New Lab Grounds First-Year MSW Students in Motivational Interviewing

November 11, 2019 @ 6:00 pm
By Communications Office

An innovative skills-based lab program has become an integral part of Practicum Learning for all first-year students.

Imagine that you’re a first-year student starting your first practicum assignment. With only one month of classes under your belt, you’re meeting a new client—perhaps a refugee, perhaps a person with a substance use disorder, or perhaps a teen referred by the courts. Learning that they’re facing some very challenging life circumstances, you wonder, “What kind of advice can I possibly give?”

According to Professor Allen Zweben and Associate Dean for Practicum Learning Kathryne Leak, the best advice may be no advice at all.

Zweben and Leak recently launched the School’s new Skills-based Lab Program for Advancing practicum Instruction, which aims to teach new students the fundamental principles and skills of motivational interviewing (MI) so that they can enter direct practice with a grounding in what it takes to interact with clients in an effective way. Leak describes the MI approach as “leading from behind,” while Zweben says it immerses students in the values and orientation of social work and other helping professions.

Zweben has frequently collaborated with Bill Miller, who developed the MI approach with Stephen Rollnick. Based on evidence that most people are ambivalent about change, MI holds that a practitioner can best help a client by supporting him or her in exploring that ambivalence—by reflecting, affirming, or clarifying the client’s statements and beliefs. From within this framework, the client is the expert on his or her own life, and the practitioner need no longer offer solutions but rather is there to empower the client to make their own decisions, solve their own problems, and make the changes they want to make in their lives. The focus is on building a collaborative relationship with the client through empathy and compassion—values that form the basis of what is referred to as the MI spirit.

According to Zweben and Leak, MI is so accessible and versatile that students can begin using it from the very first day of training. That means they’ll be able to offer more value, more quickly, at their direct-practice practicum placements. They will also have more confidence.

A Lab That Bridges Classroom and practicum

Asked about where the idea for creating the lab came from, Leak tells us she frequently observes a disconnect. “Students always say, ‘I got an A in my class. So why am I having trouble with practicum?’” By the same token, she often receives feedback from practicum instructors saying that students are unsure how to begin a client relationship on the proper footing. In the absence of adequate training, they tend to ask too many questions and be too judgmental or prescriptive. Clients do not feel heard or understood and sometimes respond by distancing themselves.

Most people would agree that social work is a learn-by-doing profession, but Leak thought the School could be building more of a bridge between classroom and practicum. That’s what made her consult with Zweben, an MI expert known for his intervention treatments for individuals with alcohol problems. Having earned his Ph.D. in social work from Columbia, Zweben is intimately familiar with the issues faced by students heading out to practicum for the first time.

Zweben told Leak he agreed with her instincts: the School should be doing more to prepare first-year students before sending them into practicum placements that involve direct practice with clients.

“Students are in a room with a client and they need rapport-building skills to call on,” Zweben says. “That’s the first step in the helping process.”

Convinced that MI could be a useful skill set, Zweben and Leak, along with Mary Piepmeier, who now serves as program coordinator, worked together to create a plan for what an MI training program for budding social workers would look like. Upon receiving the green light from the School’s management, the team launched a pilot program in fall of 2018. They trained and tested a dozen hand-picked instructors and 70 first-year students selected by lottery. As word spread, practicum supervisors, advisors, faculty members, and even clergy affiliated with the School expressed interest in signing on as instructors. “Many clergy members are already working in the MI Spirit,” observes Leak, “though a compassionate approach isn’t, of course, limited to them.”

This semester the program rolled out for all on-campus first-year students, and a pilot program was launched for online-campus students. Starting in spring, the lab will be available for all online-campus students.

Sessions last for two hours and take place once a week, for seven weeks. Each session introduces one MI topic. The lab is designed to model experiential learning, whereby students are introduced to each concept or skill by practicing first, through role play. This is followed by feedback and discussion to allow the group to process their experience of applying MI in real time—a form of learning that is empirically supported as the best way to transmit clinically oriented skills.

Session activities include client simulation exercises and MI demonstration videos for students to observe specific strategies in practice. Zweben, Leak, and Piepmeier concur that the training will have succeeded if by the end of the seven weeks, a student knows how to hold a person-centered, collaborative conversation, with an emphasis on empowerment, compassion, and acceptance.

The Response from Students and Instructors

Speak with a few students who went through the lab or instructors who have been trained for it and you’ll start to see the impact of this curriculum innovation.

Victoria Draper, a student in the clinical concentration, says that upon receiving the training, she started handling student intakes differently in the high school where she provided supplementary services, counseling, and case management. She began asking open-ended questions, paying more attention to the students and less to forms, notes, and papers. “The course helped me to become a better listener,” she says. “I started to use reflections to keep the conversation going and find out where the client really was rather than give leading questions and guide them toward the correct answer.” 

Draper adds that the training meshes well with the School’s new Power, Race, Oppression, and Privilege (PROP) framework, because MI’s emphasis on listening fosters cultural humility. Clinicians can draw on MI when interacting with clients from different backgrounds or cultures or who have a mental health issue the clinician is encountering for the first time.

After going through the lab, student Ashley Lizarraga felt “more equipped to work with people,” especially the refugees with whom she worked in a resettlement office, who were ambivalent about their legal status and sorting out where they would live and work. “My training in motivational interviewing helped me provide that extra support in case management that many times clients wouldn’t seek on their own,” she says.

Judy Mason, who is currently teaching in the lab, at one time served as the MSW internship director at Mount Sinai Hospital. She believes MI can be invaluable in a medical setting, where clients may be coping with physical, mental, and social challenges all at once. That can be a lot to sort out—but it’s the client’s job to prioritize a course of action.

“One of the things that was important to me and to my practicum instructors was the issue of students having this rescue fantasy and really trying to tell the client what they should do. But that is not what MI is all about. The client is doing that work, and you’re just helping them with decision balancing: what change they want to make first, and what is their motivation,” she says.

A Spirit That Transcends practicum and Classroom

But perhaps the most ringing endorsement of the new MI training was the fact that every single student and instructor we spoke to felt that the MI spirit of compassion, empathy, and reflective listening had improved their lives overall. MI has a way of seeping outside of social work and into one’s relationships with co-workers, family, and friends, they told us. Since taking the immersion course, all are experimenting with giving less advice in their personal life as MI becomes almost second nature to how they approach and interact with their fellow human beings.

Draper, for instance, recalls receiving a phone call from a friend who often solicits her advice about his job as a manager. Recently, she responded by using MI: listening, reflecting, and asking questions as he resolved his own ambivalence.

At the end of the conversation he asked, “Is this what you’re learning in social work school?”

When she replied affirmatively, he said, “You’re gonna be really good at this.”

Stories like these are extremely gratifying for Zweben and Leak. Zweben credits the School’s administration with committing the funds: the lab is now permanently embedded in practicum practicum. Leak points out the competitive advantage this curriculum change confers on the School, particularly in the tristate area, predicting that other schools of social work may follow Columbia’s lead.

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