stephenrollnick

[stephenrollnick]

Three Pieces on Empathy

These three short blogs were originally written for www.sportscoachuk.org. I put them together here for a slightly longer read.

Empathy: 1. Beyond Lip Service

I’m a clinical psychologist and even inside my psychology orbit I hear colleagues talking about the importance of empathy in a hollow way. I imagine the sporting world might also be vulnerable.  Words and phrases are no doubt exchanged in meetings, pasted on walls, and “empathy” and “good relationships” might appear among them as a marker of a club’s mission or core values.  How do they pan out in practice?

If I was worried about sloganeering in sport about empathy I had a wonderful awakening, courtesy of an interview with a football coach developer Edu Robio talking about the selection of coaches (https://playerdevelopmentproject.com/webinar/developing-forward-thinking-players/).  When asked what attribute do you look for in your academy coaches his response was immediate and heartfelt: “I would say the biggest one (is) empathy.”  You don't often hear trainers of psychologists talking like that.  One exception in my field is a colleague who runs a counseling service. So strong is her conviction about the importance of empathy that she asks job applicants to send her a tape of their best effort at listening, and shortlists only those who reach beyond a certain standard.  If Edu dived into the psychology literature he would find his conviction strengthened: empathy has emerged from 60+ years of evaluation of psychological treatment as one of the most robust predictors of good outcome.

Empathetic listening is a skill. I’ve struggled for a log time to help colleagues like doctors, nurses, social workers and psychiatrists to grasp the value of repeated practice with skills like empathetic listening.  Sports coaches, on the other hand have no difficulty appreciating the importance of practice.  So I would encourage someone like Edu Rubio to take heart: your coaches can learn to get better at using empathy. How and why are questions I’ll address in a second blog if my host says he didn't yawn once when reading this one.

Empathy 2: A useful muscle

People who feel empathized with are more likely to flourish.  If they are angry, upset or confused they will calm down much more quickly if they are empathized with.  I’d wager my every possession on the validity of those observations.

This is a two-step process: first to imagine someone’s experience, what its like to stand in their shoes, and then secondly, to convey this to them.  In this second step your attitude and manner are important for sure, and then there’s something else, a verbal skill that’s observable, measurable and, just like a muscle, amenable to practice.  This is variously called empathetic listening, reflective listening or reflecting.

You can get a get feel for that first step by watching people and imagining what they might be experiencing.  Here’s a neat video that challenges you to do just this: 

or you can even apparently visit an empathy museum.  

The second step, the verbal skill looks like this:

Example 1

Athlete: (clearly very angry) I’m telling you now I’ve reached the end.  I’m fed up with the way he speaks to me, like he’s the only one who knows how to play, ordering me around and talking like I’m some kind of idiot. Coach: You know what’s helpful for you and this isn’t it. Athlete: Exactly.

Example 2

Athlete: I tried honestly I did but I don't know what went wrong, it was like I froze and stopped thinking then all of a sudden it was bang, the chance was gone. Coach: You slipped out of gear Athlete: Yes, you got me, and I never expected that.  

Notice that what the coach in each example was a statement, not a question.  I have honestly forgotten who made this observation: if asking a questions is like knocking on a door, empathetic listening is what you do when you go inside. Here’s an example of me using this skill in response to an angry patient in health care, in an unrehearsed simulation produced for a medical journal:

Notice how questions were used very sparingly.

A Norwegian colleague was struggling to translate the word for this skill into his language, so he came up with a very simple phrase – a short summary; you make a short summary of what the person said or is experiencing and leave it to them to amplify if they want to. Your summary captures the essence of what they are saying or feeling.  There’s no more direct way of empathizing with a person.  

Who knows how much better would sporting outcomes be if empathetic listening was widely practiced to a high standard. I’ll pen a third little article if my editor in Sports Coach UK promises me again that he never yawned once, and I’ll try to convey how this skill can save time and help to build motivation in an athlete. Its what underlies a method called motivational interviewing (MI). More on that in the third and final piece.

Empathy 3: The most useful tool of all?

In his last book, Over But Not Out, on its first page, the cricketer Richie Benaud said: “Never discard listening as a source of learning. It could be the most important decision you ever make”.  What did he mean? He never really explained.  

In this third and final piece on empathy I will turn to its various uses, having defined it in previous posts thus: its a skill, involving firstly listening to and imagining what someone is meaning or experiencing, and then secondly, capturing the essence of this and handing it back to them in the form of a statement, an imaginative guess, not a question.  

