Diversity, inclusion, compassion, integrity and mindfulness are some of my core values as an individual, trainer and clinician. The values of inclusion, compassion and mindfulness have driven me to the mental health field and to motivational interviewing. The values of diversity and integrity drew me towards the social justice field and to facilitating diversity dialogues. Cultural Humility (CH) and Motivational Interviewing (MI) seem like a natural fit to me. They compliment each other, and when combined I think that these two concepts make each other more whole and more effective.
One of the most important and most rewarding roles of a supervisor is supporting staff in their development by facilitating a staff's self reflection. In a clinical setting, this often means supporting staff in looking inward to identify both strengths and areas of growth. A good supervisor is able to guide a staff member in this reflective process and ultimately support a staff member in developing a plan to change their approach or actions in some way that improves their performance, self efficacy or outcomes. While supporting a staff in this self exploration can seem simple, it is one of the most challenging tasks that supervisors face.
Agenda setting is an important part of the one-on-one supervison meeting. Agenda setting is "a short focusing metaconversation in which you step back with the client to choose a direction from among several options" (Miller and Rollnick, 213). When used in a one-on-one supervison meeting (referred to in this article simply as "supervision"), this term refers to a collaborative conversation between the supervisor and the supervisee about what supervision topics are important to talk about. Ideally this conversation ends with a prioritized list of topics for supervison that is agreed to by both the supervisor and supervisee.
As an MI enthusiast, I am always seeking opportunities to practice OARS skills. As a supervisor of 8 clinicians, the primary way that I interact with individuals one-on-one is during supervision, so it naturally fits that I have taken advantage of this time to practice the use of OARS. At first this practice was clumsy and awkward, and after about 6 months of practicing this 8 times weekly, it continues to be challenging yet rewarding. I find that when I am able to use OARS with staff, it helps them to develop their inner locus of control, builds their perceived self efficacy and helps to strengthen the relationship between supervisor and supervisee. I have found that using OARS with staff is the most efficient way of communicating information and the use of these skills yields better results from the supervision conversation.
I had the opportunity to attend a lecture by Dr. Miller in September of 2014 at Washington University in St. Louis that focused on the recent trends in opiate abuse. Speakers present at this lecture discussed the demographic shifts in opiate abuse, the underlying economic drivers that contributed to the issue, and the need for an increased focus on this crisis among medical professionals. Dr. Miller was the final presenter and he focused solely on one concept: Empathy.
Motivational Interviewing teaches that the natural helping instinct of jumping to problem solving is anything but helpful. Solving problems for others can take away autonomy, deplete another's sense of self efficacy and deprive an individual of lessons that can be learned through failures and successes alike. When a clinician solves a problem for a client, the solution imposed onto the client tends to be more generic and less of a good fit. The client is less likely to follow through with the solution. Even if the solution is carried through, the client will not get credit for it; if the solution works the client will credit the clinician, but if the solution fails the clinician is to blame. Fixing problems for clients damages the therapeutic alliance, violates a client's autonomy and does not promote healthy interdependance in a client. Problem solving often comes from a clinician's drive to help, but it can ultimately harm the client.
I was engaged in a discussion with a colleague a few weeks ago about staff training, supervision and leadership. During the course of this conversation one of my colleagues asserted that the ability to be a good supervisor is due to innate qualities in an individual and could not be taught. The idea was that "you either have it or you don't," when it comes to supervisor and leadership skills. This idea really struck a nerve with me and I found myself adamant in the defense of the view that supervision represents a large range of skills and strategies that can be taught, learned and developed within an individual.
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.
Jesse Jonesberg (Berg) is a mental health professional, field instructor, trainer, and MINT member. He is passionate about issues of mental health, cultural humility, compassion, and motivational interviewing.
Jesse Jonesberg (Berg) is a member of the MINT network and active member of the MINT IDAC.
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