Blog

Opening the door to change: Why Motivational Interviewing is at the heart of Ignition's work

Opening the door to change: Why Motivational Interviewing is at the heart of Ignition's work

Ambivalence, resistance and respect

There are several underpinning planks to ignition’s work around domestic violence and abuse or intimate partner violence and abuse. Motivational Interviewing (MI) is a core approach, allied to a wider perspective on therapeutically informed working, with experiential or ‘action’ techniques forming the final corner of the triangle.

Motivational Interviewing was developed in the early 1990s and outside of the domestic abuse field has become an increasingly well-known approach to facilitating change in problematic behaviour, so I thought it might be interesting to say just why it occupies such an important place for ignition.

Not 'two populations'
MI began in the substance misuse field as a response to a heavily judgmental medicalised model that saw ‘alcoholism’ and ‘addiction’ as moral failures - a behaviour which harmed others and which was essentially selfish. There was a sense that ‘alcoholics’ and ‘addicts’ formed an entirely separate population from ‘the rest of us’  and what worked in helping anyone change their behaviour would not work with this group, as they were essentially ‘different’.

The way ‘denial’ was seen is an example: imagine you feel you are drinking too much and you seek help. You are told you are an alcoholic – you deny this – you are not an alcoholic, you have a job, you have a home, you're not sleeping on the streets, that's what alcoholics are aren't they? – and your denial is then taken as proof of your alcoholism because ‘that’s what alcoholics do – deny they are one’.

Colleagues with long enough histories in the substance misuse field tell of a punitive and punishing culture arising from this moral judgement, so that – for example – detoxifying ‘alcoholics’ would be given vitamin injections with a deliberately large–bore needle, so that the injection hurt more than was necessary, as a ‘deterrent’.

By contrast, MI instead offered a ‘psycho-social’ functional analysis that explores what a particular behaviour is doing for a person, as well as the difficulties it causes them, and what they might want to do about it.

For me, there is a clear parallel to what happened in the alcohol field with the judgemental nature of what still happens now in  much work with domestically abusive men in particular: they are often seen as ‘different’ to the rest of the population and  a special kind of manipulative, lying, abusive individual, forming a separate group rather than being on a continuum of human behaviours.

They're all liars

A widespread understanding of denial around domestic abuse is very similar to that regarding ‘alcoholics’: you tell a man that what he does is domestic abuse – he denies it – you haven’t seen her when she’s had a few, what about when she has a go at me – and this becomes ‘minimisation, denial and blame’ because ’that’s what abusers do’. The perceived approach to this is then to attempt to ‘tell’ the man 'we're here to talk about you not her', or ‘break down the resistance’, which only serves to entrench defensive resistance and for which the man is then blamed, thus solidifying this self fulfilling prophecy.

The above may seem an unfair picture, and in probation and prisons where all work with convicted offenders occurs, the redevelopment of the Integrated Domestic Abuse Programme (IDAP) has meant a move closer to the principles of effective practice through MI which ignition was espousing in consultancy support to probation areas nearly fifteen years ago. However a recent conversation with colleagues still working in probation and whom I used to supervise for many years, revealed that they could not name a single colleague with whom they would feel comfortable or confident of in working in a less hostile way than is ‘the norm’.

Acceptance facilitates change

MI offers an entirely different stance to this judgemental critical approach, placing empathy, warmth, respect and a non-judgemental stance at its core, deriving this from the person centred therapy of Carl Rogers. Engagement is central, and absolutely vital is an ability to differentiate between the behaviour of a person - however repugnant is what they have done - and who they are. ‘Acceptance facilitates change’ is a core principle that ignition is proud to uphold in the company's work.

Incidentally, in another arm of probation and prison work, with sexual offending, there is a host of research to support an effective facilitator having the characteristics of warmth, empathy and respect and taking a strengths-based approach – see work by William Marshall and others in particular. But somehow this attitude does not translate to domestic abuse work, where we are still too often doing a domestic abuse variant of what used to be known in sexual offender groups as ‘ped(ophile) bashing’.

Again, MI offers an alternative so that we move from a hostile and confrontational stance to one where there is a high degree of challenge - not confrontation - made possible because there is a high degree of support. This challenge is about opening up the individuals’ thinking feeling and behaviour to scrutiny – not so much by the worker – but the individual themself.

Opening the door to change

This is achieved through the much-undervalued core skills in MI of reflective listening which, when done properly, create a space of great potential for change. As examples of this, I remain a consultant to Bracknell Forest Council where the Strength to Change one to one programme developed by ignition works with men from families where a child protection plan is in place, due to domestic violence and abuse concerns. Similarly I am currently consulting to another local authority developing its own in-house programme. In both cases, both workers from both sites (one of whom is a forensic psychologist with a prison background) have testified that it is the non-judgemental space created through MI that is the ‘door opener’ to change.

But MI is not just person centred counselling: what makes it ‘MI’ is the combination of this core stance with a strategic direction: enabling the subject of domestic abuse to ‘stay on the agenda’ by understanding ambivalence, helping explore and resolve it, and enable an individual to clarify and build their importance of change, and confidence to achieve change if they tried. This involves working with where the person in front of you is with regard to change, and not where we think they ought to be.

Ambivalence
Part of MI’s functional analysis of substance misuse is understanding that in the vast majority of cases, a problematic behaviour both does something for an individual and also causes them difficulties. Most people behaving abusively don’t actually want to do just this abusive part - it is this ambivalence that keeps people ‘stuck’ and a key feature of MI is helping people to explore and resolve their ambivalence sufficiently to make a decision. This might be to stay the same, but is more often to try to make a change.

Arguably, some degree of ambivalence is a key feature of abusive behaviour for all people, except perhaps for extremely instrumental and psychopathic individuals – which does not describe the vast majority of individuals in domestically abusive relationships.

Understanding and tackling  ambivalence enables MI to work from strengths and values – helping the individual to identify what matters to them and align their agenda with that of the ‘official’ concern: an example in child protection is enabling a parent of a child to work for change because they want to be a good parent however dysfunctional their attempt to be so currently is. This ensures ‘buy in’ and a much greater likelihood of sustainable change rooted in intrinsic motivation, rather than 'false compliance' due to external pressure.

Why do people change?
Motivational Interviewing aids immeasurably with creating the ‘pre conditions’ for change, helping individuals to:

  • Recognise the advantages of change
  • Feel we have the self-worth to make the change
  • Believe in our own ability to change
  • Have knowledge of alternative behaviours and how to achieve them

These conditions are as applicable to individuals behaving abusively as anybody else. A directly relevant link is to desistance theory  – which considers why offenders stop offending (see the work of Fergus McNeill for further discussion). Desistance theory emphasises a holistic, flexible and person-centred approach where a key component of this is the creation of hope –  the link to MI and its strength-based, solution-focussed perspective which is also reality tested, should be clear.

Clear values, clear model
For me Motivational Interviewing offers a set of clear skills and principles for effective, respectful work. More importantly, it models and ‘walks the talk’ of the kind of values I would want abusive individuals to espouse, as well as being a demonstrably effective approach, enabling individuals and families to achieve lasting change. This is in clear contrast to work where a toxic combination of personal moral judgements and negative beliefs about 'abusers' combine with a sense of their 'difference,' to encourage a replication of the confrontational, bullying and punitive dynamic of domestic abuse, in what is supposed to be treatment.  

What works with domestically abusive individuals in facilitating change is what works with everyone else: respect, empathy, warmth, support and through these, challenge.