A coach might benefit hugely from practicing empathy. Richie Benaud might have meant that the most important contribution you bring to coaching is you, in your authenticity, your ability to listen, the quality of your relationships and your desire to really help athletes develop.  Practicing empathy is a direct way of demonstrating this. The effect of empathy is to leave the player with this thought: “This coach considers me as important and is really trying to help and understand me”.  This also balances out the power in the relationship, from one in which the coach knows everything to one in which two equal partners are working together in the service of improvement in the athlete. You don't have to know everything to be a good coach. Indeed, that idea might have a toxic effect on the athlete’s learning. Your vulnerability and willingness to learn is surely what Richie Benaud was thinking of? Empathy changes you.

As you practice empathy other benefits often become apparent. Here’s a useful one: there is no more rapid way of connecting with a player than by using empathy and nothing else. Consider this sequence, where every coach contribution is an empathetic statement in an exchange lasting just a couple of minutes:

Coach: Hey, good morning, you look a bit rushed Player: I’m rough to be honest, but I’ll improve as the day goes on Coach: (sitting down alongside) You’re not at your best Player: Say that again, I hardly slept and I’m still angry with myself after last week Coach: You don't feel you did yourself justice Player: or you sir. I’m sorry about how I performed Coach: You wish you could have done better Player: I know I can do better, my confidence was slipping Coach: and that’s something you want to improve on Player: Definitely and I hope I can find a way Coach: You want to at least get some benefit from today’s practice Player: You guessed right there. That would help a lot, and I’ll sleep much better. Coach: It might help a little with your confidence. Player: A little might help a lot Coach: Let’s see now. Two heads will be better than one…..

Imagine the above player, on another day, furious with a teammate, red hot angry, shouting and refusing to even speak with her colleague. What’s the most efficient and effective way of calming the situation down?  My experience in other fields is that if you only use empathetic listening it does exactly this. Quickly. Then you can consider how to turn this into a learning experience for both parties.

Empathetic listening can be used to steer a conversation gently in the direction of change and improvement, a discovery that gave rise to a counseling style called motivational interviewing. You will notice this use of empathy in the last few statements of the coach above (“and that’s something you want to improve on”, “You want to at least get some benefit from today’s practice” and “It might help a little with your confidence”).  The statements are all purposefully forward-looking, and the athlete’s response is to talk about change more clearly. How motivational interviewing can be integrated into the coach’s conversation toolbox is yet to be properly explored.

[stephenrollnick]

A confrontational approach to football coaching: Does it lift motivation?

There’s a TV documentary in two episodes called The Class of 92 about a football club taken over by celebrity ex-players, and its journey from a lower level to a higher one. They sack the coach and appoint two new ones, who have a firm and clear approach to the task at hand.

Ashley was told to leave. The club and the team clearly meant a lot to him, and he arrived in his kit all ready to play. They coaches met him for what they might call a one-to-one conversation, although it’s a two-on-one, and they could be talking to someone with little need for respect.

Coach 1 (pointing a finger at Ashley’s chest): You’re not in the squad. Were leaving you out of the squad. Ashley: Why’s that? Coach 1: We’re picking someone else over you Ashley: Why? I should be playing today. Coach 2: In your opinion Ashley: Yeah Coach 2: You honestly feel that since we have been here (in the club) you have done well enough to stay in the team. Ashley: yeah, definitely. If I was in your plans, and I was, I am good enough Coach 2: If you were good enough you’d be starting (in the team today). Forget the excuses. Ashley: I was good enough (in that last game) Coach 2: You were poor. I thought you was poor. I thought we were definitely poor as a team. You’ve been at this club all season and you’ve not been pulling any trees up. If you were honest you’d be telling yourself (that), you’ve been given free games mate, some players haven’t had that chance. You’ve had your chance. Ashley: But I don’t think I have done anything wrong.

Ashley got confronted, defended himself, and that was that. He wasn’t just dropped for the game, but sacked, for good. “I just want to go home and die in (my) room sort of thing….”, he said later. As Coach No 1 says, “Its not a democracy”, suggesting that there are only two ways for coaches to function: you either tell people what to do, or you make the mistake of taking on board their views.  

