Lesson 4: Motivational Interviewing - Engaging

Attention

http://squamish.ca/yourgovernment/engage/

It is the same with teaching, counseling, and selling cars...if you cannot capture the attention of your audience you are not going to be effective!

One of the key philosophies of our work is that we want our clients to be the CENTER of the process. There will be times when clients with "check out" and not participate, preferring to simply let things go or allow you to do the work. We need to FIRST build a relationship with our client so that we can help each client become an engaged part of his/her own treatment and recovery.

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Discuss the importance of establishing rapport.
  • Demonstrate effective use of OARS methods in a conversation.

Teaching

Engaging

Read pages 9-12 in the CCNC Motivational Interviewing (MI) Resource Guide.

As you have just read, establishing rapport is a key predictor of client success. We are able to have our clients more ENGAGED and we have more INFLUENCE on them when we have established a genuine relationship with them.

This is where our interpersonal skills come into play.

While at some times our clients want to get right to solving pressing problems, we often have the time to get to know our clients. This step in the process can be rather casual. For instance, I have talked about personal likes and dislikes in music or movies as a way to focus the conversation on building rapport. One client in particular would not talk to me until he found out I liked Pink Floyd!

The real skill is learning how to establish rapport while at the same time gathering the information you need early on to move toward treatment planning. If you take too much time developing rapport you will run out of time to create a treatment plan outlining your future work together. In Maine most third party payors (the insurance company paying for the service) allow a mental health worker about 30 days from the day a case opened to the development of a complete treatment plan written, reviewed and signed off on by the client.

How To Build Rapport With Clients by Dr. Barbara LoFrisco

Posted on December 6, 2012(https://www.mastersincounseling.org/how-to-build-rapport-with-clients.html)

Building rapport with your clients is one of the most important counseling skills to possess. Did you know that approximately 40% of client change is due to the quality of the counseling relationship? It’s no secret that we must get clients to trust us and feel comfortable in the counseling room. If we don’t, then clients won’t share important details with us, won’t trust what we say, and in general won’t participate in the counseling process in the way that we need them to. But how do we build this rapport?

Here are some suggestions:

  1. Use your active listening skills to understand the client and their story. Before you make any attempt at an intervention, demonstrate to the client that you understand where they are coming from.
  2. Watch your speed. Your speed of intimacy, that is. Depending on the client’s culture, background, personality, etc., it may take longer to build the trust required to discuss more personal and sensitive issues. In order to assess the trust level, pay attention to both the content of what the client is sharing (some clients will only share surface-level details at first) and the client’s body language, as they will be important indicators of how much the client is ready to share. It is important to be aware of these non-verbal signals because not all clients will clearly verbalize their discomfort.
  3. Small successes first. Before delving into their biggest problem, try giving helpful information, positive feedback or encouragement. You may even try to help by making a plan to address a smaller problem early on in the process. But at this stage only attempt those problems you are reasonably confident you can address successfully. This will help the client build confidence in you.
  4. Treat the client with respect. This may seem obvious, but from your very first contact treat the client as an important person. Return calls promptly, arrive to appointments on time, dress professionally, have paperwork ready for them, etc. Respect their time as much as you do your own. (Which you should, or we need to be having a different type of conversation). Imagine how you would like to be treated as a client, and adjust your behavior accordingly.
  5. Be competent. It should seem obvious, but probably the best way to destroy a counseling relationship is to be incompetent. The client isn’t going to trust you if you don’t know what you are doing. Ensure you have proper training and experience before tackling the client’s issue. Be forthright with the client about how much experience and the scope of what you can assist him or her with during one of your first contacts. In the end the clients always have the decision of whether or not they want to work with you. It’s really their decision, not yours.
  6. Self disclosure. Disclosing small strategic pieces of personal information is also another way to build rapport but be careful with this one. Too much disclosure, too personal, too much focus on you - not the client, or done too early or for the wrong reasons can easily backfire.
  7. Remember, the counseling or interpersonal relationship is really the most important factor in the room. It matters more than the theory and interventions you use.

Paying Attention

Have you ever tried having a conversation with someone who was not attending or paying attention to you? They were distracted? Maybe not making eye contact? How did you know they were not attending? What did you do?

In our busy lives we can sometimes fail to attend to what is going on around us. Add to this the allure of technology and our ability to remain "connected" but what are we connected to? What is the effect of all this technology around us on our ability to attend to what is going on?

As counselors we develop a comfortable "vigilance" as to the behavior of our client. It does not read as clearly as words, but they are taken into consideration when we work with clients.

We attend to:

  • Visual/Eye Contact
  • Vocal Qualities
  • Verbal Tracking
    • Key words
    • Emotion words
    • Contradictions
  • Body Communication

OARS

We will be revisiting these skills throughout the course. Despite the fact that they appear at the beginning of the process, they are actually continually used throughout the process!

Referring to the table on p. 11 (CCNC Motivational Interviewing (MI) Resource Guide) we see that our interactions with our clients need to be full of statements like these that build rapport.

OARS stands for:

  • Open-ended Questions
  • Affirmations
  • Reflective Listening
  • Summaries

Here are some additional descriptions of OARS techniques with examples: OARS Essentials

This small collection of skills, when used appropriately, sends a very clear message to our clients: "You are important and I am listening to what you are saying." During any interaction we have with someone else, isn't this how we all want to feel? That the person we are talking to cares and is paying attention which has me feel that I am important and valued.

We are moving our clients toward a point where they establish a sense of self-efficacy ("I can do it!")...while this is not the same as self esteem, ensuring that our clients know they are important and worth listening to is a step in that direction!

Assessment

Lesson 4 Lab

You are going to complete your first Lab Assignment as part of this lesson. The goal is for you to demonstrate your ability to engage in a casual conversation while using the skills outlined by OARS as described in this lesson. To complete the assignment read the instructions the Lab Tab/Section in Blackboard.

Lesson 4 Quiz

For this quiz I want you to engage a significant other in a discussion. The topic can be about anything you wish to talk about. In this conversation I want you to be very attentive as to the body cues you are receiving from the person. At some time during the conversation, when they are trying to tell you something, make an effort to be distracted and "not listen". (Be sure to continue attending to body cues.)

After a short time the individual may become irritated so be ready to stop the experiment and tell them what you are doing! Ask them how it felt to be "not listened to."

  1. Describe this experience and any other experiences you may have had when you did not feel attended to. Considering the stigma that many of our clients experience due to their physical or psychological disabilities, describe how they might experience not being attended to and why it is so important for us, as mental health workers to pay attention to our clients.

Lesson 4 Discussion

Why is it important to establish a "friendly" rapport with your clients? If you have a story to tell, describe a situation in which a person who was helping you DID or DID NOT establish this rapport. What was the outcome? (Note that the goal of building a "friendly" rapport is not to become their friend. You must always maintain appropriate professional boundaries.)