9 things a trusted friend won’t tell you

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Trusted friends

I have been thinking recently about a dear friend of mine who died a while back. It was the anniversary of his death recently and at this time of the year I take time to really appreciate the type of friend he was and how lucky I was to have him in my life. He was a mentor to me. He encouraged me to be more than I could be, to strive for more out of life, and to keep the passion alive for things I do in my life. I realised that he taught me a lot about what it means to be a friend. He taught me the following nine things that a trusted friend won’t tell you.

  1. You are always right, you know you are
  2. The other person (often a partner) is always to blame
  3. Life just treats you unfairly, life is unfair anyway
  4. The other person deserved what they got
  5. Your lifestyle is just fine
  6. Alcohol, drugs and cigarettes won’t harm you
  7. Live life on the edge and not worry about tomorrow
  8. Don’t get too committed to relationships, they only end in pain
  9. Don’t let people see your vulnerable side, they will take advantage of you

If this is what a trusted friend wont tell, what will they tell you? A trusted friend is someone who is prepared to have those tough conversations with us. Someone who is prepared to level with us regarding our good and bad behaviour. Someone that despite how we sometimes behave is willing to stand by us and nurture us in the direction of change, of doing what is right. Someone who is prepared to ‘agree to disagree’ with us while at the same time working hard to maintain our relationship. Someone who is prepared to be out in the cold for a while, knowing that if we are big enough we will invite them back into our lives and apologise for our behaviour. So a good friend would tell you.

  1. You are always sometimes right, you just have to admit when you are wrong and stop being just stubborn
  2. The other person (often a partner) is always sometimes to blame but have a real hard look at your own behaviour first before seeking blame in other places
  3. Life just treats you unfairly as life treats you, at times it will feel unfair and other times you will feel blessed – ride the wave and look for both sides
  4. The other person deserved what they got deserves to be treated with respect and dignity no matter the difference – hard to do but this is the heart of integrity
  5. Your lifestyle is just fine requires constant readjustment as we move through life’s developmental stages
  6. Alcohol, drug use and cigarettes won’t will harm you if they are not carefully managed. Know when to say ‘no’ over what to take and know when to say I have had enough
  7. Live life on the edge to it’s fullest, take calculated risks and be aware of the impact of your risk taking upon those who care about you. Definitely not worry about tomorrow as it is certainly coming to a place near you soon
  8. Don’t get too committed to relationships, they only ends in pain Understand your reluctance to commit and work with it, so that you can find connection, nurturance and love in your life
  9. Don’t let trusted people see your vulnerable side, they will take advantage of you it will allow them to provide you with support at those tough times

So as you can see, a trusted friend is like having gold in the bank. You will be rich beyond your means as a friend will travel with you, look out for you, and be there for you when you need them. How are you at the art of  being a trusted friend. Love to hear your ideas.

New MI DVD in post production

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New MI DVD coming soon

We are excited to have nearly completed post production on our motivational interviewing two-set DVD. We have been fortunate to have captured rich footage of clinicians doing MI along with key thinkers in the field reflecting upon what MI is all about. The DVD has the real advantage of exploring MI across a range of practice fields including: alcohol problems, cannabis use, tobacco, gambling, chronic health condition (diabetes) and criminal justice.

Peter Fenney and Joel Porter are the producers and Graham Elliot from PictureTalk has been in charge of production.

Have a look at our trailer for a sneak preview of what we are talking about by clicking here.

From Ken’s Desk April 2012

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It is amazing that we are now at the end of the first quarter of 2012. Since we came back from the Christmas holidays and summer break our HMA training team has:

  • delivered 102 days of in-room training
  • taken 75 flights to destinations as far away as Singapore and Perth, from Auckland to Invercargill
  • sponsored and run the second International Symposium on Motivational Interviewing in Auckland during March
  • delivered the 10 week criminogenic programme as part of intervention for high risk youth offenders at Te Puna Wai
  • started to deliver our short course programme for 2012 (www.hma.co.nz/workshops)
  • HMA staff have also been heavily involved in leading the development of a new motivational interviewing training DVD with will be available around June 2012
  • Invested a huge amount of behind-the-scenes work on our learning platform where people will be able to access online learning using self-paced materials.

