Objectives
Care workers often face challenges in building good therapeutic alliances with adolescents in residential youth care. Important for a good therapeutic alliance are positive treatment skills of care workers like self-reflection, being supportive and understanding, and being able to make an accurate interpretation of what is said by the client (Ackerman, & Hilsenroth, 2003). A treatment method that is specifically designed for building good alliances with clients and explicitly focuses on applying positive treatment skills by care workers is Motivational Interviewing (MI). A care worker that applies MI shows MI-consistent behaviors in terms of among others reflective listening and seeking collaboration with the client. MI care workers abstain from MI-inconsistent behaviors, including confronting, directing and advising without permission of the client. By applying MI-skills, care workers can build effective, positive relationships with adolescents that aim to increase adolescent’s intrinsic motivation for change (cf. Henriksen, Degner, & Oscarsson, 2008). Despite its potential presently no studies have looked at the application of MI by care workers during individual conversations with adolescents in residential youth care.
Considering the importance of a good therapeutic alliance and the lack of knowledge about these alliances between care workers and adolescents in residential youth care, this study aims to identify how care workers try to build a good relationship with adolescents in residential care. In doing so, we specifically look at the (MI) treatment skills that the care workers apply. We also assess how the adolescents react upon the actions of care workers during these conversations, including behaviour indicating their motivation for change.
Method
We conducted a detailed conversation analysis of 27 one-on-one conversations between care workers and adolescents in residential care. There are two measurements, namely before care workers received a training in Motivational Interviewing (baseline), and after that training. In this presentation we will focus on baseline conversations. By means of detailed conversation analyses we will examine the micro-level of the primary process in residential youth care, i.e. the one-on-one conversations between adolescents and care workers. We use observation research because observations can provide objective information about the actual behaviour of both adolescents and care workers.
For the analysis, observations by means of audio recordings of one-on-one conversations are used. The observations are conducted to identify 1) applied treatment skills by care workers, 2) expressions of motivation for change by adolescents, and 3) the interaction patterns between the care worker and the adolescent. The application of MI-skills by care workers and the motivation for changes among adolescents are measured by existing encoding schemes for MI (MITI and MISC). We studied the interaction patterns between care workers and adolescents using dynamic systems' analyses.
Results
Results show that care workers regularly show MI-inconsistent behaviour during conversations with young people (Eenshuistra et al., 2016). Further results will be presented at the congress.
Conclusions
Considering the lack of MI-consistent behaviour by the care workers, they might benefit from receiving a MI-related training. In that manner they can improve their treatment skills to build good alliances with the adolescents.
References
Ackerman, S.J., & Hilsenroth, M.J. (2003). A review of therapist characteristics
and techniques positively impacting the therapeutic alliance. Clinical
Psychology Review, 23(1), 1-33.
Eenshuistra, A., Harder, A.T., Van Zonneveld, L., & Knorth, E.J. (2016). Look
who's talking: A Motivational Interviewing based observation study of one-on-one conversations between residential care workers and adolescents. International Journal of Child and Family Welfare, 17(1/2), in press.
Henriksen, A., Degner, J., & Oscarsson, L. (2008). Youths in coercive
residential care: Attitudes towards key staff members’ personal involvement,
from a therapeutic alliance perspective. European Journal of Social Work, 11
(2), 145-159.