Then there was a two-pronged attack on a player in the changing room at half-time, in front of his teammates:

Coach 1 to striker: I don’t know what you’ve done for 45 minutes. I think you’ve touched the ball twice. Like a lost little boy, that’s what you look like, lost. Coach 2 to their striker: Listen to me yeah, all you’ve done for 45 minutes is blame every other fucker. In my opinion the game’s gone. Striker: What’s the help with that fucking attitude Coach 2: That’s not my attitude, my attitude at the beginning of the game was .. do what you’ve done for the last three weeks and you’ve not….. Striker: That’s not (the best way) to gee people up, to single someone out. Coach 2 (interrupting): Single yourself out……Stop doing all this with your hands. Throwing your hands about …… Striker: That’s to get myself up and going Coach 2: Oh to blame everyone else gets you up does it Striker: I’m not arguing Coach 2: No we’re not arguing. We get it straight. At least I know now where we move on from this. Striker: I just said it to not single any person out Coach 2: I’m not singling anyone out, I’m just saying do your job. You do your job let me worry about anybody else’s.

The coaches no doubt have a plan in mind, as coaches must in this competitive environment. How they speak with players however, is open to question. Their style is consistently confrontational: do as we say or you’re done for. Engaging with a player is not given priority at any point.  What effect does this have on the players’ motivation and behavior change?

Confrontation evokes resistance

The coaches have some points to make at half time, yet seem unaware of the difference between the message content (e.g. “you could be playing better” or “try not to blame others on the pitch”) and the style used to convey it.  For them, they are merged into what is sometimes called the “hair dryer treatment”, widely used in military settings, where a dose of humiliation is assumed to breed conformity. As it turns out, the striker fails to acknowledge the message, and starts to criticize their coaching style (“That’s not (the best way) to gee people up, to single someone out”).   The style in itself evokes resistance.  He was hardly likely to say, “yes I agree, I am behaving like a small boy, I’m sorry, I’ll be a big man now and not blame other players”.  He defended himself instead.

Are these coaches aware of a trap they fall into, that when a player resists their message, because of the style they use, they mistakenly assume that he doesn’t really grasp the content, and then blame him for being any of a wide range of things, like stupid, arrogant, and so on? If they shifted their style, they would certainly get a different reaction.

Their striker saw through it all: “I thought he was making a show of me really”. The coaches on the other hand, were still caught in the trap: “I asked him a question at halftime, and he tried to go around the houses….”

This approach to lifting motivation is not uncommon apparently e.g., 

Are there more effective methods? These coaches show no evidence of an ability to reflect upon their own style, and adapt accordingly. Might this be a marker of what being a good coach involves?

“The Game”: How far can you take it?

There was a system for treating people with addiction problems in the US in the 1960’s that took this all a step further. “The Game” involved a group of fellow addicts and their leader all focusing on someone and humiliating them. In the Synanon organisation women were “obliged” to shave their heads, men to have vasectomies, and violence towards others was actively promoted. It was based on the idea that confronting others with the folly of their ways was the best way to promote change. This idea reached into the addictions field for decades, like a sticky glue, and endured, despite a lack of evidence for effectiveness.  

Confronting

To confront means to come face-to-face with something, clearly necessary sometimes, for both individuals or a team, especially when they are losing.  The goal seems clear enough: to help individual players to change, to lift their motivation, and to come “face-to-face with” a new perspective about their game. Ideally, its something that happens within someone. Its not unique to sport, let alone football. Parents, teachers, doctors, managers in organizations all know the experience, “I’ve got to help this person to see things differently”.

The desirability of coming to a new perspective is often confused with how a coach does this with his or her players.  Quite a wide range of approaches could be used to help a player do this.  Quiet contemplation, a helping hand of encouragement, a focused one-to-one guided discussion about change, and so on. These are all routes to improving motivation and performance; as is the use of fear, which these coaches seem to rely on.

Inducing fear

Striking fear into people is a well-oiled strategy in many settings, with some evidence in social psychology apparently suggesting that it can be helpful. Doctors, teachers, prison warders, sergeant majors all use it. Footballers sometimes report positive reactions, which might be because they have developed the resilience to respond well, or perhaps because they also have a particularly good relationship with a coach that allows for a full-frontal approach to lifting motivation. Engagement and trust might be important.  However, it would be a bold coach who would argue that striking fear into players works for everyone, let alone that this should be a cornerstone of club culture.