So you can imagine we all enjoyed a really good break over Easter. This of course coincided in New Zealand with school holidays which means a great time for connecting up and spending quality time. We always recognise that in order to maintain such a pace of activity that there are a team of people who stand behind us and allow this to occur. Thanks to our families for freeing us to make the contribution in the public world that we do.

The end of the first quarter also sees three changes to our team. Mark Tisdall who has been an associate with HMA for the past 10 years has taken a fixed term appointment with Department of Corrections doing development work. Julie Pullman is the other change to the team, she is now working as a regional learning and development adviser for Corrections. It is always nice to know that the quality of our people are sought after by the systems that we consult with. We thank them both for a wonderful contribution to our team. We also welcome Brinley McIntosh to our team as our intern. Brinley is completing the postgraduate Diploma in Child and Family at University of Canterbury and has been working alongside Matt running the high risk youth offenders programme at Te Puna Wai.

Some of you may be aware that I have started writing a regular blog on both contemporary issues and training ideas. We have recognised for some time that we have a huge amount of information and ideas around clinical practice that we know are valuable and worth sharing with a wider audience. You can sign up to our blog and contribute your own ideas as well. We are keen to make this a collaborative learning event. We have also started work on a practice book around contemporary interventions around family violence. Rather than a chapter book which we have published several of over the past few years, this one will be a combination of contemporary theory and practice ideas that promote family safety. It will be very hands-on and full of practical intervention ideas that workers will be able to utilise.

We have  finally got resolution around the demolition of our building in Cashel Street, Christchurch. For some of you who don’t know the back story around the drama, we have experienced a series of major earthquakes to Christchurch over the past 12 months and we have been in negotiation with the insurers to settle our claim. Demolition begins on 8 April 2012 and should be completed within a three month period. Once that is completed we will be in a position to know what financial losses we are likely to have sustained. I must say that this extraordinary event has certainly tested my endurance and capacity for creative solutions.

 

Integrated Practice Framework – NZ Department of Corrections

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Just under three years ago a consortium of HMA and Able Training began work on training design for the rollout of the integrated practice framework. This has been one of the biggest changes to practice for the New Zealand community probation service for 10 years. It brings to life is the core purpose of the organisation which is to: contribute to safer communities, hold offenders to account and manage them to:

  • comply with the requirements of their sentence or order
  • reduce their likelihood of re-offending
  • minimise the risk of harm they present to others.

These three separate and interlinked elements to the CPS purpose each have overall intermediate outcomes. For a more direct link between the purpose and the way service delivery should be designed, it is useful to describe the elements and the outcomes as they relate both to an offender and to a probation officer. It must be clear to the offender what the probation officer is trying to achieve and how the probation officer’s actions affect the expectations of what the offender will achieve.

One of the problems with the earlier structure was that was very highly manualised and didn’t provide enough structural supports for assessment and responses to the changing nature of dynamic risk. What transpired was that rather than taking an offender centric response, processes were much more focused around managing the sentence rather than managing the offender.

The key components of the proposed Integrated Practice Framework (IPF) include the following components.

  • Mandatory Standards set the bottom line for all probation officers about what they need to do in managing offenders on each sentence/order.  They must be followed each and every time for every offender.  Mandatory standards typically address legislative requirements including sentence/order compliance and integrity.
  • Supported Decision Framework. The second part of the IPF is the Supported Decision Framework (SDF) which: Guides staff in using the tools and information available to exercise their professional judgement to ensure they take the right action, with the right offender, at the right time.
  • Knowledge Bank. The third part of the IPF is the Knowledge Bank which provides staff with relevant information such as research and case studies, and other resources to enrich their understanding of the work they are doing.

The new integrated practice framework is designed to focus staff on doing the right thing, at the right time, with the right offender.  It is clear about what actions are mandatory and provides support to staff to make sound professional judgments and decisions. The outcomes anticipated from this change to practice will focus on achieving better outcomes with offenders and their families/whānau that ultimately improve public safety and contribute to safer communities.

The Integrated Practice Framework to summarise, at the heart of the change is a repositioning away from only managing sentences/orders (compliance) to also focusing on an offender’s likelihood of reoffending and their risk of harm to others.

Ensuring sentence integrity remains critical, by significantly increasing the focus on managing offenders according to the risk they present – in particular their likelihood of reoffending and their risk of harm to others. Ensuring sentence integrity remains critical, hence focusing on our legislative responsibilities around holding the offender to account for their sentence and ensuring they comply with their sentence/order and ensuring actions and mitigations to reduce the likelihood of reoffending and minimise risk of harm to others.

