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2014 Convention News
Washington, DC, February 18–21

Presenters Up Close — Motivational Interviewing

By Terry Molony & Jacqueline Karlsson

Helping students choose to change their behavior, rather than doing so simply because they have been told to do so, is an important step in developing positive alternative behaviors and better decision-making. This “Presenters Up Close” Q&A takes a closer look at motivational interviewing, a direct intervention approach that utilizes collaborative conversation to increase motivation and commitment to change. Convention presenters Terry Molony and Jacqueline Karlsson discuss the process and application of motivational interviewing, which is the primary focus of their mini-skills presentation, “Motivational Interviewing in Schools: Counseling Tools to Enhance Motivation,” on Friday, February 21.

NASP Please describe motivational interviewing.

Molony & Karlsson: Motivational Interviewing (MI) can be characterized as an approach, rather than a discrete counseling intervention, composed of a specific set of techniques. MI originated with addictions treatment and is currently being applied in schools. When using MI, the practitioner recognizes that the individual has the ultimate responsibility for choosing to change and listens intently for what is called “change talk.” Developers of MI believe that the focus on why people do not change distracts attention from the more important question: “What change is someone ready for?” MI helps to identify what stage of change the individual is in according to the stages of change model of Prochaska and DiClemente (1984), and uses different strategies to help the person move through the process of change. In schools, many interventions start and end with an adult lecturing the student about errors in judgment or behavior, which often increases the student's resistance to change and negatively affects the relationship. Many experts agree that the most effective behavior change occurs when individuals develop internal motivation for change as opposed to external methods such as lectures or persuasion. MI can guide school-based practitioners to help students improve their behavior through developing internal motivation to change.

NASP In what situations would a school psychologist benefit from using this approach?

Molony & Karlsson: MI can be used with students, teachers, parents, and others in many different situations. With students, MI can be used in conflict situations, to help students accept responsibility for actions, to increase students' awareness about how their choices impact their lives, and in helping set goals.

School psychologists can also use MI in consultation with teachers to help them understand the impact of their interactions on student behavior. Once they develop this self-awareness and the motivation to change their own behavior, teachers can then learn different ways to interact with their students to enhance intrinsic motivation. MI also can be used in developing behavior plans, especially when the teachers feel discouraged about the possibility of the student changing. For instance, the school psychologist would ask questions in a supportive tone to elicit responses about the negative consequences if the situation does not change. When the practitioner “amplifies” the teacher's reflections, the teacher often comes to his or her own conclusion that something has to change and that is where the motivation begins. For example, after a series of questions from the school psychologist the teacher states, “If nothing changes, I'm not going to make it through the year. I've got to do something!” That type of statement, which indicates recognition that change is needed, is called “change talk,” and can lead to more flexible problem solving.

NASP What advice would you give to school psychologists who are first learning to apply this strategy in schools?

Molony & Karlsson: On the surface, MI might seem simple, but it requires training and practice to reach mastery. MI is about nuances and is not simply the sum of its parts. MI has four general principles that guide all interactions. These include expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. The school psychologist has to learn to listen for change talk and decide what to reflect back to the student or teacher and how to reflect it. Change talk does not always sound like a direct statement about wanting to change. Different kinds of reflections, such as simple reflection, amplified and double-sided, take practice to master. There is a great deal of research and training information about MI that school psychologists are encouraged to read and discuss with a colleague. Perhaps the best way to learn how to use it would be to apply it in your own life about something you might want to change but are ambivalent about. Consider how it feels when others are talking you into the change as opposed to finding the reasons within yourself to change. The books listed in the references are excellent resources to learn about MI.

NASP How is this approach different from other brief solution-focused counseling approaches?

Molony & Karlsson: There is certainly overlap between MI and brief solutionfocused counseling because they are humanistic approaches focused on strengths, and use similar communication techniques and strategies. However, MI is less concerned with finding a solution and more concerned with helping the individual find the intrinsic motivation to change.

Therefore, you don't have to use it only in a counseling situation; you can use MI strategies in your daily interactions with others by listening carefully and reflecting change talk. MI and other brief approaches also can be used in conjunction with each other, using MI to increase the motivation to change while other approaches can be used concurrently to solve problems.

NASP In your experience, is this a common approach used in schools? If not, why?

Molony & Karlsson: MI is not commonly used in schools, probably because most people don't know about it. Also a lot of what happens in schools is related to controlling students' behavior and telling them what they should do. Teachers don't realize that often their approach of lecturing and reprimanding diminishes intrinsic motivation.

NASP What are some suggestions to help school psychologists advocate for a comprehensive role that would promote the use of MI on a regular basis?

Molony & Karlsson: In a school counseling session, we are not suggesting that a school psychologist would use only MI techniques in its purest form in all situations because it is not meant to be used this way. Instead, once you understand the spirit of MI, you might find that you could use MI principles every day in school. Whenever you hear yourself trying to persuade someone (parent, teacher, child) to do something, you probably should stop and use an MI technique. While persuasion might accomplish the goal to effect the external change, that change will be short lived if the person is not inherently motivated.

I [TM] have used MI successfully when working with a second grade teacher who was very frustrated by the child and said, “It doesn't matter what I do. Molly can't change.” I used an amplified reflection and said in a neutral tone, “Molly is only 6 years old and it's too late. She can't change.” The teacher immediately made a face and said, “Did I say that? Of course she can change. I just can't figure out how!” That was change talk that led to problem solving in developing an intervention plan.

I also used MI in working with a high school student who cut class frequently but who would walk to school every day after missing the bus. School personnel were asking why the student wasn't going to class (why isn't he changing?) but MI asks the question, what is getting the student to come to school (what is he ready to change for?). Finding out what motivated him to come to school led to information about family problems, which allowed for an entirely different direction of supportive problem solving as opposed to Saturday schools and detentions.

Adding MI to a school psychologist's toolkit can enhance practice and add depth to our competencies. Being knowledgeable about MI will help school psychologists to process conversations differently, to identify change talk, to ask strategic questions, and to roll with resistance so that ultimately intrinsic motivation can be strengthened for positive behavior change.

References

Miller, W., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd edition). New York, NY: Guilford Press.

Prochaska, J., & DiClemente, C. (1984). The transtheoretical approach: Crossing Traditional boundaries of therapy. Homewood, IL: Dow/ Jones Irwin.

Reinke, W., Herman, K., & Sprick, R., (2011). Motivational interviewing for effective classroom management. New York, NY: Guilford Press.


Terry M. Molony, PsyD, NCSP, is a school psychologist at Cherry Hill PS (Cherry Hill, New Jersey) and an adjunct professor at PCOM NJ, and Jacqueline Karlsson is a school psychologist at Midland Park Public Schools, Midland Park, New Jersey.