“Enhancing athlete engagement in sport psychology interventions using motivational interviewing: a case study“
MACK, Rory, BRECKON, Jeff, O’HALLORAN, Paul and BUTT, Joanne (2019). Enhancing athlete engagement in sport psychology interventions using motivational interviewing: a case study. The Sport Psychologist, 33 (2), 159-168.
Sarah Murray – Sport Psychologist – Director – performance-edge.org
“The paper speaks to the need for sport psychologists to pay attention to relationship building and the therapeutic approach required to build trust with an athlete. The basis of trust between athlete and practitioner is the foundation that informs the depth and quality of the interactions had. This in turn directly impacts the effectiveness of any intervention.
It seems interesting to note that it is only recently that we have experienced an increase in the more counselling based and therapeutic approaches to sports psychology practice. There are elements of the paper within the introductory section that still have an ‘us and them’ feel to the narrative. By this I am referring to traditional PST approaches and counselling based therapeutic approaches to athlete intervention.
Given the vast differences between a more traditional CBT approach and a Rogerian therapeutic approach, there is a natural intersection where motivational interviewing can provide a useful structural base for practitioners to more deliberately integrate relationship building and counselling approaches to developing the relationship with the athlete alongside CBT intervention.
Motivation Interviewing (MI) seeks to almost breakdown Carl Rogers counselling approach into easy-to-use components: the MI spirit; technical or micro skills (OARS); and the four processes.
- Open questions
- Affirmations
- Reflections
- Summaries
- Four processes: engaging/focussing/evoking/planning
MI can be a helpful way of early years practitioners knowing how to process the engagement and early relationship they are wanting to build with an athlete.
Case study notes
Before reading too much further into the case study presented in this paper, the word ‘mandated’ jumped out at me; there is an entire piece that we could write around the dangers of athletes being mandatorily sent to a psychologist, rather than engaging in the conversation through choice. This often speaks to a lack of understanding of the role of the psychologist within that particular environment. However, it was the athlete’s experience of working with a psychologist that created a shaky foundation upon which a new relationship with a new psychologist needed to be built. From the case study it is clear as to the decision-making process with regard to employing an MI approach to building the therapeutic relationship before intervention was delivered. There is a lesson in here for sports psychologists around the power of empathy and understanding of the athlete in front of you. At our best, a sport psychologist will meet the athlete where they are.
Take homes
Using a therapeutic alliance approach to build a relationship with an athlete does not have to feel or look unstructured, this is a perception that many have about the counselling approach and therefore it is not a skill that neophyte sports psychologists tend to understand, use or practice. The case study demonstrates that motivational interviewing can provide structure, and support the foundations of trust and relationship building upon which an intervention can be effectively delivered, resulting in positive impact for the athlete.
What is really clear from this paper is that no matter what your philosophy, the one thing that is shared by psychologists who wish to support positive changes for an athlete is that the athlete engagement must create a foundation upon which further work is then carried out. Having an integrated approach and recognising how other philosophies can support the work we are doing with the athlete in front of us is vital when we are engaged in our professional judgement and decision making.
Whilst we cannot deliver interventions that are solely based around relationship building and engagement without clear structure of the psychological skills that will support the athlete to develop, equally it has been supported by this paper that using a PST approach will not be hugely effective if there is no foundation relationship built between the athlete and practitioner.
As with so much in our profession, balance is an effective way of ensuring that we can provide a listening ear yet also a structured intervention whereby psychological skills and behaviours are understood and developed towards improved performance.”
Betsy Tuffrey – Sport & Exercise Psychologist – Director – Seed Psychology Ltd.
“This article really served as an introduction for me on Motivational Interviewing. I had never really delved into this topic, and naively I did not realise the structure it possesses.