Also critical is ensuring resources are more efficiently and effectively targeted.  This means that once the mandatory standards are met, staff will focus time, energy and effort on offenders who present a higher likelihood of reoffending and/or risk of harm to others.

The change also requires a comprehensive redesign for the supporting policies, systems and tools that assist probation staff to do their jobs.  Probation officers will know and manage the bottom line and move away from simply following strict procedures to making supported decisions for individual offenders using their professional judgement.

Managers will shift focus from ensuring staff only follow procedures to supporting them day-to-day to ensure the mandatory standards are met, that their focus is on offenders presenting a higher risk and to make good quality judgements and decisions. Managers will assist with making decisions on actions to mitigate likelihood of reoffending and harm to others.

So as you can see a significant shift in the nature of the practice. We have been pleased to be able to contribute to the train design for all of the sentence types and as well as deliver training in each of the areas. Over the course of this project we have delivered training around sentence types including:

  • parole
  • home detention and post detention conditions
  • supervision
  • intensive supervision
  • provision of advice to courts
  • community work
  • community detention

In all our HMA team have delivered 450 design days and 366 training days on this project. I think our work is now done and it is now the challenge for the internal systems within Community Probation Service to ensure the ideas bed down and that the integrity of the design is maintained.

 

40 effective facilitation strategies

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A group of keen learners

It is my belief that it is the small things that happen within a group setting that make the difference. Noticing someone, helping a person to realise something not pleasant about themself and save face during the experience, being purposeful and clear about our intentions, all lead to a much better result for the group we are working with.

Instruction giving

  1. When giving instructions to the group, do this from a standing position – it gives more authority to what you are saying.
  2. When there is a series of questions, decide which questions are the key ones to deliver, then deliver them one at a time.
  3. You can interrupt the group by saying, “pause in your discussion and move onto the next question.”
  4. The questions are specific in terms of talking about the talking (warm-up or refocusing), doing the talking questions or reflecting questions. The outcome from each question is therefore related to the purpose of the question.
  5. Do a process check by asking a group member to repeat the question, therefore allowing the group members to hear the question twice – also a good idea to write the question onto a flipchart or on the whiteboard. Also, you can circle around the sub-groups inquiring about their clarity of the task.

    Breaking group into sub-groups
  6. When breaking into sub-groups, get people to move before telling them what you want them to do.
  7. Use different sub-groups which achieves two aims. The first is to increase diversity of ideas within the group. The second is that it energises the group by creating movement.
    Dealing with complex concepts
  8. When dealing with relatively complex concepts, decide in your planning, as to the depth you want to take these ideas. Remember that early on in the session you are foundation building so your challenge is to provide a base on which to build.

    Processing and Scribing
  9. A good guideline is when processing what group members have generated, do this from a sitting position on the front edge of the group.
  10. Remember to lean forward in your chair to show attentive listening and engage with the group members.
  11. If your co-facilitator is scribing then sit on the opposite side of the room to the board. This gives you the best view of what is occurring in the group.

    Managing performance anxiety
  12.  At the beginning of sessions we can all be anxious so use the anxious energy to your advantage.
  13. Stand up and greet members as they enter the group.
  14. Feel free to move around in the initial phase.
  15. Remember the tips on breathing exercises prior to the group coming into the working space and during the first five minutes of the session remember to breathe deeply rather than shallow breathing.
  16. Be well prepared with your materials and ready to manaaki group members.
  17. Have undertaken your co-facilitation check-in prior to the session so you know where each person is at.

    Joining group members’ experiences
  18. An effective techniques to manaaki and awhi group members is to ask, “Who share the views that … has expressed?” or “Who can add to what ‘… has said?”
  19. Also try, “What can you add to what … has said?”

    Joining a group member after an absence
  20. Welcome the member back into the group.
  21. Ask the group members who were present in the last session to catch the person up with what they covered – this acts as revision as well as sharing of information
  22. If the absence is a planned one then it is best to deal with the issue in a low-key manner.
  23. If the issue is a more deliberate absence, then some explanation to the large group may be required – this can assist in the development of accountability.

    Supporting a group member to have their voice in the room
  24. When having group members respond by putting their material on the board, you can support them by standing on the opposite side, or sitting in close proximity. This can feel supportive for the person presenting and can give you some degree of control during the process.
  25. Provide affirmation for input.
  26. Ask the group what they make of the person’s effort.
  27. Coaching around clarifying the meaning of what the person has said.

