Psychiatric Rehabilitation Journal 2014, Vol. 37, No. 1, 65– 67

© 2014 American Psychological Association 1095-158X/14/$12.00 DOI: 10.1037/prj0000034

BRIEF REPORT

Employment Support Workers’ Experiences of Motivational Interviewing: Results From an Exploratory Study Jenny Secker and Kerrie L. Margrove

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Anglia Ruskin University and South Essex Partnership University NHS Foundation Trust Objective: Motivational interviewing is suggested as a means to increase the success rate for people receiving employment support. This study explored employment workers’ experiences of using motivational interviewing following training in the techniques. Method: Semistructured interviews were conducted with employment support workers after motivational interviewing training and again 9 months later. Interviews were audio-recorded and transcribed for analysis. Results: At first interview the majority thought motivational interviewing had potential but some described difficulty using the skills. At second interview most reported using the skills and motivational interviewing was perceived to have a positive impact. Conclusions and Implications for Practice: Employment support workers find motivational interviewing helpful to use in employment support services. Opportunities for ongoing assessment of skills appeared important for facilitating skill development. Peer supervision might mitigate the resource demands in terms of supervisors’ time, while inclusion of relevant requirements in formal role documentation would provide a supportive framework. Keywords: employment support, motivational interviewing

practice, and exercises. Semistructured interviews were carried out after initial training. Follow-up interviews were conducted with nine employment support workers still in post 9 months later. Interviews explored experiences of using motivational interviewing techniques and perceptions of the impact for people in recovery. Analysis of the interview transcripts was carried out following thematic analysis processes as described by Braun and Clarke (2006). The study was submitted for National Health Service (NHS) ethical review. The opinion of the reviewing committee was that it did not require NHS ethics approval. Approval to proceed was received from the responsible NHS service provider.

The Individual Placement and Support (IPS) approach has been identified as effective in enabling people in recovery to find work (Bond, Drake, & Becker, 2008). However, trials typically report a 60% success rate, leaving 40% who do not find employment. One factor of potential significance is the individual’s motivation to actively engage in job seeking (Alverson, Carpenter, & Drake, 2006). Augmenting IPS with motivational interviewing, a personcentered communication approach to exploring and resolving ambivalence (Rollnick & Miller, 1995), may therefore have potential for increasing employment rates. However, research is at an early stage. This study aimed to make a contribution by exploring employment support workers’ experiences of using motivational interviewing techniques.

Results

Method

At first interview the employment support workers reported mixed experiences of trying out motivational interviewing. For five participants who had begun to use the skills, beginning to put them into practice appeared to have been relatively unproblematic. For example:

All 12 employment support workers and their two supervisors working in one English county attended 2 days of initial training in motivational interviewing, followed by two 1-day refresher sessions. Training adhered to motivational interviewing frameworks (Miller & Rose, 2009), using demonstrations, coaching and skills

Sometimes I’d get to a point with someone where they were contradicting themselves, they were almost like they desperately want to do this but their behavior just isn’t promoting what they want themselves, and I never had anything in my tool kit that helped me move that on . . . and I’ve used it and actually it’s a brilliant way to reflect back somebody’s own unhelpful kind of either thought processes or behavior . . . And that was really important for me in being able to help move things forward to a different stage. (ES18)

This article was published Online First January 13, 2014. Jenny Secker, PhD, and Kerrie L. Margrove, PhD, Department of Health, Social Care & Education, Anglia Ruskin University and South Essex Partnership University NHS Foundation Trust, Essex, UK. Correspondence concerning this article should be addressed to Jenny Secker, Anglia Ruskin University, Faculty of Health, Social Care & Education, 2nd Floor, William Harvey Building, Bishop Hall Lane, Chelmsford, Essex, United Kingdom, CM1 1SQ. E-mail: [email protected]

However, other participants’ accounts suggested that they were experiencing difficulties that revolved around a sense of awkward65

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ness or inauthenticity. As one participant (ES16) put it, “It feels a bit staged at the moment.” Two of these participants also thought that their own feelings of awkwardness had been picked up by the people they worked with: I think one or two of them looked at me as if to say, why is this woman repeating this back to me. (ES21)

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In contrast, participants who were experiencing less difficulty described positive responses on the part of the people with whom they tried out the skills: I notice people actually sort of having those kind of lightbulb moments where they go, I’ve never really thought about it like that, and I’ve only said back to them what they’ve said themselves . . . what’s made the difference to them is the fact that they’ve been able to think about it in a different way, so it’s very positive. (ES18)

Among the nine participants who were reinterviewed at followup, experiences of using motivational interviewing appeared to have shifted in a positive direction. Most reported using motivational interviewing in their work, particularly with people who seemed to be “stuck”: I think the training is really helpful when you’ve got a very difficult client . . . because lots of clients want it but are so scared. That’s the really good thing I find with motivational interviewing about looking at their barriers, or them actually seeing their own barriers and then their own potential. (ES3)

