Helpful Conversations
Talking with disgruntled parents: lessons from
motivational interviewing
A brief workshop considering guidelines for better
practice, using motivational interviewing as the
reference style
Welcome!
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Our workshop format
Three sections
1. The challenges and pitfalls of talking with parents
2. A few simple messages from MI
3. Guidelines for better practice
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Objectives
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
• Anything else? Your suggestions ...
An enjoyable and stimulating workshop for all!
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Your Presenter
Jeff 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.
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Your Presenter
Tim Anstiss
• insert
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Your Presenter
Judith 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)
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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 | 2010
The psychologists who originated and developed MI during the last 30 years
www.motivationalinterview.org
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Section 1 | The challenges and pitfalls
of talking with parents
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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
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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
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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
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The challenges and pitfalls of talking with anyone
• Persuade or evoke?
• Wrestle or dance?
Your conclusions?
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Section 2 | A few simple messages from MI
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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
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Why do conversations about ‘hot issues’ and change
often turn sour?
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
justified
The pummelled parent is never a happy parent
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Why do conversations about ‘hot issues’ and change
often turn sour?
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 misery
Overwhelming with science? Stop it!
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Why do conversations about ‘hot issues’ and change
often turn sour?
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
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Why do conversations about ‘hot issues’ and change
often turn sour?
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!
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Why do conversations about ‘hot issues’ and change
often turn sour?
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
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Why do conversations about ‘hot issues’ and change
often turn sour?
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
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Why do conversations about ‘hot issues’ and change
often turn sour?
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
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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?
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Why do conversations about ‘hot issues’ and change
often turn sour?
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!
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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!
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What is resistance and what causes it?
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
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What is resistance and what causes it?
Reactance leads to Dissonance leads to Resistance
• When independence is threatened, people
attempt to re-establish their capacity to be selfdirecting, often through symbolic behaviour - like
arguing with you
• Proscription makes the object all the more
attractive - smoking and the chocolate éclair naughty but nice!
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What is resistance and what causes it?
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!
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What is resistance and what causes it?
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!
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What is resistance and what causes it?
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?
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What is resistance and what causes it?
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!
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What is resistance and what causes it?
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!
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What is resistance and what causes it?
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!
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What is resistance and what causes it?
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!
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What is resistance and what causes it?
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!
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What is resistance and what causes it?
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
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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.’
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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.’
• This is called Sustain Talk: any parent speech that
favours a continuation of the problem - it may
predict no change - bad news!
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What do we want to hear from parents?
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!
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What do we want to hear from parents?
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
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What do we want to hear from parents?
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!
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What do we want to hear from parents?
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?’
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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?’
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What are the recommended practitioner behaviours
for productive engagement and being helpful?
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 feeling
Good listening skills go a long way
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What are the recommended practitioner behaviours
for productive engagement and being helpful?
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
conversation
Good listening skills go a long way
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What are the recommended practitioner behaviours
for productive engagement and being helpful?
Supporting independence
• The practitioner acknowledges and encourages
the parent’s expression and experience of
personal control and choice
Good listening skills go a long way
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What are the recommended practitioner behaviours
for productive engagement and being helpful?
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 happen
Good listening skills go a long way
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What are the recommended practitioner behaviours
for productive engagement and being helpful?
Staying focussed
• The practitioner takes every opportunity to steer
the parent toward discussing the focal issues
Good listening skills go a long way
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What are the recommended practitioner behaviours
for productive engagement and being helpful?
•
•
•
•
•
Being empathetic
Being collaborative
Supporting independence
Evoking the case for change
Staying focussed
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What are the recommended practitioner behaviours
for productive engagement and being helpful?
• Being empathetic
The key skill - let’s practise some examples ...
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Section 3 | Guidelines for better practice
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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 ...
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What’s the quickest way to engage? Being empathetic!
‘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?
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What’s the quickest way to engage? Being empathetic!
‘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?
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What’s the quickest way to engage? Being empathetic!
Exercise: offering more helpful listening statements
• Refer to Worksheet 2, but first ...
Making empathic statements: a brief guide
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What’s the quickest way to engage? Being empathetic!
Making empathic statements: a brief guide
1. 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 guess
4. Respond: offer a statement that shows you’re really
trying to understand
5. Repeat: perhaps adding an open question
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What’s the quickest way to engage? Being empathetic!
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
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What’s the quickest way to engage? Being empathetic!
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?
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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 ...
National Child Measurement Programme | Helpful Conversations
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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
National Child Measurement Programme | Helpful Conversations
59
Helpful Conversations
Talking with disgruntled parents: lessons from
motivational interviewing
A brief workshop considering guidelines for better
practice, using motivational interviewing as the
reference style
Thanks & Goodbye!
National Child Measurement Programme | Helpful Conversations
60
Appendix | If time permits
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
National Child Measurement Programme | Helpful Conversations
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Appendix | If time permits
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
National Child Measurement Programme | Helpful Conversations
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Appendix | If time permits
Exercise: a demonstration of contrasts
• Persuade or evoke?
• Wrestle or dance?
Your conclusions?
National Child Measurement Programme | Helpful Conversations
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Helpful Conversations
Talking with disgruntled parents: lessons from
motivational interviewing
A brief workshop considering guidelines for better
practice, using motivational interviewing as the
reference style
Thanks & Goodbye!
National Child Measurement Programme | Helpful Conversations
64