Motivational interviewing for the trauma-informed practitioner

Motivational interviewing can create lasting change when working with children and families, social workers from Rochdale told visitors to the Social Work Show in Manchester.

Rachel Kenyon and Emma Thompson, Advanced Practitioners with Rochdale Borough Council discussed the approach, which is a key component of the borough’s family safeguarding model.

Other essential parts of the model include simplified processes and recording, working with the whole family, drawing on multi-disciplinary teams, and on group supervision.

Emma Thompson said that the approach drew in part on the work of two clinical psychologists, Miller and Rollnick, and was about supporting people to help them identify for themselves the ways they needed to change.

She outlined techniques for effective conversations in motivational interviewing , based on
- Curiosity – ‘what trauma has the person experienced and how has that affected change they are trying to make?
- Congruence – having positive regard…meeting the person with respect. ‘We have to separate the person from the deed.’
- Empathy, and
- Positive regard

There is a clear structure to the interview: engage, focus, evoke and plan.

Rachel Kenyon discussed interviews in detail, using a format defined as OARS (open-ended questions; affirmations; reflections and summaries).

The pair deconstructed a fictional interview, based on the social worker’s first visit to a family who have been referred to children’s social care.

It began with the mother saying ‘I don’t know why you’re here, we don't need your help. That school have got it in for me just because we are sometimes late. It’s not even like we are late every day. They have no idea what it’s like for me, it’s just me, getting three kids into school every day. I deserve some time for myself, doesn’t everyone have a drink from time to time. Yeah maybe I go a bit over the top some times, but I don’t do it in front of the kids. But some days I just can’t get them to listen and at the end of the day I just need some me time.’

They highlighted what they were looking for:
- Recognising strengths: single parent getting three children up and in school daily (even if late), and they were not late every day
- Change: ‘a bit over the top’ and ‘don’t do it in front of the kids’ was a recognition that there is something about the situation that they don’t want their children to see or pick up. As a potential sign that it is something they’re not completely comfortable with it is a point for exploration.
- Affirmation: highlighting strengths such as the person is getting the children up, dressed, fed and out the house every day, and saying, ‘it is important for you that the children don’t see you drinking.

Ms Kenyon said that open-ended questions and points such as ‘tell me more about…’ allowed everyone to think about the answer.

Reflection and summarising were crucial too. ‘If you say to a person “this is what I have heard, they can come back and say yes or that is not what I meant.”’

‘We must listen carefully, rephrasing using their own words and being careful when reinterpreting -- ‘it sounds like you…’ ‘So what you are saying is…’ ‘You feel that…’

‘In the past, we’d tell families what to do and how to do it and that was not really working,’ Rachel Kenyon said. ‘So we introduced the Family Safeguarding Model, as a whole family approach to working with families. The aim is to reduce the numbers of children in care, and coming into care. It is strengths- based –- social work in the past has focussed on what is not going well, and has not taken into account what is working.’