Doing this in a group must be a high-risk strategy, unless the only goal, like in a military exercise, is to ensure immediate conformity to a simple plan that everyone understands. People react differently to threat.  The striker struck back, his teammates recoiled and shut down. Is there a Plan B, which does a better job of helping players to new insights and for lifting their motivation and performance?

Detecting deficits

It is one thing to acknowledge that a coach must analyse, solve problems and direct strategy, particularly at half-time with a group of players, quite another to observe leaders with no other way of helping players to improve.

It follows the logic of their approach that, since these coaches apparently know everything, or at least should appear to, then players don’t, which is why the latter need “the truth” pointed out to them.  Its what doctors, teachers and parents do when they try to “make” someone change.  One becomes an expert at noticing deficits. Correction is the obvious solution, something that’s been called the “righting reflex” in the health care field. Its also what they were trying to do in “The Game”.  The response is not uniformly positive.

These coaches were expert deficit detectives. With blind conviction they noticed what was wrong, and corrected it. Its like they are wearing set of goggles through which they see only deficits. They would probably say that they are motivating the players. In truth, one cant really motivate people through coercion, instill this into them, like lifting a lid on their heads and stuffing the motivation into them.  Put another way, only people themselves can change their behavior and improve their performance.  Coaches can scream, cajole, threaten and induce fear, and then its up to the player.

A switch to different set of goggles, one that filters and focuses on player strengths and internal motivation would lead to some quite different strategies in the changing room. For example, praise, or its older sister affirmation would be much more widely used. Players themselves would be seen as people with the strengths, insight and willingness to say why and how they can improve. You’d hear football coaches affirm players’ new insights about how to improve performance. The French polymath Blaise Pascall put it sweetly thus, “People are better persuaded by the reasons they have themselves discovered then by those that come into the minds of others”. There’s not a whiff of this wisdom in what’s on show in and around this changing room. Again, there seems to be no Plan B.

But time is short

There’s a paradox on show here in the heated atmosphere of the half-time team talk: the faster the coaches rush, the slower is their progress. Precious time was spent in a largely fruitless exchange with the striker, and the coaches looked rushed, like they were thinking, “I need to get as much information as I can from my head into theirs”, and off they went, like a corner man in boxing, who has only 60 seconds to provide feedback. What followed was a shower, a potentially toxic mixture of confrontation, fear-induction and deficit correction. How much do players absorb, retain and act upon?  How much time is wasted as a result and could be better spent another way? Would a few carefully chosen words be worth more than many mouthfuls of busy talk?  

Its well-known in health care settings that patients can forget most of the information they are given, often confined to the first and/or the last things they are told. (https://en.wikipedia.org/wiki/Serial_position_effect). A colleague told me recently that a boxer he knew discovered that his corner man was giving him the most important information first, as he reached his chair, but he soon forgot it, because it was last thing the coach said that the boxer remembered before going into the next round.  They adjusted the process. Leaner information, carefully delivered.

And its effective?

There’s a striking lack of research on sports coaching styles and their impact. In health care they run controlled trials on communication styles to explore what works best.  Just because a team improves after an all-out verbal attack at half-time does not confirm the effectiveness of the approach. The nuances of this kind of biased and faulty logic are well described by the cricketer and writer Ed Smith (www.espncricinfo.com/magazine/content/story/945535.html). Put bluntly, a lot of other things can lead to improvement, not only within the team selection and performance, or in the poorer play of the opposition, but also by chance, with luck and because of something even more perverse: people and teams hover either side of their average level of play, and there’s a natural tendency to swing back and forth. A poor performance is statistically highly likely to be followed by a better one, and vice versa.

In the absence of research, and the presence of this complexity, the best approach sounds like a willingness to learn from one’s coaching mistakes, to reflect, to develop a range of strategies, and critically, to observe how players react moment-to-moment in one’s conversations with them.  

A club culture emerges

The Class of ’92 presents the emergence of a new club culture, as old as the military rituals that seem to fuel it. Norms are established, and the conversations follow suit. They were not that far off from teaching the players to march. It’s like a traffic light system, with green and red lights flashed in front of panting players.  

This simple approach to motivation and behavior change has been roundly criticized in school education, primarily because the drivers are external to the students, when many teachers know that the challenge is to inspire, model and elicit internally-driven motivation to change.  Good relationships are seen as the foundation for all else in the effort to approach, withdraw, reconsider, and start new conversations that seem to be really helpful. Ricky Ponting, emerged from his cricket captaincy into retirement and said,

“The biggest part of captaincy for me was understanding personalities. We all know how important communication as far as captaincy or leadership is concerned. But you can't communicate well with people until you UNDERSTAND how to communicate well with them. I could sit in a team meeting and deliver the greatest tactical speech of all time but half a dozen guys would interpret what I would say in different ways, so I had to understand the personalities to get deep inside them to get the best out of them.”

