How to manage resistance and have difficult conversations that make a difference

By Richard Devine, Social Worker for Bath and North East Somerset Council

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Preface: This is a review of Motivational Interviewing For Children and Families (2021) by Donald Forrester, David Wilkins and Charlotte Whittaker.

Introduction 

Are you able to be the type of social worker you would like to be? Or is there a gap between how you currently practice and how you would like to practice? I confess that I am not always the social worker I would like to be. 

I work in the child protection system. I work with many parents whose behaviour often unintentionally and without their full awareness, harms their children. I want to help families. I also want to be strengths focused and relationship based. However, parents often deny the concerns, resist our involvement, and appear unwilling to change. I have a responsibility to intervene on behalf of children when the level of care they receive is not good enough. This means when the parents have lots of problems and it is badly affecting the children, I must put in place a child protection plan or enter pre/care-proceedings. This makes relationships even more tense and challenging. Like lots of other social workers, I have received very little training, nor have I been able to find many tools or resources, that help me navigate difficult conversations in a way that makes a difference. 

‘The telling people what to do trap’

Over the years I have gained a sense of what doesn’t work. For example, simply telling a parent what their problem is and how they need to fix it rarely, if ever, succeeds in creating change. The impulse however to do this is strong. I can see the problem clearly and I can also see the effect it is having on their children. Surely, if I just point this out to them and help them see the impact it is having on their children, this will make them want to change. 

In Motivational Interviewing this is called the ‘righting reflex’ or as Forrester, Wilkins, and Whittaker put it ‘the telling people what to do trap’ (p.101). Research into social work practice reveals that it is very common. However, not only does this not work, in my experience and according to research undertaken by the authors, it makes parents more defensive and our relationship less helpful. Should we be surprised by this? 

On the one hand, it is surprising because it seems reasonably logical. We readily experience a lot of sympathy for children suffering harm. Therefore, we want to point out to parents quickly and directly their behaviour that is causing the harm and what they need to do. In addition, there is much pressure within social work to identify the risk and resolve it. On the other hand, it shouldn’t be a surprise that telling parents what to do doesn’t work. Many behaviors that cause harm to the self or others are often ways of coping that, although have some negative consequences, also help in other ways. 

For example, a parent who misuses alcohol might experience many difficulties looking after their child. They might also find it to be most effective (and only available) solution to cope with loneliness and/or emotional distress related to past experiences. The pain of recognizing the harmful effects alcohol use might have on their functioning, parenting, and children can sometimes be too much to tolerate. To deal with this, some parents try to minimize or deny it’s effects to their self and others. 

Ambivalence: friend or foe

 A central idea in motivational interviewing is Ambivalence. That is, when (we or) a parent needs to address a problem, they can think of reasons for changing, but also reasons for not changing. In other words, ambivalence is normal. An important finding from motivational interviewing research is that the way we, as helping professionals respond to the parent’s ambivalence can either increase or decrease their resistance depending on how we react to their ambivalence. In motivational interviewing, resistance is seen not within the individual but in the relationship between the helper and the individual. 

When a social worker tells a parent what their problem is and how they need to fix it, resistance increases, and they become less likely to want to change. Drawing on the work of Carl Rogers, motivational interview advocates listening in non-judgmental way, genuinely and attentively trying to understand the parent’s point of view. The challenge is to see if we can ‘enter into the internal world of others feelings and personal meanings so completely’ that we lose ‘all desire to evaluate and judge it?’ (Rogers, 1961: 53). If we take a parent misusing alcohol as an example, this approach will involve us attempting to fully, without judgement, understand their rationale for using alcohol. Research into motivational interviewing has shown that when this approach has been adopted, resistance has decreased. This is such a powerful finding. I have come across very few ideas that are as immediately actionable and evidentially effective as this one. 