    Doing the work while saving face
  28. Try to always be tolerant and understanding.
  29. Encouragement and praise are among the cheapest and best of all facilitation tools they are also among the least used.
  30. Imagination can play an important role in learning.  ”Suppose you had to say what you would do?” or “What suggestion would you give someone else in this situation?”
  31. Try to make every member feel ‘involved’ – to feel they can share experiences freely, without fear of ‘losing face’.
  32. Real experiences are the most effective. Remember in the room is real.
  33. Words are the least effective teaching aid.

    General tips
  34. Be prepared to adjust each step, not only to the group as a whole but also to any individual in the group.
  35. Determine their readiness to learn through simple scaling questions, “How interested/ready are you to be in the room today?”
  36. What do you already know about … – find out their familiarity with what has to be learned
  37. How do you learn best (visual, auditory, kinesthetic (active), reader/writer).
  38. Assess how much repetition the group needs to take in new information, practice a new skill, or understand a new concept – this impacts upon their speed of learning.
  39. Try to put yourself in the other person’s shoes and to imagine how you would feel, react, and behave if you were that person.

    And the last tip
  40. Really enjoy what you are doing, the group members and your co-worker. At this moment we are truly alive.

5 ways to build emotional literacy through using Feeling Face Cards

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Example of Feeling Face Cards

For many years we have been using these very cool Feeling Face Cards in our group work. We have also been finding ways to integrate their use within the design of programmes, particularly those targeting men. We have found over the years that one of the challenges many men find themselves struggling with is around recognition of the wide range of feelings that they have. By default this limits their ability to recognise the feelings in others and respond accordingly. Building empathy skills concurrently builds safety and connection in relationships. The four stages of empathy are: firstly recognition of a emotion; secondly, recognition of a emotion in others; thirdly, being able to put yourself in another position and approximate the emotional experience; and fourthly, using the information available adjusting behaviour accordingly.

This is where we had found the Feeling Faces of huge benefit. At a simple level it helps to build an emotional repertoire while at a more complex level allows a person to have a deep sense of connection with others. We all know that feelings can be frightening things, particularly when they are very intense. Normalising feelings and the expression of the appropriate ways contributes to safety so that we don’t have to be a slave to them.

Below are five ideas about how to use the Feeling Faces Cards within a group programme.

  1. Learning the language of feelings. Having the Feeling Face Cards on the whiteboard (they are magnetized) allows for asking questions at certain moments within sessions what the feeling might be at any particular moment in time.
  2. Learning to meet needs appropriately. One of the challenges in group work is how to provide enough opportunity to rehearse and practice skills. We know that repetition and over learning are key ingredients in consolidating change. If a group member has identified a feeling such as sadness, then I am interested to know what the person might need by way of support from others. Many men in our experience isolate themselves with their feelings and expect others to guess what they are feeling. Ultimately they are asking other to be more mindful of their feelings than they are. Therefore practising the skill of negotiating to meet needs appropriately within the group becomes a great opportunity.
  3. Spot the emotion. This is a fun warm-up exercise for group members whereby the Feeling Face Cards are sorted with each group member taking a turn to come up to the front of the group and model the feeling. The task for the other group members is to guess with some accuracy the feeling being expressed. This does two things, firstly it helps the person miming the feeling to be more consistent, and secondly it allows group members to check on the accuracy of what they are seeing.
  4. Building a cultural language for emotion.You will notice that we have translated

    Bi-cultural Feeling Face Cards

    where possible emotions into a Maori bicultural set for the indigenous culture of New Zealand. This helps to build language competency alongside feelings competency, with a language that is at some risk. This also helps facilitators to be more responsive to indigenous participants in programmes.

  5. Distinguishing between thoughts and feelings. It will not be a surprise to any person working with others that clarifying the distinction between what is a thought and what is a feeling, is often a theme in change work. Social competency is based upon the ability to communicate clearly, ensure meanings are clear, and respond accordingly. The Feeling Face Cards provide an opportunity to work back and forth between these two positions allowing for greater clarity. “What is the feeling that goes with that thought?”, is one of my favourite questions to help make the distinction.