 And here, in this emerging club culture, the young men absorb the rules and try make headway.  They learn to shout back, yell at and criticize each other, just like the coaches do with them.  Perhaps not surprising then to find that the coaches’ main criticism of the striker was that he was criticizing his teammates on the pitch.  James Baldwin captured this well: “Children have never been very good at listening to their elders, but they have never failed to imitate them”.

Some questions to answer

If this is a model of good practice in coaching, the subject of bullying might need attention. Bullying is commonly defined as a repetitive physical, verbal or social act intentionally designed to be hurtful, in a relationship where the perpetrator is in a superior position.  Celebrity co-owner Ryan Giggs seemed to notice this: “They are aggressive and close to crossing that line”.

Exploitation also raises its head. Another co-owner Phil Neville notes, “They (the coaches) wanted everyone to run through a brick wall for them…. I think we’re at the ruthless end of football… if you don’t play them (in a match), you don’t pay them, you don’t have to give them contracts…. There’s no security whatsoever…. You’re just a piece of meat.”

Players or people?

Perhaps this all comes down to another choice of lens: are they viewed as players or people? The latter is probably closer to the front end of current coaching wisdom than the former, and carries as responsiveness to individual needs visible in The Class of ’92 only very occasionally, and not from the coaches themselves. Yet.

Lifting motivation

Some of the strategies on display in this documentary, like confrontation and fear induction, might well be used by coaches elsewhere with skillful timing and perhaps with a stronger emphasis on engagement beforehand.  As for alternative approaches to confrontation, their breadth is as wide as the decades coaching wisdom, associated stories and textbooks will allow. What unites them is probably at least an emphasis on building relationships and on using a wider range of communication styles in response to diverse players’ needs.

[stephenrollnick]

Jason Gillespie and a pact to do nothing

The righting reflex is alive and well in sport, as is the wisdom to withhold it.  Have a look at Jason Gillespie’s pact agreed with his coaching team below.  

Expert-driven advice can confuse

The righting reflex is a phrase developed in motivational interviewing to describe the sometimes irresistible urge among experts to solve complex problems for the people they serve, whether this be a doctor giving dietary advice, a counselor talking about addiction, or a probation officer telling someone how to stop re-offending.  It’s well intentioned, and often elicits confusion and resistance.

In cricket, the execution of technique is a finely balanced thing. Tinker with one part and others are affected, including the mind. The answers don’t always lie in the expertise of a coach, but in the players themselves.  Motivational interviewing involves conducting a conversation so that the wisdom and motivation to solve a problem are drawn out of the other person, if its needed or wanted.  Advice-giving never predominates over engagement and the affirmation of strengths.

What’s lovely about Jason Gillespie’s pact is the decision to do less, not more, indeed nothing, with Jonny Bairstow’s batting technique.  The wisdom to say nothing as a coach sounds a bit like removing just a small brick from a dam and allowing the water to flow through. Then Jonny Bairstow batted like a dream.

‘So we made a pact…’: Jason Gillespie’s coaching decision

“So we made a pact: the Yorkshire coaches – myself included – agreed we would not speak to him about his method ….No longer would he have support staff stopping him every second ball in the nets, telling him to change his grip, stance, backlift or alignment. Instead, the only advice would be when he sought it and based solely on his gameplan for any given day…… Ultimately we have backed Jonny to take responsibility for his own game and the results are there to see.”  Jason Gillsespie, Yorkshire cricket coach http://www.theguardian.com/sport/blog/2015/jul/20/jason-gillespie-column-england-jonny-bairstow-talent-ashes-recall

[stephenrollnick]

Good on you, Andy Murray  - May 2015

What are helpful conversations like for elite sportspeople?   Here’s Andy Murray unpacking the limitations of “macho talk”:

"I've found it difficult to open up sometimes as you feel judged or that it's seen as a sign of weakness. Sometimes, when we're competing and working out, trying to be macho, it can get a bit testosterone-fuelled. I've ended up having some big arguments.  I don't feel like I'm competing with Amelie (his female coach). When we're talking, it's more of a collaboration."

http://www.bbc.co.uk/sport/0/tennis/32779092

[stephenrollnick]

Kevin Pietersen and the art of not listening – April 2015

Things happened.  There was lots of action, reaction, years of it, a poor outcome, and how much listening took place? 

