Most Rehab Counsellors are aware that there are a range of social, psychological, environmental and economic factors at play for our clients. So often, for Rehabilitation Counsellors, the question isn’t, “How can I help my client get better?” but rather “How can I help them feel ready to work, and start engaging in the process?”
We saw in a previous post that the motivation for people to improve their function and begin working again isn't just about the injury. In fact, I know of one Rehab Counsellor whose motto is "It's never about the injury" and I have to agree. There's no magic wand here - after all, we can't decide what is right for another person - but there is evidence that an approach called Motivational Interviewing can help people identify their own reasons for change, and address their ambivalence towards it.
Ambivalence: Change is Thine Enemy
Ambivalence about work often raises its head when a person is at the cusp of making a decision about whether working is something they'd like to do - "Will this help me get better?" "Or does it have to wait until I am well?" Or... "work is what made me sick in the first place". As another example, on one side, a person may see that work is a way to earn money, reconnect with people and be productive…. But on the other, work may seem scary in light of an injury: “What will people think of me? How will I manage?”
So as a person begins to contemplate or prepare for change, a lot of feelings and thoughts are likely to appear for them. Some of these thoughts are disabling in and of themselves. The spirit of Motivational Interviewing encourages us to be curious about the person we are working with: how can we understand them better? And how do we validate their feelings and uncertainty instead of trying to suppress them?
You might see now that Motivational Interviewing is more about a way of approaching people rather than a rulebook. It involves reflective listening, asking open questions, affirming and supporting people, making them feel heard and understood. This allows us to...
- Help a client see how their behaviour might not be matching up with their goals and values
- Roll with resistance, rather than oppose, argue or dissuade against it
- Build self-efficacy by supporting the client’s belief in their ability to change and create a plan
Motivational Interviewing isn’t so much a technique or a “trick” as it is a way of relating to people and understanding how their views, beliefs and values are affecting their behaviour. And, most importantly, Motivational Interviewing recognises people's autonomy and right to make their own deicions – this is never about making someone change in ways they don’t want to, but about exploring a person’s reasons for change and ideas about how they might want to make that change happen.
We so often find ourselves in Tug o’ Wars with others about what we believe is best for them; we get stuck trying to counter or argue.
But think about it this way: who has ever left an argument feeling less convinced of how they felt going into it? If anything, we leave these discussions more convinced of our beliefs than ever.
Arguing, persuading and pleading is counterproductive and we need to stop.
So, to begin, consider how you might (perhaps unconsciously) be creating an oppositional relationship with your clients rather than helping them feel heard and understood. Consider how you might empower them to reflect on their goals and values and how work might play into this. The only expert on the client IS the client, and you can help them tap into a wealth of knowledge about potential solutions and plans. Help someone identify their personal “carrot” – what they ultimately want to chase – and how work, with all of its benefits, may factor into this.
Training in motivational interviewing is offered by a range of organisations and ASORC (Australia’s peak accrediting body for Rehabilitation Counsellors) occasionally runs workshops – keep an eye on this page to see whether anything is happening near you.
And remember that Motivational Interviewing is a way of relating to people – it takes practice and time. It's not a paint-by-numbers approach that you can learn overnight. Start by embracing the spirit of Motivational Interviewing – which is to make client feel like they are back in control.
Galileo had the right idea when he said, “You cannot teach a man anything – you can only help him find it within himself.”
References and Further Reading:
Levensky, E.R., Forcehimes, A., O’Donohue, W.T., & Beitz, K. (2007). Motivational Interviewing. American Journal of Nursing 107(10), 50-58.
Page, K.M., & Tchernitskaia, I. (2014). Use of Motivational Interviewing to Improve Return-to-work and Work-related Outcomes: A Review. Australian Journal of Rehabilitation Counselling, 20(1), 38-49.
Miller, W.R. & Rollnick, S. (2009). Ten things that Motivational Interviewing Is Not. Behavioural and Cognitive Psychotherapy, 37, 129-140.