These are some of the ideas of how we use the Feeling Face Cards in our practice. I am aware that we have sold significant numbers of these to facilitators involved in programme delivery around the world. I am really interested to know some of the creative ways that you have found to incorporate these on your practice. Love to hear from you.

For more information about where you can source these Feeling Face Cards go here.

 

6 ways to get greater group involvement

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Keeping a training group engaged for 5 days

Have you ever had a passive group of learners who have been told to turn up rather than self-selecting into the learning opportunity? Or the energy in the group of very low. Or the group are used to being lectured to, rather than participating and being responsible for their own learning. This is every trainers nightmare. The risk in these situations is that we often end up trying harder than the group does itself. When this occurs we are doing the work for the group which isn’t good for them or for us. We are left tired and often doubting our abilities. Below are six methods for getting group involvement quickly in the session and maintaining that involvement throughout.

  1.  Learning buddies. This involves simply pairing group participants and giving them an overall challenge for the session. For example in a group of 10 participants that works out five tasks for the session. These tasks are generally set around the content of the session with the learning buddies having to report back either throughout or at the end about what they have discovered during the session.
  2. Set expectations early. If a participatory culture is not established early in the session, then the group itself will make the decision about the level of involvement it is willing to make. While being mindful of different levels of comfort and sharing within a group, creating an opportunity for appropriate self-disclosure within the first 10 minutes is critical. This can be as simple as two things that you want to get out of the session today.
  3. Expect responses. Unless I hear from the group what they are thinking about a particular issue, then I have no idea of the relevance of the material we are working with, to the group participants. I am not in favour of doing the group round as this can be quite tiresome. Have group members share when they are ready but set the expectation that they will. I do expect to hear one or two ideas from each group member.
  4. Let the group come to us. This is linked to the above point so rather than asking each person by name to feedback, I will make this much more invitational. For example I might say, ”Who’s are we going to hear back from first?”, then, “Whose next?” And so forth.
  5. Create competency. One mistake many facilitators often make is that they ask far too generalised questions to group members who often don’t know where to start. I have found it particularly useful to frame questions that allow participants to respond within their competency. For example I might ask, “What is one way you have found helpful to deal with this issue?
  6. Question cards. Scatter small cards and pens around the group. If a question comes up as the session progresses and is not appropriate to ask at the particular time, then the participant writes the question on a card to ask at a later point in session.

Of course there are many other strategies on developing engagement within the session, for example, panel discussions, subgroup activity, large group discussion, et cetera. I’m sure that you have your own way to really get to group moving. Love to hear them.

The six cornerstones of motivation

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What are the key drivers

Last week HMA hosted the International Symposium on Motivational Interviewing: Beyond an Effect Size: Innovations in Thinking & Practice in Auckland, New Zealand. Besides being a rich opportunity to share contemporary practice around motivational interviewing, it was a timely reminder of the very essence of what motivation is. Without motivation we generally do not embark upon the journey of exploring new ideas and behaviours. It therefore felt timely to go back to basics and reflect upon the cornerstones of motivation. For those of us who work in the area of change with others there is little doubt that understanding these concepts is central to work.

