Why a Motivational Phone Call Before Trauma Treatment Begins Will Make All the Difference in the World?

An interesting phenomenon occurred in our Family Systems Trauma (FST) research. If we began trauma treatment using a FST- Motivational Phone Call, a “soft start-up” took place. If not, “harsh start-ups” occurred.

Harsh start-ups happened when the FST therapists began treatment using a traditional start (a phone call to simply schedule the first appointment). Within this context, burned-out and traumatized parents would often demonstrate high no-show rates or come to the first session with walls up and defensive body language.

However, after the FST motivational phone call, outcomes dramatically changed. In sharp contrast, the parent or caregiver would now enter the first session more relaxed, trusting, and open to hear what the FST therapist had to say right from the start.

Soft start-up benefits directly correlate with the findings in Gottman’s couples’ research (Gottman and Silver, 1999). Harsh start-ups to the conversation (criticism, sarcasm, defensiveness, or stonewalling), would likely end that way. However, if the conversation began with a soft start-up (appreciation and politeness), the outcome was productive, stable, and happy, even if conflict emerged later.

In this issue, I will show how you can use a 15 to 30 minute specialized motivational script to increase both the motivation and attendance of your clients.. The script can be effectively used for parents and modified for older children or adolescents. For in depth knowledge on this technique, readers are directed to Chapter 4 of Treating the Traumatized Child: A Step-by-Step Family Based Approach.

Theory and Motivational Phone Calls

  • Traditional motivational interview (MI) principles have been available for some time (c.f., Miller & Rollnick, 1991).
  • However, unlike traditional MI, Ellen Souder and I developed a specialized FST motivational technique that uses key directive strategies and an actual step-by-step script.
  • The FST motivational phone call script questions were designed based on key marketing outcomes found in Neil Rackham’s (1995) book: SPIN Selling. In this book, Neil Rackham conducted research studies of 35,000 actual sales phone calls to determine the central ingredients needed to motivate even the most resistant customer.
  • The outcomes that Rackham found were both surprising and groundbreaking. A quick summary of the most important finding that we incorporated in the motivational phone call technique are presented in this month’s newsletter.

It’s More Important to Understand First

Rackham discovered the most successful sales people [and therapists] were those who listened to clients first before trying to persuade them to do anything (buy a product; attend a first therapy session, follow a homework assignment, etc.).

Once the client felt understood and heard, then and only then could that person be persuaded to take any kind of action.

Surprisingly, out of thousands of sales calls researched, very few salespeople used this approach.

Simply stated, applying Rackham’s research to trauma treatment… People don’t care how much you know until first they know how much you care. – Scott Sells

A Traumatized Family is Not Easily Engaged

  • Rackham discovered that in small sales, customers did not need or even want to be understood before being persuaded. Instead, they wanted to know the benefits and features of the product or “what’s in it for them” within the first 5 minutes of the call.
  • However, in large sales, this tactic did not work. These customers had to first state their problem or need and then clearly see how the product being offered would solve their specific problem. If not, the sale would fail.
  • Therefore, when creating the FST motivational phone call, we asked ourselves the following question: “Does asking the parent or child to come into trauma treatment represent a small sale or a large sale?”

We believe that the answer is a “large sale” because of the time commitment, cost, or the fact that most people do not want to change or share their problems with a stranger. This is especially true when it comes to trauma or revealing family secrets.

SPIN Framework & MI Phone Call Script

To create a “soft-start” environment addressing “large sale” needs, the FST treatment model custom built a motivational phone call script and format that applied Rackham’s SPIN framework. SPIN is an acronym for:

S- Situation
P- Problem

Table 1 illustrates the touch points between the FST motivational phone call script and SPIN framework. Please have this six-question script in front of you when making the motivational phone call. This script is recommended for the adult parent, caregiver, foster parent, and/or extended family member. There is a modified phone call script for the older child or adolescent in Chapter 4 of the Treating the Traumatized Child book.

Please do not allow the entire phone call to exceed 15-20 minutes in length. Otherwise, you move from motivational phone call to a full-blown therapy session. If the latter happens, many of your clients will not think that it is necessary to attend the first session. Techniques such as “stick and move” are presented in Chapter 4 of the book to show you how to keep your parent or adolescent on track during the motivational phone call.