If a governing body, coach or captain meets a problem with a player, the initial responsibility lies with them to repair the damage.  Skillful listening can go a long way.

How much of the following went on?  A person behaves in a way that’s hard for others to accept. Happens every day.  The person gets blamed, labeled and confronted. The reaction?  Ask anyone whose felt blamed and shamed.  Ask a school kid, or a recently divorced person. You protect your self-esteem and pride, and defend yourself.  This leads to further confrontation, denial, counter-attack, and so the cycle continues….

Could this pattern be avoided by a manager or coach?  Engage and connect and establish trust as a first step?  Then have a look together at the way ahead?

This approach is simple

and

difficult, requiring conversation skills that reach beyond confronting, to the use of listening to connect, establish trust and draw out from the person how they see change happening for the good.  Did anyone do this consistently, and in a caring manner with KP?  It might not be too late to try.  The harder the problem, the softer is the style that might be necessary to solve it.                   

[stephenrollnick]

Free resource for trainers in MI

An old friend from San Francisco, Steve Berg-Smith, put decades of experience as a trainer into this handbook on the spirit and skills involved in working with groups of people to learn MI. There’s even a competency checklist for rating yourself and others in an appendix. Then he gave it away free, and you can download it here: http://www.stephenrollnick.com/resources/The%20Art%20of%20Teaching%20MI%201.1.pdf.

Many many thanks Steve

[stephenrollnick]

“Can you teach people to listen?”  “Are we born able/ unable to empathize?”

I got asked it again, in public.  “Are some people born unable to listen?”.

My brain has been bent with this kind of question countless times in public exchanges, when I always seem to stumble for a simple, clear answer.  “Why cant some of my students grasp the value of listening?”; “Why do those doctors seem like they were born unable to empathize?” or the worst of all, “Is the ability to listen genetically inherited with some people born unable to do it?”

I tend to freeze, because the question is so naked, and clearly borne of frustration, which we have no time to explore. Rather, I must provide the answer.

Then, like one of those dogs that freeze in front of you then yap away when your back is turned, I end up talking to myself afterwards, to find that answer.

So here’s a quiz of sorts:

Are you human?  If yes, then do you know that feeling of being curious about something, about another human being? If yes, then do you sometimes enjoy speaking with people about their lives?  If yes, then you can empathize. Period.

If a practitioner’s mind and heart are so cluttered with other things, then those things need attention, a sort of de-cluttering and cleansing process. When my daughter was 12 we taught her to use reflective listening, and she had no difficulty?  If Dr Ng in Singapore could do it, why cant everyone? She said that it actually saved her time? 

You can also check me using these skills on the free BMJ module, for better or worse…. http://learning.bmj.com/learning/module-intro/.html?moduleId=10051582

[stephenrollnick]

Wonderful use of righting reflex...

Check this reply from friend about my desperately unsuccessful attempt to ride 6ft waves in Hong Kong:

"Will you stop your moaning, you winging old fart. Commit to going to the pool and you are more than half way there. Work on the core at home and you will be back before you know it. As I am a fitness manager I can pop over and show you the way to eternal happiness in the surf. Peace be upon you Master Jedi. Mikey"

Mikey Buchanan Fitness and Wellbeing Manager

[stephenrollnick]

From the consulting room to public health efforts to promote change

I gave this talk at a large conference 30th October about the need for people to improve their lifestyles, and tried to do something I’ve avoided for some time – traverse the world of the consulting room and see what can be taken over into public health efforts. Not sure I succeeded, but it’s a start. You can find the talk and slides here:

http://www.stephenrollnick.com/healthy-ageing-conference-2014.php

[stephenrollnick]

Conversations in schools

I am writing a book on MI in schools, for teachers, and had the experience, for the first time, of receiving a teacher who had registered for one of my Cardiff workshops.  Quite why I and others came so late to the potential of MI in this setting is an interesting question. The synergy is almost complete, with both education and MI being about growth and change.