Participants also reported positive responses from the people with whom they worked: I get a lot of feedback that they actually find it really useful. They’re often quite shocked at what that hour’s given them in terms of what they thought was a problem, they now don’t feel is such a problem, now they feel that they understand a little bit more about where they are and what they need to do. I do get a lot of good feedback actually, yeah. (ES18) They do respond to it . . . it’s a useful technique to use, so I found it useful and they found it useful. (ES22)

However one participant did describe a continuing sense of awkwardness or inauthenticity that she felt was still affecting individuals’ responses: You have to be very careful with some of the ways in which you use it, because I think sometimes they feel that they’re a little bit under the spotlight, so you’ve got to be very careful how you use it . . . if you’re challenging somebody it can be quite difficult at times. (ES16)

view that motivational interviewing training for employment support workers merits further investigation. The difficulties in using motivational interviewing skills described by some employment support workers at both first and second interview suggest a need for ongoing assessment and support to develop and maintain motivational interviewing skills. Only one participant (ES18) described opportunities to practice and receive feedback, not in his employment support role but during other training not related to his employment support role. At both interviews he saw this as central to the development of his skills, further highlighting its importance during his second interview when he described a tailing off of his skills during a break in training. Previous research reported by Miller, Yahne, Moyers, Martinez, and Pirritano (2004) supports the implication that more frequent observation, feedback, and coaching in the use of motivational interviewing skills may have been helpful in overcoming some of the difficulties described by other participants. It seems unlikely that these difficulties are unique to motivational interviewing, since similar feelings of inauthenticity have been documented in relation to training in other fields, where opportunities to rehearse and practice have also been found to be key to achieving greater fluency in the use of new skills (Secker, 1993). Although it was originally intended that the two supervisors would provide observation and coaching in the workplace, in the event the demands on their time meant they were unable to do this consistently. One solution may lie in additional resource investment in terms of supervisors’ time, since they are arguably well placed to support skill development, but experience in other fields of counseling suggests peer supervision could also be valuable (Goldsmith, Honeywell, & Mettler, 2011). In addition, the inclusion of relevant requirements in job descriptions and appraisals would provide a framework to support skill development.

Conclusion and Implications This qualitative study indicates that employment support workers report positive effects of using motivational interviewing with people using employment support services. Further research is needed in relation to the views of and success rates for people using employment support services. Opportunities for ongoing motivational interviewing practice and feedback in the workplace emerge as of potential importance for facilitating and maintaining skills. While providing training in motivational interviewing may in itself be relatively inexpensive, there are therefore implications in relation to the demands on supervisors. Peer supervision may provide an alternative, and is arguably worth testing in future research, while inclusion of relevant requirements in formal role documentation would provide a supportive framework.

Discussion

References

The conclusions that can be drawn from this small-scale, qualitative study are limited and can make only a preliminary contribution to assessing the potential of motivational interviewing as a means of augmenting IPS. In particular, it was not possible either to objectively assess the employment support workers’ skill in putting motivational interviewing techniques into practice, or to obtain information about the views of and outcomes for the people with whom they worked, both of which are clearly important avenues for future research. The results do, however, support the

Alverson, H., Carpenter, E., & Drake, R. E. (2006). An ethnographic study of job seeking among people with severe mental illness. Psychiatric Rehabilitation Journal, 30, 15–22. doi:10.2975/30.2006.15.22 Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31, 280 –290. doi:10.2975/31.4.2008 .280.290 Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi:10.1191/ 1478088706qp063oa

EMPLOYMENT SUPPORT AND MOTIVATIONAL INTERVIEWING

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Goldsmith, C., Honeywell, C., & Mettler, G. (2011). Peer observed interaction and structured evaluation (POISE): a Canadian experience with peer supervision for genetic counselors. Journal of Genetic Counseling, 20, 204 –214. doi:10.1007/s10897-010-9341-x Miller, W. R., & Rose, G. S. (2009). Towards a theory of motivational interviewing. American Psychologist, 64, 527–537. doi:10.1037/ a0016830 Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 1050 –1062. doi:10.1037/0022-006X.72.6.1050

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Rollnick, S., & Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325–334. doi:10.1017/ S135246580001643X Secker, J. (1993). From theory to practice in social work. Aldershot, UK, Averbury.

Received April 27, 2013 Revision received October 21, 2013 Accepted October 22, 2013 䡲

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Employment support workers' experiences of motivational interviewing: results from an exploratory study.

Motivational interviewing is suggested as a means to increase the success rate for people receiving employment support. This study explored employment...
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