Abstract
Social work was quick to adopt cognitive behavioural therapy (CBT) as part of its repertoire as it emerged as a profession through the first half of the 20th century. It has since remained a fundamental element of much social work training and many social workers' tool kits. More recently, Motivational Interviewing has equally become intrinsic to many approaches to social work practice and is utilised by increasing numbers of social workers. Making this claim more widely for helping professions, and addressing the possible contradictions between the expert-led approach of CBT and the person-centred emphasis of Motivational Interviewing, Naar and Safren have provided an informative and insightful text which clearly identifies the shared elements of the two approaches and a guide as to how they may be combined to enhance each other for more effective interventions.
This text sits within the excellent Rollnick, Miller and Moyers series of ‘Applications of Motivational Interviewing’. In this context, Naar and Safren have not sought to provide a basic introduction to Motivational Interviewing. Rather they have highlighted four core process elements of the approach: engaging, focusing, evoking and planning, and in turn, through each subsequent chapter applied them to seven stages of CBT. This offers a clear, if somewhat repetitive and formulaic sequential structure, but probably requires at least some previous exposure to the basics of Motivational Interviewing. Naar and Safren importantly deliberate the CBT process to emphasise the need for relationship building and engagement to precede any directed behavioural change. Throughout the stages of the intervention explored, the text appeals to the exponents of both methods, clearly identifying the elements retained and where the approach feels like deviation.
Each chapter is easy to follow. The chapters contain many clear case scenarios and examples of practice dialogue. These additionally and usefully highlight Motivational and Rogerian skills in action. With a focus on the practical, each chapter has tips for practice, exercises for the reader to reinforce their learning and a range of handouts/tools to take in to practice scenarios (I further checked out that these are readily available as downloads, as signposted within the text.). The final chapter pulls many of the threads together and illustrates how the whole approach can be utilised with a range of different behavioural or treatment concerns through case scenarios exploring: gambling, anger management, chronic pain and depression.
Two apparent contradictions for current social work practice occurred to me when reading this book. Firstly, how to balance the strive for evidence-based practice against effectiveness of being about who we are rather than what we do. In this regard, Naar and Safren have offered an insightful contribution, emphasising the importance of the spirit of Motivational Interviewing, and its way of being with people, as a means to enhance some of the more prescriptive procedural elements of CBT. Secondly, that skilled effective therapeutic interventions often require a role and time commitment that can be at odds with experiences of modern day case management. The detail of this book, and the author’s intimation that it might serve as an ‘integrated modular treatment manual’, suggests to me it is perhaps only of real use for those social workers who feel they have the opportunity within their roles to engage in substantive therapeutic interventions. For many, they may see the content of this book as something to which they have to refer others to do, rather than have the capacity to undertake themselves.
This is a valuable contribution. It is rich in detail and abundant in exercises and resources to aid practice. It is not an introductory text, so is useful for those who have already acquired experience at providing motivational and behavioural-oriented interventions. It feels as though its primary appeal is for the therapist, and those social workers who identify with this as their role will undoubtedly find it an excellent addition to the bookshelf.