Change Process

The School Brawler This intervention took place in a school setting, where the social worker saw a 12-year-old African-American girl named Bettina, who had been in trouble for frequent fighting. Following a few minutes of introduction, Robyn, a 26-year-old Caucasian female, began by setting a brief agenda: “Bettina, you’ve been sent to me to talk about some problems at school and what we can do about those, but we can also talk about whatever else you think is important.” In this way, Robyn directed the focus of the meeting, but allowed for flexibility so that any or all of the client’s concerns could be given attention. Still, Bettina chose to focus on the presenting problem.

The social worker listened with empathy as she tried to elicit statements about change from the client. She asked Bettina, “What are some of the good things about fighting?” and “What are some of the not-so-good things about fighting?” Like many clients, Bettina was surprised at the former line of question- ing. Robyn explained, “There must be some good things about it, otherwise you wouldn’t keep doing it, right?”

As Bettina responded, the social worker probed for more information and selectively reinforced the client’s statements about change. When reflecting on why she liked to fight, Bettina said that it made her feel proud when she won. It also ensured that her peers “respected” her. On the other hand, Bettina said she didn’t want to get expelled from school or end up in juvenile hall. She was also afraid of hurting people. For instance, she found herself pounding another girl’s head against the sidewalk during one fight, and she didn’t want to do that kind of thing. Rather than just allowing Bettina to list these reasons for not fighting, Robyn explored with her the disadvantages of the status quo. For in- stance, the social worker asked, “What worries you about getting expelled for fighting? How will getting expelled for fighting stop you from doing what you want in life?” Thus the social worker helped the client talk herself into changing rather than using direct persuasion.

The social worker avoided challenging the client’s statements because direct confrontation was likely to escalate resistance rather than reduce it. Any resistance to change was sidestepped. For instance, when Bettina said, “If I don’t fight, I’ll get disrespected,” the social worker used the technique of amplified reflection: “So the only way to get people’s respect is to fight them.” Amplified reflection often results in verbal backpedaling from the client, who attempts to soften the extreme posi- tion reflected by the social worker. In this case, Bettina said, “No, sometimes I just give them a look. I can give some pretty mean looks.”

As part of her motivational interviewing, Robyn picked up on what the cli- ent held as important in her life. She then worked to enlarge the discrepancy between the client’s values and her present problem behavior. Bettina valued her friendships at the school, but her fighting was endangering those relation- ships: “So on one hand, those friends are important to you, and on the other, if you get expelled for fighting and get transferred to another school, you won’t be able to see your friends like you do now.”

As the conversation continued, the social worker focused on instilling in Bettina some optimism about change. For instance, when Robyn asked the question, “What makes you think that if you decided to make a change, you could do it?” Bettina said, “I can do it if I set my mind to it. I only wanted to cut my fighting down a little bit before. But now I want it to stop.” Robyn asked, “What personal strengths do you have that will help you succeed?” The client answered, “I can talk. I know how to talk to people so they don’t mess with me. I just lay them straight. No need to fight most of the time.” Robyn further inquired about who could help Bettina make these changes. She identi- fied her friends as a support system: “I can say to them, ‘you-all, talk me down, because I can’t fight no more. I don’t want to get kicked out of school.’ So when I’m in an argument, they’d probably say something like, ‘forget her— she ain’t worth it.’ And they’d be right—she ain’t.”

The social worker assessed the client’s commitment to change, as well as her confidence that she could make changes. To begin, Robyn used the commit- ment ruler technique: “If there was a scale to measure your commitment, and it went from 0 to 10, with 10 being totally committed—nothing could make you fight—where would you say you are right now?” Bettina identified herself at a “7,” and Robyn asked her to account for this value. Bettina said, “One more fight, and I’m kicked out of school. They already told me that. They might mean it this time.” The social worker then asked Bettina to rate herself on a similar ruler in- volving her confidence that she could change. Bettina gave herself a “5” ranking, and said, “I already changed some. Like last year I got in trouble every day, but this year I don’t get in trouble very often. I try to stay away from people I got a problem with. Before, I wouldn’t think about it, and I would just fight people and not think about what would happen. But now I think about it.” Because Bettina’s confidence that she could change was lower than her commitment, Robyn turned to a technique that would enhance the client’s self-efficacy, asking evocative questions: “How might you go about continuing to make change? What would be a good first step?” Bettina answered that she would continue to avoid people who bother her. She would also talk to her friends about helping her “calm down.”

When asked about possible obstacles, Bettina admitted that it could be diffi- cult if someone “got up in her face.” The social worker and client began brain- storming about how to handle this obstacle. With some prompting and suggestions, Bettina produced three options: making threats but not necessarily following through, staying in public settings so that other people could intervene, and telling the instigator, over and over again if need be, “You’re not worth it.” In motivational interviewing, when the social worker offers information and advice, it is phrased tentatively (“If it’s okay, I’m going to make a suggestion. I don’t know if it will work for you or not. It’s worked for others who have struggled with the same things you have.”). The social worker avoids struggling with the client about what she must do. Instead, the social worker strategically applies techniques so that the client’s motivation to change is bolstered. In this way, during the course of a single session, Bettina decided that she was ready to commit to a change plan. She met with Robyn for several more weeks, report- ing on her progress in staying out of fights and getting feedback that helped to maintain her positive direction.