Motivational or confrontational interviewing

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Systematic Practice and Process

Should those working with offenders motivate or confront?

The following essay intends to discuss whether a person working with offenders should motivate or confront the service user. In order to this the author will discuss the differences between motivational and confrontational interviewing.

Stephen Rollnick and William Miller first introduced motivational interviewing in the 10's. The intentions of motivational interviewing were to enable a person to make changes in their behaviour without causing confrontation. Using this technique a person can develop a safe environment in order to help another person recognise the need for a change in their behaviour. If motivational interviewing is carried out effectively a person will start to examine their behaviour for themselves. Those using motivational interviewing techniques believe that the service user is the one who iniates the change and realises their ability to motivate themselves. It is believed that the counsellor will encourage the service user to become fully aware of their inner ability to change.

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" The counsellor's task is to release that potential and to facilitate the natural change process that are already inherent in the individual…. It is a way of being with people, which is likely to be quite different from how others may have treated them in the past." (Miller and Rollnick 00. P41.)

Miller and Rollnick believe motivation to be something that is or is not possessed by an individual and that if an individual shows an interest in changing their behaviour then they are motivated. If however no interest was shown the service user would be seen as unmotivated. Miller and Rollnick (11) also so suggest the belief that motivation stems from the personality is not strictly true. They suggest that it is the individual and their surroundings that encourage whether a person will change or not. In order to prove this they carried out a study on David, who was a drinker and two different approaches, they are as follows…

a) David drinks heavily and this is not helped by the fact that all of his friends also drink large amounts and tell him that passing out is all part of the fun. His boss also so drinks and does not take action when David phones in sick because of too much to drink; instead he gives him permission to take the day off. David's wife has to struggle with the home and the family on her own because she fears that if she complains it may upset David.

b) David's friends are getting more and more concerned about his drinking so they approach him about it in a caring manner. It has become noticeable in his work also and his boss approaches him and explains that if he does not change he will have to leave the job. His boss also offers him support if he needs it. His wife has also told David that even though she loves him she will leave him if he does not get help. She offers to go to counselling with David so that he can do something about his drinking. (Miller and Rollnick 11. P 4-5)

As shown in these examples it would appear that the motivation that David needs comes from his interaction with his surroundings. In the first example David will not realise that he may have a problem because his drinking is part of his life, all of his friends and his boss do it so it would appear to be normal. His wife is not helping matters because she is allowing it to go unnoticed and allows it to carry on because she wants a quiet life. In the second scenario by David's friends telling him in an approachable manner that they are concerned it gives David the opportunity to think about his drinking. His boss reinforces this by showing his concerns and using a supportive approach again shows David there is a problem with his drinking. Because his wife shows that she still loves him and will be there for him even go to the counselling with him she again is giving him the option to make the change. It would appear that the second scenario shows how the environment does have an effect on how people perceive their problems.

The following section will discuss the techniques used in motivational interviewing. As suggested above it is important to have the right surroundings to enable a person to want to change. According to Miller and Rollnick in motivational interviewing (00) there are four steps that need to be addressed for motivational interviewing to be a success. The first area is the need for empathy, show acceptance of the service user and of their problems. Being able to understand their problem and being non-judgemental will create a positive atmosphere. The use of reflective listening will also encourage the service user to discuss issues surrounding their problems. The second stage is to introduce discrepancy. During this stage the service user should be encouraged to reflect on where they are now, where they want to be eventually. This should be done through internal questioning not external influences. The overall intention is for the service user to be the one who presents the reason for change and not the counsellor. The third stage is the roll with resistance stage; service users can make excuses for their behaviour so the counsellor needs to redirect the question back to the service user because it is the service user who has to make the choices to want to change. The final stage is to support self-efficacy; the service user needs to believe in his or herself, but also needs to believe that the counsellor believes in him or her.

