Motivational Strategies for Challenging Situations

Transcription

1 Motivational Strategies for Challenging Situations Mandy Fauble, PhD, LCSW Executive Director, Safe Harbor Behavioral Health of UPMC Hamot James, Wyler, MA, CPRP

2 Scenario When I talked to her about my concerns, she used flattery, distraction, humor, yes ma am, comparing to others, blaming and redirecting the focus to me -- and she really believed her own perspective. She had a hard time being held accountable and swung between being an amicable team member to attacking me if she felt threatened. The team suffered as she complained. She tried to get others involved in the conflict, which complicated things. People siding with her were also poor performers, and the lack of accountability hurt the morale of the invested staff. When I asked her what her plan was to improve her performance she said, There s nothing me or anyone else can change that is going to make a difference here. You guys should be looking for a way to relieve some of our workload

3 Today s Goal We will focus on developing communication strategies that defuse crisis situations and promote collaborative resolution. When employees and supervisors differ in communication style and perception of the situation, challenges arise. This workshop will integrate: Identifying a staff person s readiness for change Motivational interviewing skills that lead to a more productive discussion about what needs to change Integrating information on physiological responses to stress and tailoring communication to stressful situations Limit setting with employees who are not able to address situations productively

4 Prochaska and DiClemente: Stages of Change/ Readiness?

5 Supervisor Actions Matched to Readiness Stage Definition Actions Pre-contemplation Who me? This person has no intention of change Contemplation Is it just me or This person has an inclination to change Preparation I am going to Change is imminent The person doesn t see a need to change. You may agree on the solution, but not their role This person is learning they are a key to the solution. Change talk = statements by the client revealing consideration of, motivation for, or commitment to change You are seeing some steps toward change Educate on the problem Point out personal risks & gains w/ change & no change Emotion can help here Motivate, listen to the change talk Point out change talk Set some goals, flesh it out Cheerlead Help the person set goals Help identify objectives and steps to meet them Action I am Maintenance I have The person has created change, but it isn t sustained The person has created sustained change Problem solve Reinforce what s working Cheerlead Reinforce what s working Cheerlead Deal with slips Set up supports

6 What is Motivational Interviewing? A strategy to help people to convince themselves that they want to (and can) change Largely focused on ambivalence, heard in change talk (DARN-C) Desire: I want, I wish Ability: I can Reason: If I, then I Need: I have to Commitment: I will, I am

7 What Skills Can I Use? This is really about letting people talk and guiding the conversation to a changed outcome, using OARS. The emphasis should be on what you want the person to hear, not what you want to say Open Ended Questions Affirmations Reflective Listening Summaries

8 Advanced Skills Simple Reflections Amplified reflections Double sided reflections (ambivalence) Shifting focus Rolling with resistance Reframing

9 Wait why do I have to change for Them? What do you mean, no?! Anger and Upset reduce our capacity for THINKING, as our brain is stimulated in immature ways! Developmental age changes rapidly Misread of social information is much more likely Often the emotions aren t just about the current situation, but the person experiencing them might not see it We are in the situation, too, and have our own reactions to it What is your own style? What are your trigger issues and feelings?

10 The Mon Yough Experience Clinical Supervisors: (31 respondents) Percentages below reflect respondents choosing agree or strongly agree in response to the question % of staff reported feeling comfortable working with their supervisor 2. 57% of staff reported their supervisor welcomes their explanations about the client s behavior 3. 61% of staff reported their supervisor is tactful when commenting about performance 4. 61% of staff reported their supervisor encourages them to formulate their own interventions with the client 5. 52% of staff reported feeling more curious than anxious when discussing difficulties with clients 6. 62% of staff reported their supervisor encourages taking time to understand what the client is saying and doing 7. 61% of staff agreed their supervisor s style is to carefully and systematically consider the material brought to supervision 8. 47% of staff agreed their supervisor helps them work within a specific treatment plan with clients 9. 58% of staff agreed their supervisor helps them stay on track during their meetings % of staff reported working on specific goals in the supervisory session

11 Mon Yough s Response Clinical Supervision training with a goal of developing a clinical supervision framework to better conceptualize their staff focusing on: Readiness for change Engagement Person-centeredness (all motivational strategies)

12 Consider Conflict Styles

13 More Ideas to Better Communicate Slow down Be Concrete Focus on behavior, not person Short, Simple Use a buddy system Write things down Calm your own appearance Dim the lights Quiet noises Allow ventilation You can allow for this without agreeing or disagreeing Avoid saying you understand I can see that you are saying you feel I can t imagine This is very difficult Validate feelings

14 Ideas to Better Help Acknowledge your limits State what the person should expect you can expect to hear from us in 2 days about your concerns, if you do not hear by contact me Give space Watch your non-verbals Use your analytic skills-anger is usually complex Be genuine Talk less and slower than you are inclined to; write it Offer what you can and what s appropriate to the situation Don t be alone if it doesn t make sense Avoid labeling angry, mad or upset try, this seems really important Many people don t connect their anger, because they are really feeling something else

15 Scenario I brought him to my office. When I told him we had found some problems with his work he said, you re a liar and pointed at me. He said, You ve been out to get me from the start. What stage of change is Steve in? What might be next for you, based on that knowledge? Use your DARN-C and OARS

16 Scenario I decided I really needed to talk with her about the issue, which was that she was late to almost every meeting and seemed scattered. When I brought it up, she said, So what if I m late, everyone else is, too. What stage of change is she in? What s next? Use your DARN-C and OARS

17 Scenario We met on Friday to review the concerns. By Monday, I had an with information about the changes he planned to make, and we set a weekly meeting to review them. What stage of change is he in? What is next? Use your DARN-C and OARS

18 Scenario She implemented the action plan, but her attitude wasn t great. She kept telling me she would do whatever she needed to do to keep her job, but really didn t understand what all the fuss was about. What s the stage of change? What s next using our OARS and DARN-C