USING MOTIVATIONAL INTERVIEWING

TO SUPPORT
FIELDWORK STUDENTS
Presented by Jeni Dulek, OTD, OTR/L, CFWE
Assistant Professor, University of St. Augustine for Health Sciences
Previously AFWC & Program Director, OTA Program, American Career College
Objectives

■ Participants will be able to discuss the application of

motivational interviewing (MI) strategies to support
students in a fieldwork setting.
■ Participants will be able to demonstrate the core
skills of motivational interviewing including use of
open-ended questions, affirmations, reflections, and
summaries in interactions with students.
Outline of Presentation
1. Exploration of anxiety, motivation, and change on fieldwork
2. Presentation of evidence supporting use of Motivational Interviewing
with students
3. Overview and application of the Spirit of Motivational Interviewing
4. Overview and application of the Core Skills of Motivational
Interviewing
5. Practice with real-world scenarios and/or case study
6. Sharing of resources
STUDENT ANXIETY
AND FIELDWORK
(Some of) The Signs
■ Rigidity and concrete thinking
■ Difficulty tolerating being a novice learner
■ Externalizing issues
■ Difficulty learning from mistakes
■ Dependence on external measures for self-esteem
■ Erratic work performance
■ Inability to problem-solve in the moment
■ Passive attitude
■ Uncertainty about professional expectations

(McCreedy & Miller, 2004; Robinson, Tanchuk, & Sullivan, 2012)

Consider the Effects of Anxiety on…

■ Client care
■ Treatment team
■ Fieldwork educator
■ Educator-Student relationship
■ Student
– Confidence
– Learning
– Ability to pass fieldwork
 IT IS PRIMARILY
BEHAVIORAL CHARACTERISTICS
THAT LEAD TO
FAILURE OF FIELDWORK
(Gutman, McCreedy, & Heisler, 1998)
 SO WHERE
DOES MOTIVATION
COME IN?
Motivation: Miller & Rollnick, 2013

■ Movement toward change

■ Occurs when ambivalence is resolved
■ Results from interactions
– Does NOT reside within individuals
 Ambivalence and Influencing Change

Make a Change

Stay the Same

Influencing Change

■Learning as
change
■Professional
growth as
change
Resistance (aka Discord)
FW Educator-Student Interactions
How Would You Respond?

■ “All the other OTs do dressing with their patients,

so I don’t get why you say I shouldn’t.”
■ “It’s unfair that you expect me to know things we
didn’t learn in school.”
■ “You told me to read the charts, but I can’t possibly
know everything about every patient!”
CAN OUR RESPONSES
ELICIT RESISTANCE IN
STUDENTS?
 ■ Defined as our tendency to
try to fix problems
The Righting ■ Doesn’t consider
Reflex ambivalence
■ May increase student anxiety
(aka How We ■ When we argue for change…
Unknowingly ■ Students argue AGAINST it!
Increase ■ Causes discord (aka
resistance)…which also
Resistance) increases student anxiety
(Rosengren, 2018)
 WHAT IS AN
ALTERNATIVE
APPROACH?
Motivational Interviewing (MI)

■ Motivational interviewing (MI) is a method of interaction

that allows practitioners to empower and engage clients
in self- identifying problem behaviors as well as guide
clients to consider for themselves paths toward
resolving identified areas of concern (Miller & Rollnick,
2013)

■ In other words...
A way to talk with people about change.
Evidence Suggests that MI can Help
Students to…
■ Decrease student anxiety
■ Address resistant behaviors
■ Improve supervisory alliance
■ Increase adoption of professional behaviors
■ Support student follow through with plans for change (Wahesh, 2016)

■ Participate in supervisory conversations and respond to feedback

■ Seek assistance from instructors and peers (Rollnick, Kaplan, & Rutschman, 2016; Sheldon, 2010)
 WHEN USING MI…
The goals must be THE STUDENT’S,
not THE EDUCATOR’S!
WHY MUST THE GOALS
COME ONLY FROM
THE STUDENT?
Spirit of Motivational Interviewing

■ Partnership
■ Acceptance
■ Compassion
■ Evocation
(Miller & Rollnick, 2013)
MI Spirit: Partnership

■ Done with and for, not to, students

■ Students are an active partner
■ Assists students to identify the changes they want to
make
■ Honors the students’ own expertise in their lives
■ Suggestions can be offered with permission only
MI Spirit: Acceptance

■ 4 components:
– Absolute worth: Acceptance and esteem; potential for
change
– Autonomy: People must and can make own decisions
– Accurate empathy: See the world as the student does
– Affirmation: Look for strengths and resources
■ Leads to less defensiveness
MI Spirit: Compassion

■ “A deliberate commitment to
pursue the welfare and best
interests of the other” (Miller
& Rollnick, 2013, p. 20)
■ Avoids force and
manipulation
MI Spirit: Evocation
■ Draws out ideas and
solutions from within
students
■ They are experts on their
lives
■ Goal to evoke reasons
and methods for change
Practice: The OPPOSITE of MI Spirit
Convince your partner to drink the water

AVOID: USE INSTEAD:

■ Partnership ■ Confrontation
■ Acceptance ■ Persuasion
■ Compassion ■ Explanation
■ Evocation ■ Authority
 WHAT WAS THAT
INTERACTION LIKE?
WHY?
WHEN USING MI…
The goals must be THE STUDENT’S,
not THE EDUCATOR’s

…AND…
 WE CAN HELP THEM
GET THERE!
“You can lead a [person] to water, but you can’t make them drink.”
…BUT you can help them become aware of their thirst
so they CHOOSE to drink!

