? •Communication breakdown!•The solution is to stop wrestling and dance!



We may cause it - but we can change our behaviour•The practitioners as ‘campaigner’- not helpful•Shaking complacency: criticising, shocking or blaming; seeking to provoke anxiety, guilt or shame•Some examples would be? •Communication breakdown!•The solution is to stop wrestling and dance!



We may cause it - but we can change our behaviour•The practitioners as ‘campaigner’- not helpful•Mechanistic problem/solution reasoning: using diagnostic labelling to explain and prescribe•Some examples would be? •Communication breakdown!•The solution is to stop wrestling and dance!



We may cause it - but we can change our behaviour•The practitioners as ‘campaigner’- not helpful•Rushing too far ahead: believing that forceful tactics will provoke action - hammering the message•Some examples would be? •Communication breakdown!•The solution is to stop wrestling and dance!



The take home message!•Our behaviour may cause dissonance in the conversation and elicit resistance from the parent•Our responsibility is to engage with parents; not the other way around•Remember! Resistance behaviours are usually associated with a decreased likelihood of change and disengagement


What do we want to hear from parents?

Speech predicts behaviour‘You’re all talking complete rubbish. My son’s fine. We don’t need to do anything. I love my son, why would I want to make him ill? He’s perfectly healthy.’‘Well, perhaps he’s a little overweight. I wouldn’t want him to get sick or anything. I suppose we all should take this a bit more seriously and get some advice.’



Speech predicts behaviour‘You’re all talking complete rubbish. My son’s fine. We don’t need to do anything. I love my son, why would I want to make him ill? He’s perfectly healthy.’•This is called Sustain Talk: any parent speech that favours a continuation of the problem - it may predict no change - bad news!



Speech predicts behaviour‘Well, perhaps he’s a little overweight. I wouldn’t want him to get sick or anything. I suppose we all should take this a bit more seriously and get some advice.’ •This is called Change Talk: any parent speech that favours a more away from the problem behaviour - it may predict change - good news!



Uncertain speech predicts uncertain behaviour‘You’re all talking complete rubbish. He’s perfectly healthy. My son’s fine, well, perhaps he’s a little overweight. We don’t need to do anything. I love my son, why would I want to make him ill? I wouldn’t want him to get sick or anything. I suppose we all should take this a bit more seriously and get some advice.’ •Ambivalence is commonplace, normal and full of possibilities - if we engage appropriately



Ambivalence is commonplace and normal •A conflict between two courses of action, each of which has perceived costs and benefits associated with it•Unresolved ambivalence is often the reason why people get stuck and feel unsettled – a great tumble of emotions, beliefs, values and aspirations•How you handle a parent’s ambivalence influences outcome - things fall apart far easier than they hold together!



Speech predicts behaviour•In promoting change, the task is the moderate Sustain Talk and evoke and strengthen Change Talk•We want to hear less arguments for the status quo and more arguments for change•Less of one, more of the other. Job done!‘So how do you do that then?’


What are the recommended practitioner behaviours for productive engagement and being helpful?

The take-home message!•A practitioner who uses a guiding style, is empathetic, collaborative, supportive of choice, and seeks to evoke the case for change, is more likely to promote positive change in attitudes, intentions and behaviours‘So, translate into plain English for me?’



Being empathetic•The practitioner shows evidence of correctly understanding the parent’s point of view - not just for what has been said but also for what the parent is thinking and feelingGood listening skills go a long way



Being collaborative•The practitioner actively encourages a strong sense of involvement in the conversation so that the parent’s ideas influence the nature of the conversationGood listening skills go a long way



Supporting independence•The practitioner acknowledges and encourages the parent’s expression and experience of personal control and choiceGood listening skills go a long way



Evoking the case for change•The practitioner takes the initiative to ask about the parent’s own reasons for change and ideas about how change should happenGood listening skills go a long way



Staying focussed•The practitioner takes every opportunity to steer the parent toward discussing the focal issuesGood listening skills go a long way



•Being empathetic•Being collaborative•Supporting independence•Evoking the case for change•Staying focussed



•Being empatheticThe key skill - let’s practise some examples ...