I asked workshop participants to mail me the day after the workshop with any stories about how their use of MI had impacted on their lives.  The teacher sent this reply:

Today I met with a 15 year old boy who is at risk of exclusion from school. Essentially he is sick and tired of being told what to do and how to do it.  I practised the skills I learnt from the workshop and he came up with two sheets of flip chart papers on next steps for change! He said he felt listened to and inspired to take the next steps.  Bravo.

No need for me to discuss synergy between MI and school teaching – the story says it all.

[stephenrollnick]

Sport and more sport

If ever there was a field where conversation is used to promote change its this one, and its here too where yelling and instructing to motivate people reaches unimaginable heights.  Passionate, yes?  Effective, ehm….. sometimes.  If it is well-timed, and the coach has a good relationship with a player, instructing can work very well.

Then there are other ways of talking about and promoting change that are more subtle, about unlocking potential, a far cry from the yelling you can sometimes observe when children play a team sport in the presence of adults. Parents are often the worst offenders, falling pray to what in the motivational interviewing field we call the righting reflex: see a problem, then just tell someone how to fix it. Effective only under certain circumstances. Best not used as a default coaching style.

What might MI offer sport?  Conversation skills to refine what good coaches do on a daily basis, and: to avoid the more clumsy use of the righting reflex; to improve personal engagement with a player; and to bring out their internal motivation to change. To solve a problem without engagement will be looking for trouble. Rapid engagement is a skill that can transform even very brief conversations.

Anyone in a helping role, including players themselves, can learn to sit down with a player and talk about change in a constructive way. This could not only help with the obvious prevention of personal difficulties like addiction and other stress-related problems, but be used to help players work out for themselves how and why they might change. That’s the essence of MI.

[stephenrollnick]

Harper High – MI in a high-deprivation school

Schools and MI are fundamentally concerned with growth and change, so its something of a puzzle why it has taken so long for the use of MI to be explored in this setting.  

I visited Harper High School in South Chicago, a majestic old building in a neighborhood facing grinding poverty, violence and collapse.  There are as many abandoned or destroyed homes as there are living ones.   Harper High has received its share of troubles, media attention (see http://www.thisamericanlife.org/radio-archives/episode/487/harper-high-school-part-one) and even a visit from Michelle Obama.  Can MI be of help in this environment?

My good friend Richard Rutschman, an MI trainer and champion of restorative justice, spends a morning each week in Harper High with the students who are most vulnerable to failing grades, dropping out and violent gangland culture.

Richard uses MI either side of adventure games and enjoyable activities, and has has little doubt about good outcomes.  His stories are remarkable accounts of how gentleness and skillful conversation can foster growth and change for young people in deep trouble in a world that is tough beyond imagination. 

In Harper High School MI appears to cross cultural boundaries with ease, and its use in schools more widely is clearly on the horizon, not just with students in trouble of some kind.  Richard and I have teamed with Sebastian Kaplan to write a book on MI for teachers and administrators. There are many ways MI can and probably will be used in education.  Just as in criminal justice, MI rubs up against the use punishment, and offers a route to change that focuses on the use of compassionate listening to give voice to what students really want.

It is remarkable to come across Harper High School using MI, because the school faces no shortage of pressure to discipline, in a neighborhood where anarchy, police intervention and chaos are a constant presence. Richard finds this not at all strange, because his call is to search for ways of helping the students grow up and out of dire straights.  He talks with pride about the values that drive the mission of the school.  MI is merely the conversational front end of something more fundamental: a view that unless you truly value young people and show respect for their ability to change, little of substance will change.  

[stephenrollnick]

From specialist problems to human growth

That’s a very lofty title for a report.  My apologies. It arises from frustration.

I have lost count of the number of enquiries I’ve had like this: can motivational interviewing be used for our patients/clients who have this condition or that problem? I was at a large meeting in Stockholm about sexual health, another about asthma, then another around sickness benefit applicants, and the same old question raised its head: can motivational interviewing be used to support behaviour change in our setting?

Specialist thinking has its drawbacks.  There’s a tendency to view our client group as a little on the unique side.  This is bound to happen if you see patients as collections of problems and pathologies.  If however you focus on commonalities rather than differences, on strengths rather than weaknesses, a different picture emerges: all people face struggles with change, whatever they are.  We all talk with other people about this.  How those conversations proceed can make a big difference.  Motivational interviewing is merely one way of having this conversation, and its momentum comes from working with peoples’ strengths and own motivation to change, whatever the issue, problem or challenge they are faced with. Its that simple. 