Table 1: FST Motivational Phone Call Script & SPIN Framework

Question #1

Are there any other caretakers such as a father/mother, boyfriend or girlfriend, partner, housemate, etc. at home? [If yes] The reason I ask is that it helps to get everyone’s opinion about the problem and potential solution. [Estimated time of completion = 2 minutes]

Question #2

What are difficult experiences that you have had to suffer in the last year because of the problems you have been having with your child or teen? [Estimated time of completion = 5 minutes]

Question #3

When I get to know you better, what qualities and strengths will I come to admire about you as a [person, parent, spouse, etc.]? [Estimated time of completion = 3-5 minutes]

S–Situation Questions and P- Problem Questions-

According to Rackham, these questions occur when we ask the client (parents, extended family, or child) for facts about their current situation and the problems or “difficult experiences” they have had to suffer? AND

We also motivate by turning a normal call into an intentional search for strengths in Question #3. Question #3 is a game changer! It completely takes the client off guard in a good way. It moves them from problem-saturated talk to hope-saturated talk.

Question #4

What do you think will happen to [your teen, child, marriage, or you personally] if the problems you described earlier remain unfixed in the next three months, six months, or even a year from now? [Estimated time of completion = 3-5 minutes]

Question #5

Have you seen a counselor for any of these problems before? [If yes] What have other counselors missed with you? The reason I ask is that I do not want to make the same mistakes twice. [Estimated time of completion = 2-3 minutes]

Question #6

Do you want to fix the problem or problems you listed [list them] fast, medium, or slow speed? [Estimated time of completion]

I–Implication Questions

These are questions that ask about the consequences or implications of not solving the problem or not receiving good therapy treatment in the past. According to Rackham, these questions are the hardest to ask but the most powerful of all the other SPIN questions combined.

This is because good implication questions skillfully build on the client’s earlier stated problems. They create a strong need or desire in your clients to want to look at the solutions one is offering later in the call.

The Use of Closing Remarks

This is the single most important step within the FST motivational phone call. It mirrors the closing arguments of a great trial lawyer. Lawyers report that the jury often makes its decision based on how well or badly the closing arguments are framed and delivered. The trial itself lays the groundwork, but the closing arguments can win or lose the case.

In the same way, your jury is the parent, caregiver, extended family, or child. The groundwork is his or her previous answers to the six questions in the MI phone call script.

Therefore, the FST therapist’s closing remarks (arguments) should be linked closely to the client’s earlier answers during the motivational phone call. The ideal timing of the closing remarks is immediately after Question #6.

Closing remarks represent the N-Need/Benefit in the SPIN Framework. These are statements you make at the end of the motivational phone call that ask about the value or usefulness of your proposed ask (i.e., attend the first session, bring the following family members, the benefits of WIIFM- What’s in it for me?, etc.) These
are powerful questions or statements that are “custom-fit” to the client’s particular problem or need they stated earlier in the phone call. For example,

Example: Closing Remarks for Parent Using Their Responses to Question #3

Earlier in our call you said that the quality I would come to admire about you was that you will never give up on your child. That was important to know because it is absolutely incredible that with everything you have gone through, you have not given up.

CUSTOMIZED NEED-BENEFIT – I think you might like this treatment approach because I will try to build on the strengths you listed, but more importantly help others like your child better see your strengths as well.

THE ASK: And based on what you said, I think your child is fortunate to have you as a parent. That being said, would you come to at least the first session to see for yourself?

In the example above, the therapist skillfully connected what the client said earlier in the call to a customized need-benefit and then to the ask or next action step. It is recommended that you take private notes during the call and write down key statements or words the client makes to then reflect back to them in your closing remarks. The client will not only feel heard but motivated. More examples of closing remarks are contained within Chapter 4 of the Treating the Traumatized Child book.

A Personal Experiment

Please join me for next month’s issue on how to use a technique called THE STRESS CHART to efficiently and effectively assess and diagnose a child with trauma or PTSD and their family.

You can also subscribe below and at the end of each month, you will receive an email reminder of each issue. Enjoy.

Scott P. Sells, PhD, MSW, LCSW, LMFT, is the author of three books, Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide (1998), Parenting Your Out-of-Control Teenager: 7 Steps to Reestablish Authority and Reclaim Love (2001), and Treating the Traumatized Child: A Step-by Step Family Systems Approach (2017). He can be contacted at spsells@familytrauma.com or through LinkedIn.

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