Miller and Rollnick also based their work on a theory developed by Prochaska and DiClemente known as " A model of change." This theory is based on a cycle of change and consists of a series of stages that a service user will go through. The first stage is pre contemplation, during this stage a person will not be considering changing. The next stage of the cycle is the contemplation during this stage the person will be considering the need for change. The next stage is the action stage this is where the person takes it upon him or herself and accepts actions need to be taken to change. Then there is the maintenance stage where the person has to continue the change in behaviour. The next stage is the lapse stage, during this stage a person will fail to maintain the change and will need to begin the cycle again. Acceptance of lapsing is important to the person because it encourages and gives him or her the determination to try and try again. It is thought that a person will go around the cycle of change a number of times before it eventually proves successful. According to this model it is believed it can take a smoker between -7 attempts at change before they actually succeed. (Prochaska and DiClemente 1)

The following section of this essay intends to discuss challenging and confrontational interviewing, it will begin by introducing what is meant by this term. According to the Oxford English Dictionary to challenge is "a summons to a fight, a calling into question; an exception taken". Confronting is to "meet face to face, stand facing, be opposite to, face in hostility or defiance".

It is often thought that when working with service users it is a voluntary agreement between the service user and counsellor. This is often not the case and service users dont even want to be in the same room as the counsellor and this may present difficulties to the relationship. Some service user even express that he or she does not need help and become unwilling to participate in the sessions. There is also the possibility that the service will try and convince the counsellor that he or she has no problems. When working with involuntary service users challenging and confrontational interviewing may be the technique to use. (Lishman 14, p.11) states "Challenging describes a low level, gentle yet firm invitation to face service users with contradictions, distortions, inconsistencies or discrepancies and inviting or stimulating them to reconsider and resolve the contradictions." In doing this the counsellor is the one who is making most of the contribution to the relationship. The counsellor is pointing out the behaviour and why their needs to be changes made by the service user. The counsellor will point out the consequences of the service user problem in hope that it may alter his or her ways. For example the kill your speed not a child campaign on television, by showing this it is hoped a person will confront his or her behaviour and challenge the belief that their behaviour is acceptable.

(Egan, 14) states "Challenge is an invitation to examine internal or external behaviour that seems to be self-defeating, harmful to others, or both-and to change that behaviour." Egan (14) suggests that by using this technique it would confront a person's blind spot and enable that person to accept new ideas and take different actions. There is little evidence to prove that these techniques are successful,

(Lloyd 15) carried out a study into the effectiveness of these approaches; the study was based on working with young offenders using scare tactics with regards to the consequences of their behaviour. The outcome showed that these techniques had little or no effect on the juveniles.

Egan also believed that if challenging of confrontational interviewing was to work there has to be a supportive relationship to begin with other wise the service user will be unrespondant. Effective confrontation needs to have guidelines set and they need to be reached at all times. Below are some of the guidelines that need to be in use.

1) Goals should be kept in mind.

) Self-change should always be encouraged.

) Earn the right to challenge.

4) Challenge tentatively.

5) Build on success; encourage the service user not to put unreasonable demands on themselves.

6) Be specific, focus on the task at hand and explain things.

7) Respect clients; do not enforce your values on the service user.

8) Deal with defensiveness.

) Use common sense, these are guidelines and are there mainly to do just that guide. It does not mean that you can not be more flexible to accommodate each service user.

In conclusion to this essay it would appear that that aims behind motivational, confrontational and challenging interviewing is to change difficult behaviour. It would appear that these techniques address behaviour from different angles but intend the same outcome. The main one is to address the behaviour and encourage the service user to question and develop their thinking in order to change their ways.

By using motivational interviewing the counsellor respects the service user's rights and believes it is the service user who has to make the decision to change. The service user has to identify the need for change and then must be the one to take action, self-motivation is the answer. Because challenging and confrontational interviewing takes a more direct approach it is often best used with certain service users. Confrontational interviewing can be seen as an aggressive approach where as challenging is less aggressive than encouraging. There is also the possibility that the counsellor may transfer his or her own feelings and opinions about the service users behaviour and force the change rather than encourage it.

So to answer the question set it would appear that motivational interviewing is probably the best form of interviewing technique because it takes a less aggressive form and enables the service user to have the option to make choices in his or her life.

BIBLIOGRAPHY

Egan, E 14 The Skilled Helper Brooks/Cole Publishing Company.

Jones, R.A 177 Self-Fulfilling Prophecy Social, Psychological and Physiological Effects of Expectancies. Hillside

Lishman, J 14 Communication in Social Work Macmillian

Miller, W. R & Rollnick, S 00 Motivational Interviewing Preparing people for change New York Guilford Press

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