Motivational Interviewing : An Approach To School Based Mental Health

The delivery of school based mental health services should be on the forefront of every school psychologist’s mind in the state of California. When then Governor Arnold Schwarzenegger vetoed funding for AB3632 in October 2010, he ended a 25 year history of County Mental Health providing service to special education students who needed such support to receive educational benefit. The onus of responsibility for providing these services has now shifted squarely onto the shoulders of Special Education Local Planning Areas (SELPA), and as the school staff member with the most knowledge and skills related to mental health assessment and intervention, school psychologists are likely to be called on to help fill this need.


Introduction
Fortunately, as the role of school psychologist is expanding, resources are increasingly available to assist us in developing the necessary knowledge and skill related to the delivery of school based mental health services.

The Spirit Of Motivational Interviewing
MI is not a series of "micro skills" but rather a way of being and interacting with students that is consistent with a particular "spirit" or "guiding philosophy" (Miller & Rollnick, 2002;Rosengren, 2009).The three aspects of this "spirit" are collaboration, evocation and autonomy.Our role as the school psychologist is to collaborate with the student.We are their partner in the process not the "expert".In fact, the student is the expert because they know more than anyone about their own history, motivating factors, and obstacles to change.Consistent with this sense of collaboration, our aim is to evoke or draw out from the student both their reasons for change (motivation) and ideas about possible solutions to the problem.And lastly, we must keep in mind and convey to the student that they are autonomous in their decision to change.No matter how much we may want to, we cannot force a student, or any other person for that matter, to things "our way".This may be even more important for adolescents for whom developing autonomy is the core developmental stage.

The Guiding Principles Of Motivational Interviewing
In addition to the spirit of MI, it is essential for a school psychologist to ground themselves in certain guiding principles.These principles include expressing empathy toward the students, supporting the development of self efficacy, creating a perceived discrepancy between the student's values or goals and their current behavior, and rolling with resistance when it arises (Miller & Rollnick, 2002).
MI is a client centered approach rooted in a true sense of empathy for the student and their experience.This requires that we really listen to students, a skill that sounds simple but in reality requires a great deal of practice.Listening involves accepting the student's perspectives and feelings as they experience them even if we don't agree, for example.
In addition to empathy, we must support the student's sense of efficacy when it comes to solving their problems.A student may perceive change as necessary but at the same time not perceive themselves as capable of change.In MI our goal is to empower students by helping them to perceive themselves as capable, see that they Therefore, our aim is to resist this "righting reflex" and rather than offering reasons for the student to change, we roll with resistance by siding with the student (Miller & Rollnick, 2002;Rosengren, 2009).And again, because of the student's ambivalence, when we join them in siding with the status quo, and perhaps even overstate the argument in absolute terms, they respond by taking the other side and arguing for change (e.g."well sort of, but…").

The Oars Of Motivational Interviewing
OARS is an acronym for the micro skills involved in MI, and for that matter most other counseling approaches.OARS stands for Open-Ended Questions, Affirmations, Reflective Listening, and Summarizing.Since these skills are foundational to other client centered counseling approaches, and it's likely that you are already familiar with and perhaps even using these techniques as a school psychologist, I won't describe them in much detail here.What separates MI from other client centered is the directed use of OARS to move the student towards "change talk" and away from "sustain talk" (Miller & Rollnick, 2002;Rosengren, 2009).

