Negative Practice

Abstract: In preparation for teaching an interpersonal skill, trainees experience first-hand what happens when the opposite approach is taken.

Overview: This exercise is designed to raise trainees' awareness of common responses that are not reflective listening or motivational interviewing, and how they can obstruct motivation and change.

Guidelines: Provide a lot of structure for this exercise so that trainees dont wander off. Allow only about 5, no more than 10 minutes per exchange once practice begins. The usual format is to use dyads, with one person as a speaker and the other as a counselor. Give the speaker a specific topic or role appropriate to the exercise. This tends to work better when the speaker talks about personal material rather than playing a prescribed role. Give the counselor clear and specific instructions, so that he or she doesnt wander off into a natural style. The exercise can be (but doesnt have to be) repeated, with the two switching roles. When it is over, debrief, asking for reactions and observations from the speakers perspective in particular, but also from the counselors perspective. Common speaker reactions are fight or flight: feelings of frustration, anger, withdrawal, giving up, etc.

Negative Practice Example 1: Roadblock Exercise (based on Thomas Gordons twelve roadblock responses)

* Have people pair up in dyads and decide who will be the first speaker. Explain that both people will play both roles.

* Assign the speaker to talk about "Something I feel two ways about." Ask the speakers to choose a topic that they are comfortable sharing, but that has important meaning for them at present (not "I feel two ways about walnuts").

* Explain that the speaker's job is to explain this dilemma, and the counselor's job is to fit in, within a relatively short space, as many of the twelve roadblocks as possible. (It is helpful to have a handout or display of the roadblocks to which the counselor can refer.) Without further ado or discussion, say "Begin."

* After about 5-10 minutes, interrupt and have the two switch roles.

* After about 5 minutes more, interrupt again and debrief. What was it like for the speaker trying to talk about ambivalence? How did the speaker feel? How did the counselors do at fitting in the roadblocks? What are the underlying messages conveyed by roadblocks? [e.g., "Listen to me, I know the answer." "What you have to say doesn't matter."]

Twelve Roadblocks to Listening
(Thomas Gordon)

1. Ordering, directing, or commanding
2. Warning or threatening
3. Giving advice, making suggestions, or providing solutions
4. Persuading with logic, arguing, or lecturing
5. Moralizing, preaching, or telling clients what they "should" do
6. Disagreeing, judging, criticizing, or blaming
7. Agreeing, approving, or praising
8. Shaming, ridiculing, or labeling
9. Interpreting or analyzing
10. Reassuring, sympathizing, or consoling
11. Questioning or probing
12. Withdrawing, distracting, humoring, or changing the subject

Negative Practice Example 2: Persuasion Exercise

This is an exercise for dyads, in which one person is the speaker and the other the counselor. The speaker talks about a topic of ambivalence B something he or she is thinking about changing, or "should" change, or might want to do. The counselor uses a variety of methods to try to directly persuade the speaker to make the change. It is important to instruct the audience that this is not motivational interviewing, and that the counselors are not to be empathic listeners in this exercise.

Speaker role: Identify a change that you are considering, something you are thinking about changing in your life, but have not definitely decided. It will be something you feel two ways about. It might be a change that would be "good for you, that you should make for some reason, but have been putting off. Tell the Counselor about this change you are considering. [Trainer: Speakers, this time I would like you to talk about something you have been thinking about changing in your own life. It could be a habit, attitude or behavior, but it should be something you havent changed yet. Maybe its something that would be good for you, or that you think you should change. It should be something you feel comfortable sharing -- not your deepest, darkest secret, okay? Any questions about that?]

Counselor role: Your task is to try as hard as you can to convince and persuade the Speaker to make the change that he or she is considering. (This is nota motivational interviewing exercise.) Fit in as many of the following persuasion tactics as you can in the short time allotted:

- Ask Questions. Why hasn=t the Speaker made the change? What stands in the way of making the
change?
- Advise. Directly advise the Speaker make the change, and discourage him or her from delaying
or not changing.
- Explain why it is important for the Speaker to make the change.
- Warn the Speaker what may happen if the change is not made.
- Make Suggestions as to how the Speaker could go about making the change.
- Direct or tell the Speaker what to do, perhaps in should or must language.
- Refute. Disagree -- offer logical counter-argument -- if the Speaker resists or gives excuses.
- Analyze what the Speaker=s real issues or conflict may be. Give your interpretation of why the
Speaker hasnt changed.
- Reassure the Speaker that he or she will be successful in making the change.

The exercise can also be done as a role-play in which each participant is assigned a situational identity.

Notes:
This exercise is usually a lot of fun, and the room can fill up with hilarity as trainees become more outrageous in their negative practice. Monitor the level of energy in the room, and end the exercise while it is still high. Its important not to let this one run on too long. The point of the exercise is realized quickly.

Trainees who are very committed to the method that is being used in a negative practice exercise may argue that the approach was very effective for them, that their practice session went well and would have elicited change, etc. Substantial time can be used and ill will generated if the trainer takes an oppositional approach here (which also fails to model the clinical style of motivational interviewing). One good approach is a brief acknowledgment of style differences, perhaps a reframe, and then move on. A pretraining Skill Assessment can be useful before the roadblock exercise. To do this, distribute a questionnaire before you begin to discuss reflective listening or roadblocks. The questionnaire contains 6- 10 statements that might be made by a client or friend who is talking about personal material. Trainees are asked to write the next thing they would say in response to these different statements, restricting themselves to one or two sentences. If this has been done earlier, trainees can examine their own questionnaires at this point to determine which of the roadblocks they are most likely to use.

ALTERNATIVE:
The exercise can be done as a role-play in which each is assigned a situational identity, as in the
scenario below.

NURSE'S ROLE

The Situation. You are a busy occupational health nurse. Your company has encouraged you to conduct health screening among the employees. Having done this, you are feeding back the results of a health screen to an employee. You only have about 10 minutes for your first discussion with this person.

The Client. This person is clearly overweight, also smokes, and drinks about 6 beers a night. Both blood pressure and cholesterol are elevated, and you are very concerned about this person's diet and weight. The employee is married, has 3 children, and has been working with the firm for 15 years.

Your Task. Try as hard as you can to persuade this person to do something about his or her diet, smoking, or drinking. This is a serious matter, and you do not have a lot of time. It's not your job to be a "therapist"; rather, you are paid to be a competent, concerned, and forthright health practitioner.

EMPLOYEE'S ROLE

The Situation. You filled out a health questionnaire at work, and had a blood pressure reading and blood test as part of a company-wide effort to improve employee health. Now you have been called in to see the company nurse. You have been a hard-working and loyal employee for 15 years. You're not looking forward to this session, because you know you are overweight, besides which you will probably be told to quit smoking, but you don't think there is anything you can or want to do about it.

Your Home Situation. You lead a busy life, and have a spouse (who also works) and 3 children. You don't have much in the way of recreation, besides going out for a meal and some drinks with your spouse and friends on Saturday nights. You drink a 6-pack of beer most nights, but don't see this as a problem. You like your food, and though you are a bit overweight you're not really concerned about it.

The Session. Though you're not looking forward to the session, you don't plan to be rude to the nurse. You have only 10 minutes to talk, before you have to get back to work.

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from Motivational Interviewing Training for New Trainers (TNT), Resources for Trainers, http://www.motivationalinterviewing.org/