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Farrall june9- workshop xii

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Farrall june9- workshop xii

  1. 1. Being on the receiving end: Qualitative aspects of client experience in MI (with reference to some practice questions) Mark Farrall
  2. 2. My concern? <ul><li>The ‘turn to language’: </li></ul><ul><li>+VE (helpful?) : Quantitative, observable, codable, what is observed (MICO etc) links to outcomes, teachable skills (Moyers, elicit ChT) </li></ul><ul><li>-VE (less helpful?) : Only the words not the music, focussed on worker not client, danger of mechanic, emphasises cognition not affect </li></ul>Wagner & Ingersoll ‘technical & relational’
  3. 3. My concern? <ul><li>The ‘turn to language’: </li></ul><ul><li>+VE (helpful?) : Quantitative, observable, codable, what is observed (MICO etc) links to outcomes, teachable skills (Moyers, elicit ChT) </li></ul><ul><li>-VE (less helpful?) : Only the words not the music, focussed on worker not client, danger of mechanic, emphasises cognition not affect </li></ul>Wagner & Ingersoll ‘technical & relational’
  4. 4. My concern? <ul><li>The ‘turn to language’: </li></ul><ul><li>+VE (helpful?) : Quantitative, observable, codable, what is observed (MICO etc) links to outcomes, teachable skills (Moyers, elicit ChT) </li></ul><ul><li>-VE (less helpful?) : Only the words not the music, focussed on worker not client, danger of mechanic, emphasises cognition not affect </li></ul>Wagner & Ingersoll ‘technical & relational’
  5. 5. Some questions <ul><li>‘ Guiding’ as process vs. outcome? </li></ul><ul><li>‘ Equipoise’ – all workers (including me!) have aspirations for clients, but how does it affect practice? Interfering? </li></ul><ul><li>‘ Sustain Talk’ – explore or not explore? </li></ul><ul><li>Commitment talk (CtT): Sitges ‘false’ early CtT does not link to outcomes – how avoid generating false CtT? </li></ul>
  6. 6. Some questions <ul><li>‘ Guiding’ as process vs. outcome? </li></ul><ul><li>‘ Equipoise’ – all workers (including me!) have aspirations for clients, but how does it affect practice? Interfering? </li></ul><ul><li>‘ Sustain Talk’ – explore or not explore? </li></ul><ul><li>Commitment talk (CtT): Sitges ‘false’ early CtT does not link to outcomes – how avoid generating false CtT? </li></ul>
  7. 7. Some questions <ul><li>‘ Guiding’ as process vs. outcome? </li></ul><ul><li>‘ Equipoise’ – all workers (including me!) have aspirations for clients, but how does it affect practice? Interfering? </li></ul><ul><li>‘ Sustain Talk’ – explore or not explore? </li></ul><ul><li>Commitment talk (CtT): Sitges ‘false’ early CtT does not link to outcomes – how avoid generating false CtT? </li></ul>
  8. 8. Some questions <ul><li>‘ Guiding’ as process vs. outcome? </li></ul><ul><li>‘ Equipoise’ – all workers (including me!) have aspirations for clients, but how does it affect practice? Interfering? </li></ul><ul><li>‘ Sustain Talk’ – explore or not explore? </li></ul><ul><li>Commitment talk (CtT): Sitges ‘false’ early CtT does not link to outcomes – how avoid generating false CtT? </li></ul>
  9. 9. Some questions <ul><li>‘ Guiding’ as process vs. outcome? </li></ul><ul><li>‘ Equipoise’ – all workers (including me!) have aspirations for clients, but how does it affect practice? Interfering? </li></ul><ul><li>‘ Sustain Talk’ – explore or not explore? </li></ul><ul><li>Commitment talk (CtT): Sitges ‘false’ early CtT does not link to outcomes – how avoid generating false CtT? </li></ul>
  10. 10. Some questions <ul><li>‘ Guiding’ as process vs. outcome? </li></ul><ul><li>‘ Equipoise’ – all workers (including me!) have aspirations for clients, but how does it affect practice? Interfering? </li></ul><ul><li>‘ Sustain Talk’ – explore or not explore? </li></ul><ul><li>Commitment talk (CtT): Sitges ‘false’ early CtT does not link to outcomes – how avoid generating false CtT? </li></ul><ul><li>Does any of this matter? </li></ul>
  11. 11. Cognition ‘and’ affect <ul><li>False binary opposition – neo Cartesian </li></ul><ul><li>Demasio - emotional processes are indispensable for rationality </li></ul><ul><li>‘ fethinkel’: “a construct which has its origins in social interaction , is profoundly shaped by the social and emotional environment and which communicates on both a conscious and non-conscious level to shape behaviour.”[verbal or otherwise] </li></ul>
  12. 12. Does any of this matter? W C Speech & being Reflection & dialogue Speech & being (re)-experienced In dialogue with self Speech & being (re)-internalised “ spontaneous emergence of ChT w/in interpersonal context” (Moyers)
