My seven most effective engaging questions

DSC00226We all know the importance of engagement for successful intervention with people experiencing difficult and challenging behaviour. How easy is it to get off to a wrong start with somebody? One of the key elements of engagement is around connection, finding common narrative, and building that working alliance in terms of common goals for the session. Many of us have a reluctance to deal with issues in our lives and so it is not surprising that people are ambivalent about change; sometimes even coming to sit with us to begin a conversation.

While there are numerous ways that we can start a conversation in a clinical setting, I have my favourite seven questions that I want to share with you. I want to make the point that I may also engage with cultural elements if that is required such as place of origin, a karakia or prayer. So here are my favourite seven questions with an explanation of why I find them both interesting and powerful.

  1. What did you have to organise to come here today? If motivation is about behaviour, then the effort and sacrifices people make, is an indication of that. What does it say that someone has taken time off work, arranged childcare, sat in traffic for an hour and not driven straight home, to sit with someone and talk about difficult issues? Noticing, validating and affirming effort is one of the first important aspects of effective engagement.
  2. What conversations did you have with yourself and others about coming? This question evokes often different sorts of information. The first aspect is about how transparent the person is with others in their lives about seeking help for behaviour that is problematic. The second part of the question evokes the nature of those conversations and gives us a glimmer into family and/or peer group support (or otherwise) for behaviour change. In my experience working with many mandated clients these conversations can act as restraints in terms of openness to new ideas. On the other hand, where peer and family members are enthusiastic and hopeful about change, then from a relapse prevention perspective we may already have an intact support group.
  3. What is your experience of talking to someone like me? Sometimes this is the first time someone has taken the step of seeking help. It is easy to forget how daunting this can be and how much courage it takes. Engaging in change work poses significant risk in that life might radically change, sometimes for the better and sometimes for the worse. For others talking to someone like me has been part of life over time. Evoking that experience and positioning it, so that it doesn’t contaminate our current relationship, is a key issue. I’m sure that all of us have had to clean up after the not so good practice of others.
  4. What concerns you most and what do you need for this to be a safe place to explore and practice new ideas? Many of the clients we work with have issues of trust. Many have come from invalidating environments and so eliciting early concerns that they might have is important in building a working alliance. Another question that I often ask, particular in working cross culturally or across gender or sexual preference, is to reflect with the person about what it might be like working with me. I am very mindful that I’m asking somebody to trust me with their inner thoughts and feelings which from my point of view is a real privilege.
  5. What do you want to walk out the door with at the end of the time we spend together? No one walks into our office without some indication of an outcome in mind. That outcome may merely be to affirm the journey they are on or it may be to appease others. However, most people who sit with us experience dissonance regarding how they view themselves and the behaviour that they are engaging in. In my view change work is about altering behaviour. Understanding and awareness are wonderful by-products but often insufficient in themselves to bring about the level of change required. There requires activation as well is planning. The question helps me understand what goals the client has for the time we will be working together. That helps us to develop a partnership as well as a direction to change.
  6. How important is it on a scale of 1 – 100 is it to learn the skills to shake this behaviour? I’m always intrigued when asking this question as we can often state something is important, yet fail to maintain importance 24/7. For those of you familiar with strength based practice and motivational interviewing, these are powerful indicators of the willingness to engage in focused work. The higher the better, as we all know change requires determination to develop alternative habits of behaviour.
  7. How confident are you on a scale of 1 – 100 that you can learn the skills necessary? When we are not confidence we run the risk of failing. When we fail our confidence is impacted. This can so easily turn into a vicious cycle. Hearing about somebody’s confidence will often evoke failed attempts in the past to resolve the issue. This tells me that despite the person’s lack of confidence they have not given up on themselves. This allows us to position the person as somebody who has a quality of tenacity and not giving up on themselves. The job is then to create steps to build confidence and competence in overcoming problem behaviour.

You will note that the questions are directional and move from outside of the room to inside the room. These begin to shape the conversation and identify the strengths that exist in the room for the person. It also tells us of effort and energy put in to date to resolve issues.

I am sure that you have your own ways to engage that are equally effective. Love to hear your thoughts about what you have found works.

Published on Tuesday, January 22nd, 2013, under Learning & development, Motivational Interviewing, Practice tips and techniques

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