Seen in this light, it matters less what the problems are, more how people are given some gentle space to consider change, and how you can use the privilege of your role as a helper to promote this.  One of the most clattering obstacles is the refrain, “Oh but I don’t have time to do this stuff”. That’s the subject of another posting.  All I’ll say now is that a few carefully chosen words, spoken in an atmosphere of acceptance, are probably worth more than many mouthfuls of busy talk.

Motivational interviewing gains little momentum or effectiveness if you only think about problems.  By way of illustration, consider the difference between these two accounts of the same person:

"She’s 46, female, 2 children, second marriage; chest infection; obese for many years; leads an inactive life.  She’s a moderate to heavy drinker, smokes, and has a diet that is high in fried food, with little fruit or vegetables."

   or

"She’s 46, an account manager and mother of two; very determined person.  Its her second marriage, and she keeps a keen eye on her children’s well-being.  It’s a happy house.  They work and play hard. She feels unwell with a chest infection.  She has lots of friends, smokes and drinks in the pub, and gets little exercise.  She likes to make sure everyone has a good filling meal, and this often means fried food."

In one sense you have a choice about which of these two people you feel like working with.  Motivational interviewing wont get off the ground unless we allow the human spirit in the second account to grow and develop.

The questions you might ask will be less dependent on the person’s condition or problem, more on harnessing internal motivation:

What kind of change makes sense to you?

Why?

How might you achieve this?

What help or advice might you need from me?

How might you find a way through that feels comfortable and manageable?

All these questions lead to change talk (a positive voice for change), sometimes sustain talk too (a voice against change).  Using reflective listening in reply, with a keen eye on movement towards change, will evoke more change talk, and this is the heart of motivational interviewing.  It needs quiet patience more than lots and lots of time.  The content of this talk will vary across people, problems and settings; the dynamic of the change conversation will be more enduring.

[stephenrollnick]

It’s the same everywhere: listening saves time?

I’ve just travelled across cultural boundaries in a few countries and got the singular impression that practitioners and those they help value listening.  However, many say things like, I don’t have the time to listen like that, I have too much else to do”.   

That’s a topic worthy of reflection beyond the space available here.  Perhaps more instructive is a simple demonstration of the validity of this counter-intuitive idea: listening can actually save time, energy, resources and even lives.   Here’s a true and dramatic story, from Singapore, about one physician who listened and probably saved a life.

Dr Ng came to a workshop and presented a very difficult case of a man who was refusing life-saving dialysis.  A colleague (Dr Fiona McMaster) and I took this scenario and demonstrated the value of listening and rapid engagement. Two days later we were running another workshop in the same setting and Dr Ng, who was not with us, came bounding into the room and asked whether she could tell us what happened when she went back to see that same patient, just a few hours earlier.  Here is her story, which we filmed in a brief spontaneous interview. There’s a lot one can focus on in this story.  A doctor with a genuine desire to learn and receive feedback, is brave and humble, tries to improve her practice and willingly shares her progress with colleagues.  Self-determination theory would suggest that she satisfied her needs for competence, autonomy and relatedness, and her behaviour changed.  The listening involved was not a passive affair, it was focused and purposeful, it evoked change in the patient, and this saved time and much more.

[stephenrollnick]

A Ramble Through MI

Here is a talk i gave at the 3rd ISMI conference (International Symposium on MI) in Melbourne in May 2013.  It was designed to stimulate creative thinking at the start of the day……

[stephenrollnick]

Training for primary care practitioners in England: A challenging health check

People are being invited into primary care for health checks in many parts of the United Kingdom.  The people delivering them come from diverse backgrounds. Some are nurses, others are not in a clinical profession.  Not all the patients are easy to interview.  

I ran a workshop in England and they asked me to demonstrate rapid engagement, just the first few minutes of the interview.

I did this with a simulated patient, “Henry” whom I hadn’t met before, who was deliberately playing the role of someone who would be difficult to interview in a health check.  Henry was monosyllabic in his manner and behaviour, clearly unhappy about being there.  My assumption was that he was feeling ambivalent.

My goal was to engage with him first, before getting down to any measurements and other things in a health check.  I proposed to the workshop participants that we follow the “20% rule”: you spend the first 20% of your time only on engagement, and nothing else…  so here is how it went, warts and all.

[stephenrollnick]

MI presentation at MPS workshop, Feb 2013

Stephen Rollnick MI presentation for MPS Feb2013