(Rosengren, 2018)
Practice: MI Spirit
Use the same scenario,
but this time, EMPHASIZE:
■ Partnership
■ Acceptance
■ Compassion
■ Evocation
WHAT SPECIFIC
SKILLS DOES MI
INVOLVE?
Core Skills of MI

■Open-Ended Questions
■Affirmations
■Reflections
■Summaries
Open-Ended Questions

■Get more information

■Avoid assumptions
■Provide clarification
■Not inquisition
Open-Ended Questions

What might happen if you told your

fieldwork educator about your
childcare challenges?
Affirmations

■Student strengths
■Genuine statements
■“You”
■Choose specific behaviors
Affirmations

You are dedicated to giving your

clients the best care possible
[so sometimes you focus on that and
your documentation is late].
Reflections
■ Check your understanding
■ Allow for processing time
■ Capture positives
■ Reinforce change talk
■ Reflections as statements
– Avoid “It sounds like…”
– Don’t ask questions
■ Incorrect reflections are OK!
Reflections
When you ask me a question
in front of a patient, I get
really flustered. It makes the
patient think I’m
incompetent. It’s unfair that
you expect me to know
everything without warning
me that I’ll need to know.
It is important to you that
patients trust you. It makes
you uncomfortable to think
that you might not always
have the right answer for
them and that they might
question your abilities as a
practitioner.
Summaries

■ Use “and”, avoid “but”

■ Clarification
■ Change talk
■ Be concise
■ Change the path
Summaries

You have some things going on at home, and while

they are sometimes distracting, you are committed to
becoming an excellent OT. You are prioritizing your
efforts here so that you can do well on fieldwork while
managing things at home. When you are behind with
paperwork, it is because you are focusing on your
clients or just feel like it’s busy work that isn’t helping
you lead your groups. That doesn’t mean that you
don’t care a lot about your clients and your learning,
and sometimes I don’t recognize that.
Practice: How Would You Respond?

■ “All the other OTs do dressing with their patients,

so I don’t get why you say I shouldn’t.”
■ “It’s unfair that you expect me to know things we
didn’t learn in school.”
■ “You told me to read the charts, but I can’t possibly
know everything about every patient!”
Practice: Case Scenario (Adapted from Dimeo, Malta, & Bruns, 2004)

Mandy is on her first Level II experience, and is currently in Week 4. She

performed well academically during her coursework and did well on the
interview for this fieldwork placement. During her first few weeks of fieldwork
her supervisor had her practice documenting about the sessions that she has
observed, and her notes have been excellent. She has also shared astute
observations and intervention ideas during supervision.
Although she initially seemed quite comfortable in the setting and introducing
herself to clients, she has begun to struggle in some client interactions. This is
particularly noticeable when her fieldwork educator asks her to provide
education to a client about a treatment that the educator is providing, a request
that is commonly made spontaneously in the presence of the client. In these
instances, Mandy becomes noticeably nervous and flustered, and has begun
complaining to her fieldwork educator that she feels it is unfair that she is being
“put on the spot and embarrassed in front of clients.”
References

■ American Occupational Therapy Association. (2002). Fieldwork performance evaluation for the
occupational therapy student. Bethesda, MD: AOTA Press.
■ Dimeo, S. B., Malta, S. L., & Bruns, C. J. (2004). The supervisory journey. In D. M. Costa (Ed.), The
essential guide to occupational therapy fieldwork education: Resources for today’s educators and
practitioners (p. 69-82). Bethesda, MD: AOTA Press.
■ Giordano, A., Clarke, P., & Borders, L. D. (2013). Using motivational interviewing techniques to
address parallel process in supervision. Counselor Education and Supervision, 52(1), 15-29.
■ Glennon, T. J. & Van Oss, T. (2010, September 27). Identifying and promoting professional
behavior: Best practices for establishing, maintaining, and improving professional behavior by
occupational therapy practitioners. OT Practice, 13-16.
■ Gutman, S.A., McCreedy, P., & Heisler, P. (1998). Student level II fieldwork failure: strategies for
intervention. The American Journal of Occupational Therapy, 52(2), 143-149.
References

■ Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York,
NY: Guilford Press.
■ Robinson, A. J., Tanchuk, C. J., & Sullivan, T. M. (2012). Professionalism and occupational therapy:
An exploration of faculty and students’ perspectives. Canadian Journal of Occupational Therapy,
79, 275-284. doi: 10.2182/cjot.2012.79.5.3
■ Rollnick, S., Kaplan, S.G., & Rutschman, R. (2016). Motivational interviewing in schools:
Conversations to improve behavior and learning. New York, NY: Guilford Press.
■ Rosengren, D.B. (2018). Building motivational interviewing skills: A practitioner workbook (2nd
ed.). New York, NY: Guilford Press.
■ Sheldon, L. A. (2010). Using motivational interviewing to help your students. The NEA Higher
Education Journal, 153-158.
■ Wahesh, E. (2016). Utilizing motivational interviewing to address resistant behaviors in clinical
supervision. Counselor Education & Supervision, 55, 46-59.
Resources and Contact Information
■ Jeni Dulek, OTD, OTR/L
■ jdulek@usa.edu
■ My professional portfolio: http://jenidulek.weebly.com
■ My motivational interviewing page:
http://jenidulek.weebly.com/motivational-interviewing.html