  13. 13. Put them together and what have we got? <ul><li>Non-judgemental, empathic, accurate reflections reciprocally generate safe, neutral, psycho-emotional space, enabling client not only to (construct) think about it but also feel about it – to be – and subsequently (re)internalise the altered. </li></ul><ul><li>BUT </li></ul><ul><li>It only works if the space is genuinely neutral – no worker agenda or aspiration intruding – so no generating of early false commitment talk by the client sensing the ‘demand characteristics’ of the social situation - ‘change’. </li></ul>
  14. 14. Put them together and what have we got? <ul><li>Non-judgemental, empathic, accurate reflections reciprocally generate safe, neutral, psycho-emotional space, enabling client not only to (construct) think about it but also feel about it – to be – and subsequently (re)internalise the altered. </li></ul><ul><li>BUT </li></ul><ul><li>It only works if the space is genuinely neutral – no worker agenda or aspiration intruding – so no generating of early false commitment talk by the client sensing the ‘demand characteristics’ of the social situation - ‘change’. </li></ul>
  15. 15. Put them together and what have we got? <ul><li>Non-judgemental, empathic, accurate reflections reciprocally generate safe, neutral, psycho-emotional space, enabling client not only to (construct) think about it but also feel about it – to be – and subsequently (re)internalise the altered. </li></ul><ul><li>BUT </li></ul><ul><li>It only works if the space is genuinely neutral – no worker agenda or aspiration intruding – so no generating of early false commitment talk by the client sensing the ‘demand characteristics’ of the social situation - ‘change’. </li></ul><ul><li>This view closer to Moyers ‘active role for forming & speaking language w/in a specific context as ITSELF being powerful [generative of Change Talk]’ </li></ul><ul><li>– social constructionist position, language ‘talking into being’, speech both ‘states and does’ (Austin) </li></ul>
  16. 16. A Hypothesis? Not telling you! (Yet)
  17. 17. A Hypothesis? Not telling you! (Yet) ( :
  18. 18. A Hypothesis? Not telling you! (Yet) ) : ( :
  19. 19. Group set up Observer Observer Observer ? LANGUAGE: same-language groups? Client Worker
  20. 20. The issue <ul><li>You are in a relationship where your partner is quite controlling of you – you are not sure whether to stay or go </li></ul>
  21. 21. An ‘experiment’?
  22. 22. An ‘experiment’? <ul><li>Group 1 ‘Guiding’ </li></ul><ul><li>Worker have specific goal re target behaviour and ‘guide’ to outcome </li></ul><ul><li> FEEDBACK </li></ul>
  23. 23. An ‘experiment’? <ul><li>Group 1 ‘Guiding’ </li></ul><ul><li>Worker have specific goal re target behaviour and ‘guide’ to outcome </li></ul><ul><li> FEEDBACK </li></ul><ul><li>Group 2 ‘Sustain Talk’ </li></ul><ul><li>Do NOT explore any ‘Sustain talk’ or ‘counter change talk’ </li></ul><ul><li>FEEDBACK </li></ul>
  24. 24. An ‘experiment’? <ul><li>Group 1 ‘Guiding’ </li></ul><ul><li>Worker have specific goal re target behaviour and ‘guide’ to outcome </li></ul><ul><li> FEEDBACK </li></ul><ul><li>Group 2 ‘Sustain Talk’ </li></ul><ul><li>Do NOT explore any ‘Sustain talk’ or ‘counter change talk’ </li></ul><ul><li>FEEDBACK </li></ul><ul><li>Group 3 ‘Equipoise’ </li></ul><ul><li>Worker NOT in equipoise, i.e. allow YOUR aspiration to enter the dialogue </li></ul><ul><li> FEEDBACK </li></ul>All be MICO !
  25. 25. Observers <ul><li>Watch for resistance, change talk, ‘sustain’ or counter-change talk </li></ul>
  26. 26. <ul><li>FEEDBACK </li></ul>
  27. 27. An ‘experiment’? <ul><li>Group 1 ‘Guiding’ </li></ul><ul><li>Worker have specific goal re target behaviour and ‘guide’ to outcome </li></ul><ul><li> FEEDBACK </li></ul><ul><li>Worker have NO specific goal and ‘guide as process’ </li></ul><ul><li> FEEDBACK </li></ul><ul><li>Group 2 ‘Sustain Talk’ </li></ul><ul><li>Do NOT explore any ‘Sustain talk’ or ‘counter change talk’ </li></ul><ul><li> FEEDBACK </li></ul><ul><li>2) DO explore any </li></ul><ul><li>‘ Sustain talk’ or </li></ul><ul><li>‘ counter change talk </li></ul><ul><li>FEEDBACK </li></ul><ul><li>Group 3 ‘Equipoise’ </li></ul><ul><li>Worker NOT in equipoise, i.e. allow YOUR aspiration to enter the dialogue </li></ul><ul><li> FEEDBACK </li></ul><ul><li>Worker in ‘equipoise’, i.e. you are NEUTRAL </li></ul><ul><li>FEEDBACK </li></ul>All be MICO !
  28. 28. <ul><li>FEEDBACK </li></ul>
  29. 29. Conclusions?
  30. 30. A Hypothesis? “ spontaneous emergence of ChT w/in interpersonal context” (Moyers) More TRUST More TIME Less False CtT Meaningful or authentic CtT
  31. 31. <ul><li>1: Guiding </li></ul>
  32. 32. <ul><li>2: Sustain Talk </li></ul>
  33. 33. <ul><li>3: Equipoise </li></ul>

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