Using motivational interviewing for absent workers

November 8, 2007

Using motivational interviewing for absent workers

Jean Brading, employment services director at HCML, suggests using motivational interviewing to help people back to work after significant absence.

Managing absence, rehabilitation, and retention – these are all terms that are much on the mind of HR professionals and managers generally. The costs involved in neglecting this are huge. We know that time is of the essence when trying to facilitate a return to work, but once people have been off work for more than a few weeks, it becomes increasingly difficult to motivate them to return.

Unsurprisingly, the longer they have been away, the more they feel left out and lacking in confidence. Advice only goes so far, and finding a way to engage with them and help them make the decision to return is crucial.

“We know that time is of the essence when trying to facilitate a return to work, but once people have been off work for more than a few weeks, it becomes increasingly difficult to motivate them to return.”

Furthermore, the government is committed to reducing the number of people already on incapacity benefit (IB), and preventing the flow on to it. The Pathways to Work scheme, which is being rolled out in stages across the country, is a new departure in that it combines the traditional approach to supporting job search with a variety of condition management programmes. The aim of this combined approach is to modify the illness behaviours and fear-avoidance beliefs that impede return to working life.

A useful approach

Motivational interviewing (MI) is an evidence-based technique that can be used to overcome the ambivalence that people feel about making a behaviour change. Originally used in the field of addictions, MI can be successfully applied in any number of areas, including return to work scenarios.

Using this technique lets you get behind the reluctance to return to work, helps you get rid of blame, and address the ambivalence or discrepancy that absent workers may be feeling. Based on the assumption that we are all motivated towards something, MI works in a client-centred way to reduce resistance and move the person towards the goal as he/she uncovers it. It has to be the client who voices the reasons for change.

Miller and Rollnick (2002) define MI as “a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence”.

The four principles of MI are:

1. Express empathy
2. Develop discrepancy
3. Roll with Resistance
4. Support self-efficacy

Expressing empathy

MI borrows from person-centred counselling to place empathy at its heart. We need to remember that it is not pathology that we are interested in, it’s how we show respect for the process in which the client makes sense of his or her situation.

The points to remember are:

Acceptance facilitates change
Skilful reflective listening is fundamental
Ambivalence is normal

Developing discrepancy

This is where a more directional focus kicks in. We have to move beyond exploration to help create cognitive dissonance – in other words, to show the discrepancy between the current situation and where the client wants to be. This will help the client decide to change.

The key points are:

The client rather than the counsellor should present the arguments for change
Change is motivated by a perceived discrepancy between present behaviour and important personal values or goals.

Rolling with resistance

You can’t make the person change. The more the impetus for change comes from the outside, the more likely he or she will resist. What you need to do is help reframe the perception. How you react to expressions of resistance is vital: go with it, be within that person’s frame of reference – and then help the person to find the answers.

Essential elements of this are:

Avoid arguing for change
Resistance is not directly opposed
New perspectives are invited but not imposed
The client is a primary resource in finding answers and solutions
Resistance is a signal to respond differently

Supporting self-efficacy

Self-efficacy refers to the person’s belief that he or she has the ability to carry out and succeed with a specific task. Enhancing self-confidence in the client is crucial and a pre-requisite for positive change.

The main points here are:

A person’s belief in the possibility of change is an important motivator
The client, not the counsellor, is responsible for choosing and carrying out change
The counsellor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy.

A practical approach

“Using a technique such as MI can give an invaluable framework for action-oriented discussions, to facilitate willingness to return to work.”

To build a person’s motivation to change, and to strengthen commitment to do so, requires some particular techniques. One of these is to assess how the individual sees the importance and confidence about changing a specific behaviour.

So, having ascertained what the key issues are, what you would do is to help the individual use a scale of one to ten to assess these, and then, using open questions, reflections and affirmations, encourage them to see what could be done to change these numbers to facilitate change in the direction that he or she wants to move.

Moving at the individual’s pace is essential. Someone might be convinced of the personal value of change (importance) but not feel confident about mastering it (confidence), so this might need to be worked on. These factors determine a person’s readiness to change.

Using a technique such as MI can give an invaluable framework for action-oriented discussions, to facilitate willingness to return to work. It can be used by all kinds of people, whether HR, line management or professional advisers.

HCML is a provider of professional rehabilitation case management and employment services. For more information, please email jean.brading@hcml.co.uk or visit www.hcml.co.uk