Motivation

Another central idea in motivational interviewing is Motivation. In motivational interviewing, ‘motivation’ is defined as the gap between where we are currently and where we would like to be. Our potential is another way of thinking about this. We can all think of a way in which we are falling short or engaging in unhealthy habits that if we addressed would improve our lives. In that space or gap in between where we are and where we could or ideally could be is ‘motivation’. 

Conceptualizing motivation this way enables a different type of dialogue to occur that would otherwise be difficult. We can ask parents about what sort of parent would they like to be. Or even better, what type of person would they like to be. This can open a conversation about what they need to do to be the best version of themselves and importantly, what we can do to help them achieve their self-defined goal(s). This provides the parent with ‘autonomy’, an important concept in MI. Philosophically, autonomy is form of acknowledging a person’s agency. Practically, autonomy increases the chance a person will make the changes because they feel in charge. 

Tools

In addition to these important and highly applicable ideas, Forrester, Wilkins, and Whittaker detail a range of techniques derived from MI that help practitioners have focused, meaningful and impactful conversations. These include ‘sustain talk’, ‘change talk’, ‘reflections’, ‘affirmations’, ‘summary statements’ ‘closed’, ‘open’ and ‘evocation’ questions. These tools provide clear and useable strategies to employ in many, if not all interactions with children and families.  Many of these tools are organized around a key idea that people are persuaded much more by their own arguments to change than by those made by others.

Serious concerns and consequences

There will be instances whereby despite the very best application of the above principles and techniques parents will remain unwilling to change. In child protection, we must have very difficult conversations with parents about the consequences. We must explain what might or will happen should change not occur. Forrester, Wilkins and Whittaker’s chapter on ‘talking about serious concerns and consequences’ is helpfully instructive. 

There are two key principles. Firstly, every effort should be made to fully understand the perspective of the parent, even if we don’t agree with them. This idea is captured in a beautifully pithy statement:

‘seek first to understand, then to be understood’

(Covey, 2004: 237).

Secondly, we must endeavor to recognize and respect an individual’s agency and autonomy. This means we avoid the ‘the telling people what to do trap’, in part because this automatically deprives the parent of any choice or sense of agency. Instead, we simply and clearly explain the consequences, that is, what will happen if they make certain choices. Some parents will not be happy with the consequences, and we seek to understand the reasons why, demonstrate sympathy yet remain clear about what actions will be taken should change not occur.  

This highly sophisticated approach requires the social worker to be compassionate, kind, and authoritative. To recognize and skillfully use power instead of ignoring or misusing power. And to hold the child as well as the parents’ needs in mind simultaneously.  

Conclusion: 

Forrester, Wilkins, and Whittaker outline 3 reasons for their attraction to Motivational Interviewing and why they think it’s useful for children and families’ social work. Firstly, the underlying values and principles of MI are commensurate with their social work values. Secondly, MI provides a theory that helps us understand how and why people don’t or do change as well as some remarkably practical and proven tools to facilitate change. Thirdly, MI has a considerable and robust evidential base. Surprisingly few approaches in social work has a strong evidence base, and MI stands out in this regard. 

Final reflections:

This book has been the most enjoyable social work book I have ever read. Forrester, Wilson, and Whittaker have produced an impressively engaging and highly accessible book. In addition, it is also one of the most practically useful books I have encountered. It is uncommon in this respect. Very few books offer on-the-ground ideas that help social workers improve the ethics, quality, and potentially, outcomes of their practice. Motivational Interviewing for Working with Children and Families lays out a theory and repertoire of skills that I am sure every social worker would benefit from learning about. I have been in practice for over a decade and learned about a few models in depth. Yet, I am captivated by MI’s unique approach to handling many of the challenges I experience in my work in a way that might yield more favorable outcomes. 

In the beginning, I asked if you were the type of social worker you wanted to be. If your answer to this question was no, then I would kindly recommend that an easy first step to take towards bridging the gap between where you are with your practice and where you would like to be, would be to read this book. 

This brilliant webinar between Stephen Rollnick and the authors hosted by CASCADE Research is well worth watching:

By Richard Devine (23.07.21)

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