The Motivational Phone Call Technique To Engage Traumatized Families
Engaging children and parents in effective trauma treatment is difficult at best. Conventionally, engagement and rapport building begins in the first face-to-face session. More often than not it’s a harsh start-up. Parents and kids enter the first session angry, frustrated, and hopeless. Arms are tightly crossed, and at the slightest provocation, all hell breaks loose with open conflict and confrontation between parent and child.
Jay Haley, the founder of strategic family therapy, stated: “For therapy to end properly, it must begin properly.” At the Family Trauma Institute, we believe that trauma treatment begins before the first session by using the 15-minute Motivational Interview (MI) Phone Call, one of our 18 Family Systems Trauma (FST) Techniques.
Using the MI Phone Call Technique, parents and older children move from anger, defensiveness, or resistance to hope, excitement, and anticipation for the first session. From this place of hope, parents are more cooperative and willing to bring in the entire family and extended family to the first session.
However, if there is no MI phone call or a key member is not contacted, the start-up to trauma treatment is almost always harsh. Traumatized children and families are often more brittle, depressed, and overwhelmed than the average client. Hence, soft start-ups are even more critical to beginning treatment properly.
Additionally, we cannot do therapy with an empty chair. The MI phone call increases the show rate of clients coming to the first session. They are engaged before face-to-face treatment begins. A phone call from a secretary or the therapist to secure or confirm an appointment is not engagement.
The case study of 16-year-old Lucy illustrates this FST Technique.
Effective Therapy Begins with the MI Phone Call
As a consultant for the case, two red flags emerged. If these red flags were not addressed and resolved in the MI phone, my face-to-face consult would be a harsh start-up and ineffective:
Red Flag #1: Parent and Sibling Burn Out
Kelly, the family therapist, had been seeing Lucy’s family for six months. During that time Lucy was stabilized, and self-harming had stopped, but she was still aggressive, anxious, and depressed. As a result, both parents were shutting down. The family – parents and siblings – felt bitter and angry.
Therefore, the MI phone call had to re-energize the parents, give them a reason to continue treatment, and be open to letting the other siblings participate. Hope needed to emerge, and strengths in both the parents and Lucy needed highlighting. Otherwise, the parents would have no reason to show up for the session or come with an open heart toward change.
Red Flag #2: No Extended Family
When a family is stuck, a good rule of thumb is to expand treatment beyond the family that lives under one roof (a telephoto lens) to include the extended family (a wide angle lens). Extended family members like grandparents, friends, aunts, or uncles often give a new or fresh perspective on an old and intractable problem. They can also offer support and reenergize a burnt out family. However, unless motivated, parents are resistant to the idea of engaging the extended family. There is fear or a lack of understanding as to why they should bring in their extended family or village. Therapists are often inexperienced and unfamiliar as to how to work with the extended family.
Therefore, the MI phone call had to help both the parents and the therapist to see what’s in it for them or the benefits of actively welcoming and inviting Lucy’s grandparents to the next session. The consulting therapist needed the village to help unstick this family.
MI Phone Call Scripting Therapy Techniques
Traditional motivational interview (MI) principles have been available for some time (c.f., Miller & Rollnick, 1991). But unlike traditional MI, the Family Trauma Institute developed a specialized MI phone call script using the Institute’s evidence-based FST Model. Chapter Four of Treating the Traumatized Child: A Step-by-Step Family Systems Approach outlines the steps of the MI phone call technique.
The MI phone call scripting sequence was developed for time efficiency and to prepare a family for the first session with all the right people in the village present.
I used the FST MI Phone Call script with Lucy’s family. A soft start-up started to unfold after 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.]?
This strengths-based question acts as a catalyst to revitalize traumatized and burnt out families who have forgotten how to praise one another. The question helps turn the conversation from one that is problem-saturated and hopeless to one that is praise-saturated and hopeful. Praise communication motivates resistant clients and soothes the spiritual pain that has built up over time.
Click on the audio clip below to listen to mom’s answer to this question. Focus on the hope in her voice.
Mom’s Response to Question #3
After Mom’s response, Lucy told her parents about the strengths she admires about them. Lucy shared: “My mom and dad will never give up on me.”
Burnt out parents long to hear praise of any kind from their child. It’s important for therapists to remember that parents or caregivers are just as traumatized as their child. This question helped Lucy’s parents re-engage with Lucy in family treatment. They became hopeful when Lucy said, “It has definitely helped me not give up when my parents will not give up on me”.
Lucy’s Response to Question #3
After Question #3, there are four additional questions to ask. For Lucy’s family the last question (Question #7) was critical:
There is an old saying, “It takes a village to raise a child”. Therefore, who are the people, friends, co-workers or institutions (school, work, etc.) outside of your immediate family that (a) give you support in raising your child or teenager [please give me their first names] and (b) are negative influences that do not provide support and may even undermine your efforts? [Please give me their first names.]
Listen carefully to how I explained the rationale for including the extended family. This clear connect-the-dots process is often missing in treatment, especially prior to the first face-to-face session.
Imagine what your trauma treatment would be like and the momentum generated if you have all the right people in the room at the very first session. Because of this question and the dialogue that followed, both parents were motivated to include the extended family.
FAMILY RESPONSE TO THE MOTIVATIONAL PHONE CALL
When asked “What was most helpful in the MI Phone Call,” mom and dad said it was most helpful that I was getting to know them before we met. Lucy said, “You gave me and my family a voice.”
Listen to the family’s full response.
Lucy’s response represents why this technique is so important and creates the context for a soft start-up. Traumatized children and families want a voice. They want to be heard and appreciated before the first session.
Our work is not different from that of a surgeon-patient relationship. Before we go into surgery, we want a doctor with a good bedside manner; we want them to listen to our concerns. When we feel heard, our anxiety decreases and we are prepared to go forward.
Similarly, when trauma treatment begins with the MI Phone Call before the first face-to-face session, families are prepared to move forward. After the MI phone call, Lucy’s family was rejuvenated, motivated, and ready for treatment.
The MI phone call illustrates how the therapist uses this technique before the first face-to-face session to initiate a soft start or at any point in treatment when a consultation is requested. Therapists can also use this script during in-person sessions with the family, couple, or individual. However, the ideal sequence is prior to the first session.
For more information on FST techniques, register for this month’s Family Trauma Institute free webinars. Click here to register.
Scott P. Sells, Ph.D., 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 email@example.com or through LinkedIn.