We all have been there.  We think we have the perfect therapy materials together for the perfect goals.  Maybe, usually, we had a lot of fun putting the therapy materials together.

Then the student comes in… and the therapy session goes sideways pretty fast. Not only do we not “improve communication” but we may have provoked unwanted behavior or a negative emotional response.

When we have done everything that we can and things don’t go as planned, there is one more tool we all SLPs should have in their toolbox to get everything back on track. 

Motivational Interviewing 

Motivational Interviewing is a conversation that engages a student using their motivations in order to change behavior.

Motivational interviewing was first described by William R Miller, Ph.D. in 1983 to successfully treat alcohol addiction.  It was expanded upon by Miller and other colleagues and by the early 1990s began to be successfully employed in addressing motivational issues with other deficits. 

Through the process of motivation interviewing we can build a better self-determined brain that connects to their reward center.  You have goals, this is what you want to do (personal desires), those goals are driving you to get your rewards.

Model: GOALS + PERSONAL DESIRES = POSITIVE OUTCOME/REWARD

If we don’t establish a connection with a student’s reward center we don’t get as nearly as far.

GOALS + PERSONAL DESIRES ≠ POSITIVE OUTCOME/REWARD 

Motivational interviewing has four steps:  Engaging, Focusing, Evoking, and Planning

1. Engaging – Involve the student in talking about their issues.  What are their concerns and hopes?  During this portion of the conversation we are not judgmental.  We accept whatever the child says that he wants to do (or doesn’t) and talk about ways to get there.  The purpose of engagement is establish a trusting relationship.
2. Focusing – Narrow the conversation to something that you or the student wants to change.
3. Evoking – Increase the student’s sense of the importance of change, their confidence about change, and their readiness to change.  The purpose of this step is to increase a belief that they can be successful and tie the outcome to what they really want. 
4. Planning – Introduce practical steps the student can use to implement the changes they desire.  The purpose of this step is to scaffold students so they can see themselves as successful and increasingly have them act independently. 

What Does Motivation Interviewing Look Like?

Let’s provide an example showing what motivational interviewing looks like with the “I don’t wanna do nothin’!” student. 

Chad, point to triangle and then then square. 

I don’t want to.

But I have seen you do this 100 times.  It is easy for you.  What do you want to do then Chad?

Nothin!

Have you ever met Chad?  Chances are a student like Chad will grace your caseload if they haven’t already.  Let’s continue the conversation with motivational interviewing.

(Engagement) Great! Me either.  I don’t want to do anything either.  Sometimes I just want to sit here or my paperwork is way too hard.  Look at my desktop, Chad.  Does that look clean to you?  I don’t want to do that work.  I know just how you feel.

(Focus) You are really good at naming shapes.  I know we can do nothin’ for one minute and then work together.  Do you want to take a break for one minute?

No.

Five minutes Chad?

I want ten minutes!

(Evoke) Great 10 minutes, let me get the timer.  There are 18 minutes of speech class left.  We will work for 8 minutes together and then you get the last 10 minutes to do whatever you want.  You can even clean my desk (joking to keep it lighthearted)!  And, if you get done in less time, you get even more than 10 minutes to do nothing.  I have seen you finish these assignments in 2 minutes because you are so smart.  That means you would finish before everyone. 

(Planning) Start with you name.  Write “Sara.”

I’m Chad!

How do I know?  Your name is not on the paper.  Good.

Number one, point to a big blue square and then a white circle. (strategy: following 2-step directions)

Square

Awesome!  A square is a four-sided shape (strategy: extension, adding to a child.s answer). What do you do next? It’s something that is round (strategy: expanding).

Triangle

A triangle is a three-sided shape but it sounds like rectangle so you are really close.  My turn.  Square-circle.  One down, two to go, and you still have 16 minutes left to do nothing.

Notice how the strategies were not implemented until the child appeared motivated.  Also notice how the conversation remained light-hearted to get past feelings of inadequacy and corrections were made pointing out the correct response not by saying a child was wrong. 

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How is Motivational Interviewing different from how you currently provide speech therapy?

When you are teaching desire you are teaching a way to self-regulate.  Your goal is not to teach math in this case but to teach a system that the child can eventually use to motivate himself.  You will be successful when the child is finding a reason to do his work. 

Honestly, think about how many of the students that you work with.  Are they doing their work because they want to please you, not stand out from their friends, or be the first to finish?  This is their motivation.  In Chad’s case, this is what he was missing. 

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If you want more information on how to help your students regulate emotions, increase motivation, and follow through with what you are teaching, join us inside SLPImpact and also get CEUs.

Increasing Client Motivation and Self-Direction: Executive Function 201

Strategies for executive function can be incredibly successful but there are a number of students who still have no success despite multiple interventions.  This course presented strategies and interventions for when students are not motivated to perform a task and don’t understand why they should learning something new.