Private practice and employed practice in my experience are very different – particularly when it comes to initiation of consultancy and repeated visits. Put simply, a private client has often made a considered decision on coming to see you – investing their own money to seek change or assistance. In an employed setting, however, the practitioner is somewhat ‘on-tap’, with athletes often obligated to engage with the psych as opposed to making an active choice to seek assistance. With this employed setting dynamic, the psych may frequently be faced with athletes reluctant to engage in conversation and developmental change. In a football academy for example, you are often a service available to a certain group of players, so they often make neither a personal investment, or a considered decision to engage in consultancy. However, the players themselves are somewhat an investment of the club, and therefore are often encouraged towards sessions with the psychologist – with these sessions often framed as compulsory. That said, sometimes players are keen to engage in work with the psychologist, but are reluctant to initiate contact, and therefore compulsory sessions can be a useful gateway into meaningful consultancy.
In any case, in my experience, it is much more common in an employed setting than with a private client that you experience scepticism or reluctance to change. For this reason among many others, I found MI a very interesting topic.
Perhaps my own biases find the multiple acronyms in this paper a little hard to swallow. I also remain unsure whether these processes are transparently worked through alongside the client. As an REBT advocate, the collaborative nature of shared work is a strength of therapy in my view.
As I journeyed through the case study, I sensed that I already engage in some of these principles – perhaps largely due to humanistic knowledge gained throughout my Stage 2 training. My practice is heavily influenced by CBT, however I experimented frequently in my training years with a humanistic approach – utilising skills of this approach particularly in the building of rapport with a client. However, throughout my REBT training, I have realised that rapport is not essential to effective practice, and the concepts surrounding brief contact therapy, REBT, and single-session therapy demonstrate this. That said, I often pride myself of the relationships I build with athletes I work with, and feel that these relationships help both myself and the client to be honest and open, as well as ready to discuss and initiate change. The authors rightly suggest here that there are elements of REBT (for example) and MI, which perhaps conflict and would not be helpful if used in combination – perhaps even seeming contradictory to the client.
Throughout the paper, the focus is away from performance, particularly performance outcomes, and I like this – sometimes athletes (and practitioners) need some distance on their performance focuses. What I liked about this theme was the focus remaining on change that would impact the athlete – keeping in mind sporting goals.
The questioning structures I think are effective and provide a useful backdrop to the practitioner to keep sessions on track – useful for neophyte and experienced practitioners alike. The use of rating scales also provides an ‘activity’ within consultancy which can be useful to reaffirm any prior discussions; create new avenues for conversation; and break up purely conversational practice which some athletes (and practitioners!) may struggle with.
In summary, I thought it a powerful notion to suggest that often, we don’t hold a deep enough understanding of the mechanisms that influence the therapeutic alliance. This is perhaps more important than I have previously considered, and therefore seek to learn more about MI to compliment my own practice and offer a further flexibility to consultancy to benefit those I work with.”
Summary – written by Betsy Tuffrey
When I approached Sarah about running this feature, we both quickly realised the benefits – to us both and to the reader. Often, finding time to read an academic book, or article, is tricky. It’s something I for one have not given enough time to over recent years. So, in creating this feature, both Sarah and I get to expose each other to an array of different topics, theroies, and practices. We will aim to offer a summary of sorts, as well as comment through our own applied experiences. It is worth noting that we write our respective comments in isolation – only looking at the other’s when we’ve compiled our own. This will hopefully provide an interesting area of discussion in itself – whether we take similar messages from each piece, or approach our summaries from different standpoints.
We really hope you enjoy this feature – I know we will enjoy putting it out each month.
Sarah and I certainly commented similarly regarding the ‘mandatory’ nature of sport psychology in certain settings; why this happens, and indeed what issues can arise as a result. Sarah rightly comments on how the role of the sport psych is often not well understood and I would echo this by encouraging both the psych and the wider organisation to make clear the role of the psych working with a team or squad for example, in order to align expectations and provide clarity for all. I think it is worth noting how important this is for each and every psych that may come in to work with athletes. Psychologists are people too! We vary in personality; philosophy, and general practice tendencies and techniques. Psychologists can do the ‘same job’ in very different ways and this is worth highlighting early on in working relationships.
I think both Sarah and I can see huge benefits from the use of MI – and this article has certainly opened my eyes to the use of MI to compliment other approaches I may use in sport psychology practice.