Facilitating Change Talk Through Motivational Interviewing
Perhaps the most unique contribution of MI is the focus on eliciting "change talk" (Miller & Rollnick, 2002;Rosengren, 2009).When the student argues for change (i.e."change talk") they are more likely to take active steps towards making the change happen than if we as the school psychologist make the argument for them.As mentioned above, when we make the argument for change, the student's natural response (if they are feeling ambivalent) is to make the argument against change.If this goes on long enough, the student may actually convince themselves not to change.On the other hand, if we use OARS in a strategic manner to illicit change talk from the student, they end up 'arguing' the reasons that change is both necessary and possible, and name specific steps they can take to make the change a reality.
Broadly speaking, there are two stages to change talk, a) preparatory language and b) mobilizing language (Miller & Rollnick, 2002;Rosengren, 2009).Preparatory language includes statements about one's desire to change (e.g."I wish…"), ability to change (e.g."I know I can…"), reasons for changing (e.g."I would have…"), and need for change (e.g."I can't afford to do this anymore…").Mobilizing language on the other hand is commitment language, and one of the best predictors of whether or not change will happen (Rosengren, 2009).
Mobilizing language communicates intentions to take steps towards change such as "I will…", "I plan…", or "I started…".Below are some specific strategies for eliciting change talk.
Association of School Psychologists (CASP) is supporting its members by making school based mental health the focus of the 2012 CASP Convention and the 2012 issue of Contemporary School Psychologist.One of the unique challenges, however, that school based practitioners face in the delivery of mental health services is that we typically do not work with self-referred clients.In other words, a student is more likely to end up in our office because someone else referred them, not because they themselves are seeking help to create changes in their lives.Students referred by a parent or teacher may not think a problem exists, disagree with others regarding the source or impact of the problem, or feel content with the status quo.Any one of these factors may obstruct progress no matter what theoretical approach or manualized program that a school psychologist may use.The fact is that that positive changes in students lives may be less a result of any particular counseling tool or technique and more a result of the students own desire to change.When I reflect on my own experience, and the students I've worked with over the past few years, the primary difference between students who reached their counseling goals and those who did not is that those who achieved successful outcomes wanted to change, perceived themselves as capable of change, and took active steps to make change happen.These very characteristics are the targets of motivational interviewing (MI) and the strategies for bringing them out in a student is the topic of this article.
already have ideas and skills for bringing about solutions, and can create change once they decide to start doing so.Extrinsic rewards may produce temporary changes in behavior but true long lasting motivation comes from within the student and it is our job to learn about what motivates them.In MI we do this by learning from the student about their values, beliefs, goals and aspirations.We then motivate them by creating a discrepancy between their current circumstances and their core values.When confronted with a decision to change, it is natural that one feels a certain sense of ambivalence about the decision, and when we counsel students this ambivalence may come across as resistance to our efforts to help(Miller &   Rollnick, 2002; Rosengren, 2009).Our initial reflex when working with students is often to offer advice for fixing the problem.Examples include trying to convince the student they have a problem, arguing the benefits of change, telling them what they need to do, and warning them against the dangers of not changing.Unfortunately, because of the student's natural ambivalence, every time we make an argument for change, they may very well respond with an argument for the status quo (e.g."yea…but…").

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Ask the student to explore their values and goals and compare them with their current behavior ("what are some things that are really important to you?" and "So on one hand…and on the other hand…").Ask the student to rate their readiness (motivation or competence) to change on a ruler ranging from 1 to 10, and then probe for the reasons why they gave themselves that rating.("on a scale of 1 -10, how confident are you, if you decided to make the change, that you can make it happen.Imagine 1 means you're not confident at all and 10 is extremely confident", "why did you give yourself a 6 and not a 3 or 4?", "what would need to happen in order for you to be a 7?").ConclusionThis article provides only a brief introduction to the principles underlying MI and a few MI strategies that a school psychologist may use with students to instill a desire to change, build a sense of competence when it comes to making change happen, and mobilize the student to take action towards change.School psychologists reading this article are strongly encouraged to read William Miller and Stephen Rollnick's (2002) book Motivational Interviewing: Preparing People for Change.The author's come from a clinical background working with individuals struggling to overcome substance abuse; however, the principles and techniques have clear applications to working with students in schools.I also recommend David Rosengren's (2009) book Building Motivational Interviewing Skills: A Practitioner Workbook.In addition to providing a discussion of MI techniques, Rosengren provides wonderful