  1. Cornerstone one – motivation is not fixed – all of us know that motivation fluctuates hugely, sometimes from minute to minute, hour to hour, and day to day. It can increase or decrease based on principles of human behaviour such as reinforcement theory. Most of us do not work on high-end altruism when deciding on behaviour, but more often in terms of what’s in it for me or to be fair, what’s in it for those close to me. If we can see some benefit to changing behaviour, then motivation will increase. In my own field of practice of family violence intervention and offenders intervention work we know that people are often motivated when external sanctions increase, or when they reach a certain level of maturity and start to see the bigger picture. Evidence from the general corrections field about desistance to crime includes the following ideas: life re-evaluation (around age 39), burn-out from the on-going consequences of behaviour, and fear of harm to themselves. Therefore the age of presentation may be a critical factor in motivation or responsivity to change. This also fits with life re-evaluation which can start around the mid to late 30′s.
  2. Cornerstone two – motivation is also a matter of probabilities – how likely is a person to initiate or persist in a particular action? What does this mean? The question can be posed in a slightly different way. ‘Under what conditions is a person likely to persist with change and truly deal with behaviours?’ This in my view goes back to the starting place of what is brought into the room.
  3. Cornerstone three – motivation is an interpersonal phenomenon – this in where the skills of motivational interviewing are most evident. A key aspect of MI work draws from relational theory and what occurs within the context of the relationship between the worker and the person seeking help. All of us who work in the human services know that rapport and engagement are the cornerstones of effective practice. We are asking people to trust us with their personal worlds, to respect them, to understand them, and to help them make sense of the situation they are in. As we all know trust is not given lightly and can be easily eroded.
  4. Cornerstone four – motivation is generally specific to a course of action. A person may be unmotivated to one type of change, but quite ready for another. For example they may be prepared to attend a programme in order to explore abusive behaviour, but unwilling to work on drinking or drug taking behaviour, even if this is indicated as an aspect of an abusive pattern. What are you motivated for and what not? I am highly motivated to keeping the kitchen bench tidy, but less motivated to get out and exercise.
  5. Cornerstone five – intrinsic motivation is the way to go. We know that if we make the decision to change, then it has a better chance of being successful, than if others decide for us. While motivation can be both intrinsic as well as extrinsic, the former will be longer lasting. This is where attending to change talk becomes important in MI work. Listening, responding and strengthening a person’s commitment to change for their own reasons has proven to be more enduring over time. In a later blog I will explore how we can enhance motivation by joining the hopes of the person with those of his/her family and friends/social network.
  6. Cornerstone six – Intrinsic motivation is more readily achieved by eliciting it rather than telling. Very few of us respond to being told what to do. In fact we can take on the righting reflex and head in the other direction. The power of self-talk (We believe what we hear ourselves saying) can assist change. For example, inviting a person to change their narrative about ‘having to attend programmes’ to ‘approach motivation’, where they argue for themselves the benefits of change (attending a programme may be one solution), can start to create movement in the direction of change.

To test this theory try the following exercise with a friend or family member. Elicit as many good reasons (at least twenty) for you as an individual not to drink and drive (You can pick a different topic if you want).  Take no more than 5 minutes so get the working fast. After you have finished answer the following process questions:

  • What were you aware of?
  • What did you notice happened in your thinking?
  • What is your position around drink driving now?

If you are like most of the people that we run this exercise with, you will have shifted in your position. Even if you had already taken a firm position around the issue (drinking and driving or something else) then you will become even more confirmed in that position. Reinforcing change-talk in the direction of change moves us along that continuum and builds motivation for engaging, working with or maintaining change.

 

 

 

Understanding programme drop-out from family violence programmes

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What works

All of us working in the area of family violence intervention are acutely aware of the issue of attrition from programmes. I know that I often worry about the safety of partners and children of men who drop out of intervention. If we can go by general criminal justice research we know that programme drop-out has been associated by higher recidivism rates and more severity of criminal activity. So what makes the difference in terms of who drops out and who stays to complete family violence intervention? Is it the individual characteristics of the person? Is it the nature of the programme design? Is it related to men’s own experience of victimization? These are interesting questions to explore and while some aspects have been answered, others haven’t.

I was therefore pleased to read a well-constructed and astute article titled Variables associated with attrition from domestic violence treatment programs targeting male batters: A meta-analysis, by Lisa Jewel and Stephen Wormith (Criminal Justice and Behavior, vol.37, No.10, 2010). This article did not replicate the same old issues around demographic variables or fixed characteristics of an individual which we know so much about already, (e.g. age, income, education, employment status, marital status, ethnicity, etc.) but explored the relationship of men’s own victimization, programme type (feminist versus cognitive behavioral), and other intrapersonal characteristics on attrition from programmes (e.g. alcohol and drug use, depression, risk level, motivation, psychopathology and therapeutic alliance). They also explored drop-out in relation to the three stages (before assessment, between assessment and programme engagement, and during intervention) which to my knowledge is new and fertile ground.

Key results:
In terms of demographic variables:

  • Employed individuals were 20% more likely to complete programmes than unemployed men
  • Older men were 16% more likely to complete programmes than younger men
  • Men with less education were more likely to drop out of feminist psycho-educational programmes versus cognitive behavioural programmes
  • Men with more education were likely to complete as opposed to men with less education.

In terms of violence related variables:

  • Referral source was most strongly associated with attrition with court mandated men 16% more likely to complete treatment than non-mandated (it is interesting to view this finding in the context of the current debates on whether to mandate or not, family court clients to programmes)
  • Men attending for the first family violence incident were 14% more likely to complete treatment than men previously arrested or convicted for domestic violence.