Section 3 | Guidelines for better practice


What’s the quickest way to engage? Being empathetic!

How would you respond to this?‘You’re all talking complete rubbish. My son’s fine. We

don’t need to do anything. I love my son, why would I want to make him ill? He’s perfectly healthy.’

• Always two options: the less or more helpful - different consequences follow each option!

Let’s look at an example of both ...



‘You’re all talking complete rubbish. My son’s fine. We don’t need to do anything. I love my son, why would I want to make him ill? He’s perfectly healthy.’

• The less helpful counterblast: ‘I’m sorry but you’re the one whose got it wrong. If you genuinely care about your son’s health you need to take this a lot more seriously. I can assure you that your son is indeed obese and it’s probably your fault!’

And then the parent says?



‘You’re all talking complete rubbish. My son’s fine. We don’t need to do anything. I love my son, why would I want to make him ill? He’s perfectly healthy.’

• The more helpful listening statement: ‘So it’s really important that your son stays healthy and yet the results suggest that there may be problems ahead. We seem to be reading things differently and you’re fairly certain that we’ve got things wrong.’

And then the parent says?



Exercise: offering more helpful listening statements• Refer to Worksheet 2, but first ...Making empathic statements: a brief guide



Making empathic statements: a brief guide1. Listen to the parent: focus hard!2. Ask yourself: what is the parent thinking, feeling and

saying?3. Decide: what do you suspect is most important to the

parent? Make a best guess4. Respond: offer a statement that shows you’re really

trying to understand5. Repeat: perhaps adding an open question



Some helpful statement stems to get you going• ‘So, you feel …’• ‘It sounds like you …’• ‘You’re wondering if…’• ‘It seems that you …’• ‘You’re thinking, perhaps, that…’Developing a clearer understanding - together



Exercise: offering more helpful listening statements• Refer to Worksheet 2, in small clusters• Using the worksheet, select one of the utterance

examples, and bearing in mind what we’ve been discussing, explore some more helpful listening statements in brief, improvised conversations. Work through a few examples.

Do something different - experiment!20 minutes of rigorous discussion• Do you want to see the stems again?


What’s going to change?One thing ...

• I found interesting is ...• I’ve learnt is ...• That surprised me is ...• I found helpful is ...• I’m going to do differently with parents is ...


Objectives | How did we do?To help you ...

• Better appreciate how conversation influences behaviour

• Exercise restraint when pressure mounts • Sharpen a few skills • Have more satisfactory conversations with parents• Achieve better outcomes• An enjoyable and stimulating workshop for all




reference style

Thanks & Goodbye!


Appendix | If time permitsExercise: a demonstration of contrasts | Part 1 - persuade

•In pairs - one to talk, the other to respond•Talker: describe a necessary issue of change in your life, for example, more exercise, better diet or less alcohol - you’re just contemplating doing it•Responder: explain why the talker should make this change, suggest many specific benefits of changing, tell the talker how to do it, emphasize how important it is to do it as soon as possible, insist on all the negative consequences of not doing it, demand a commitment to change.5 minutes of robust conversation


Appendix | If time permitsExercise: a demonstration of contrasts | Part 2 - evoke

•Start again - as if the first conversation never happened•Talker: repeat your story•Responder: listen carefully with a goal of understanding the dilemma, but give no advice unless it’s requested. Offer listening statements and ask these questions:1.Why would you want to make this change?2.What are the three best reasons to do it?3.Why is it important for you to make this change? 4.How might you go about making these changes?5.How will you know when you’re succeeding?6.End with a summary and ask, What do you thing you’ll do?

10 minutes of thoughtful, collaborative exploration


Appendix | If time permitsExercise: a demonstration of contrasts

•Persuade or evoke?•Wrestle or dance?

Your conclusions?




reference style

Thanks & Goodbye!

national child measurement programme | helpful conversations 1 helpful conversations talking with...

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