Incorporating Motivational Interviewing Into the Supervisory Toolkit

As a supervisor at a community mental health clinic, I am often put in the situation of needing to follow up with a staff member about their performance regarding a problematic behavior. Addressing problematic behaviors with staff is a challenging aspect of the supervisory role, and I have struggled over the past several years to identify ways of helping staff change these behaviors in way that is effective and models good use of the MI spirit.

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When a problematic behavior is identified, the supervisor is called to somehow get the staff member to change their behavior in order for the staff to meet the expectations of the job. In my line of work the problematic behavior (or lack thereof) usually falls into one or more of three categories: 1) problems in the provision of clinical care, 2) low performance in terms of productivity (i.e. billable hours worked per week), or 3) subpar, incomplete or late paperwork.  All three of these types of issues can be difficult for staff to change and pose a unique set of challenges to the supervisor in addressing them.

Traditional supervision trainings that I have received encourage some form of the "coaching" method in helping staff change behaviors to meet expectations. The coaching process typically includes the following:

1. Identify the issue of focus
2. Present supervisor perspective
3. Ask staff for their perspective
4. Identify how the issue of focus impacts the company, staff and clients
5. Develop a plan to change the problematic behavior with a follow up date
6. Send an email to the staff later that day summarizing the conversation

Over the past 2 years that I have been a supervisor employing the above method of helping staff change behaviors, I have very few examples of the process actually working well to create behavior change. The above described method does however constantly produce at least one of the following immediate behaviors: defensive posturing, withdrawing from the conversation, and crying. It is hard to measure the impact of the conversation on the staff's behavior over the long term, but I am skeptical that the process of coaching has played a leading role in any of my staff's behavioral changes. 

I have been trained to use the coaching tool, which on its face seems to be deficit-based, driven by extrinsic motivations and puts the staff at odds with the supervisor. In fact the coaching conversation can seem to model behavior that is the direct opposite of what the clinical supervisor expects the staff to use with clients. However, I believe that the structured process of coaching itself is not bad, but it is the implementation of this process along with the relationship that the staff and supervisor have that determine the outcome. 

The coaching conversation is just one example of supervisory tools that supervisors (like me) use to support our staff. Many of these tools are taken for granted by supervisors who may think, "everyone uses these methods so they must work." We know that MI is the most effective way to help another create behavior change, and we genuinely want change in our staff. This calls upon us to examine the long-standing traditional methods and tools we use to help our staff succeed and meet client and agency expectations. The coaching conversation is one of the more blunt tools in the supervisor's toolkit, and it seems opposed to many aspects of MI. It is my hope that with a few modifications and some additions the coaching method can be brought into line with the spirit of MI in order to model behavior for staff, strengthen relationships with staff and most effectively produce change in problematic staff behaviors. Over the next few blog entries, I will be exploring ways of integrating the skills and spirit of MI into the coaching conversation and tools in the supervisory tool kit.

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