In terms of intrapersonal variables:

  • Both alcohol and drug use were associated with treatment attrition (12% and 10% respectively). It is worth noting that this is also a factor in terms of recidivism
  • Cognitive functioning was also found to be a factor in attrition. Less education may be a mask for lower cognitive functioning and these men may find it more difficult to ‘keep up’ in programmes and therefore drop-out.

According to the authors the results also fit nicely in the risk, need & responsivity model developed by Andrews and Bonta (1990). This has been the core approach to general offender work for the past 20 years. It is based upon the idea that treatment intensity should be matched to level of risk posed, focussed on reducing criminogenic needs (crime causing factors) and that programmes match the ability of the person and their learning styles (including cultural matching). The overall results vindicate what this writer has been arguing for a long time; that one size does not fit all and that our programmes need to be take account of responsivity factors far more carefully. In an ideal world we would be much more careful in getting the right match of men to programme type and style. This would therefore mean better retention in programmes and the associated outcome of further enhanced safety for others.

Motivational interviewing – the tension points

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Finding the rub

Attending the International Symposium on Motivational Interviewing: Beyond an Effect Size: Innovations in Thinking & Practice, was such a stimulating experience that it got me thinking about where MI sits in relation to other approaches. Is MI an approach out there all by itself? Is MI the precursor to others things? Is there a right way to do MI and are those of us that bring into play other approaches (narrative, strength-based, cognitive behavioural theory, mindfulness) fudging it and undermining the integrity of the key ideas. At the heart of MI are reflection, noticing, and elicitation. MI is about a way of being with people that recognises their autonomy, self-directedness, and inherent strength. The approach is based in the humanist traditions of collaboration, evocation, compassion and genuineness.

It is the edges where theory and approach rub up against each other in practice that is really interesting. The friction caused leads us to think about, debate and clarify theory as well as practice.

In my view the following six areas where the interface does not sit easily are:

  1. When MI is used as an entrée to interventions – one of the debates is around what are we motivating people for? Is it for an overall aspect of a change within a person’s life (e.g. a healthy lifestyle – an overall change), to change an aspect (e.g. drinking) or to create a willingness to engage in another piece of work (e.g. attend an intervention). Do we therefore do MI then forget about it when we have engaged the person? The latter would clearly work against the spirit of MI which is as much about an approach to the work, as a technique.
  2. Maintaining integrity of the MI principles – any approach can be watered down and lose its integrity. As people move further away from the people who developed the ideas, don’t have feedback on the correct implementation of the ideas, and are not supported to maintain best practice, then slippage in integrity occurs.
  3. Who sets the direction?  MI is a directional process that assists the person to move through the change process toward a goal. It is encouraging evocation of beliefs and ideas that are supportive of change (change talk), a new direction, or new set of behaviour. One of the challenges in MI is around the degree of self-directedness versus other-directedness. Who sets the direction and focus of the change? At times many of us are required to hold a line around the focus. For example, I need to work with men who are abusive in their relationships and work from within the frame of family safety. Sometimes the clients’ goals can be different from the goals of others. A partner might want a man to develop a separated and caring relationship with their children. He might want to be back in the relationship. Where does MI come into play is shaping for change and where do we have to holding the line when the direction may appear to diverge.
  4. New and older kids on the block – where does MI and other approaches fit. It takes time to work through how different approaches fit with each other. Approaches have their own history, ideas, basis and bias. Taking the time to carefully consider ‘added versus detracted value’ is a task that I don’t see enough reflection around.
  5. What happens with limited time and resources? One of the debates is whether or not MI is a luxury in terms of time and resources. I would argue that we waste significant time on working ‘on’ people rather than working ‘with’ people. We are asking people to trust us with their inner-most thinking. This is something that is not our right to expect by the nature of our position but needs to be gained through our behaviour.
  6. Finding room for the views of others – is motivation all about individual intrinsic motivation? (Another blog is coming around this issue). How much is our own motivation a product of the motivation of others? Accountability-based approaches work on the practice of ensuring that the views of others are incorporated within the conversation. How much does current MI practice reflect an individual-centric rather than family-centric approach? These are questions that really interest me in particular coming from a narrative tradition.

As a result of attending the ISMI symposium I am now committed to exploring these ideas in much greater depth. I am looking forward to conversations around these issues with you and others. What do you think? Love to hear.