Team Consult Warm-Up

''The following exercises can be used to develop most any complex skill in motivational interviewing. They can work in strengthening closing skills, but could be used with earlier skills as well.''

Abstract: This is a warm-up to the “Team Consult” exercise, designed to allow trainees to psychologically prepare themselves for the role-play by “exercising their empathy muscles” and then brainstorming ways to use MI with a difficult or challenging client. Overview: The Team Consult Warm-Up blends the process of a classical psychodrama with the group facilitation techniques of a Balint supervisory group. The process should be open and flexible within the following suggested structure.

Guidelines:
1. Introduce the Team Consult exercise.
2. Identify a participant who would like to volunteer a difficult or challenging client. Once the Volunteer is identified, instruct the Volunteer to provide some basic information about the client, keeping in mind the importance of confidentiality and not relaying any identifying information.
3. Have the Volunteer identify the motivational challenge that s/he faces in working with this client. Examples of motivational challenges include: ways to lower the client’s resistance, identifying a focus for treatment, trying to engage a nonverbal client, etc.
4. Once the Volunteer has satisfactorily described the client, the group leader initiates a group discussion of the client. The suggested format for the discussion is as follows:
a. ASK FOR FACTS: The group leader instructs members that each one of them is allowed to ask one question of fact about the client, in order to gather further information and facilitate understanding. The leader’s job is to limit members to one question of fact and not allow the group to fall into a fact-finding mission. Once each member has had one turn asking a question, the group leader asks the Volunteer to step back from the group (literally moving his or her chair away) and to become temporarily an observer of the group process whose job is simply to listen to the upcoming discussion.
b. EXERCISE EMPATHY: The group members are instructed to figuratively become the client and, one by one, to speak what the client is thinking and feeling. The goal is to have group members identify with the client’s experience in order to facilitate empathic understanding. The group leader’s job is to model the use of empathic understanding and reflective listening in a group process, in order to facilitate group cohesiveness and a mutual understanding among group members of the client’s internal process. The group leader may offer reflective statements and summarizations of individual members’ statements, or of the communications of the group as a whole. Once the leader senses that the group has offered a sufficient number of empathic statements, the leader can offer a grand summary to shift this part of the group process.
c. IDENTIFY MI TOOLS: The group now shifts to a brainstorming and problemsolving approach. The leader instructs group members to identify the motivational challenge the client presents, and to discuss how MI could be used to address this client’s needs. The job of the leader is to facilitate the group process by maintaining a flexible MI focus and encouraging not only ideas but also specific MI strategies that could be used to help the client. The group leader should model OARS in addition to eliciting specific MI strategies identified by group members. The leader can then end the discussion with a grand summary of the member’s perceptions of the client and the MI strategies identified as potentially helpful.
d. BRING BACK THE VOLUNTEER: The leader then invites the Volunteer to return to the group and offer his/her thoughts and reactions to what s/he heard in the group process. The Volunteer will be asked to give his/her impressions of what s/he believes would be helpful to the client after having heard the group discussion. The leader should model the use of OARS and incorporate the Volunteer’s reactions into the reactions from the group as a whole.
e. SHIFT TO TEAM CONSULT: At this time the leader shifts to the team consult exercise. It is suggested that the Volunteer play the role of the client and that other group members volunteer for the role of the therapist.

Notes: The Warm-Up can help participants deepen their capacity for empathy with difficult clients in general as well as preparing the therapist for the team consult to follow. It has also increased the sense of group cohesion among trainees and can be reenergizing toward the end of a long workshop.

Thanks to: Tad Gorski and Allan Zuckoff
http://www.motivationalinterview.org/mint/MINT12.1.full.pdf