Eddie McNamara


Working with children and young people is an exciting and rewarding occupation. Significant numbers of young people grow up experiencing emotional, behavioural and social difficulties (EBSD) which, if not successfully addressed in their pre-adult years, often result in dysfunctional adults. This dysfunctionality may find expression in the person evidencing mental health problems – causing distress and problems to themselves, their families and sometimes the wider community.

The incidence of behavioural and/or mental health problems in both youth and adult populations is difficult to quantify, not least because of issues surrounding definitions and problems with regard to collecting data. However, the incidence is sufficiently high for the UK Government to give a high priority to the expansion and development of mental health services for children and young people.

Such an emphasis on early intervention has significant face validity – for successful early intervention has the potential to reduce the incidence of mental health problems in adulthood. Further, it is also intuitively reasonable to assume that the earlier problems are addressed the greater the likelihood of success – for ‘problem behaviour’ is less rigidly entrenched in the individual’s behavioural repertoire.

Up to The 1960’s psychoanalytic methods were the favoured approach.

These methods were somewhat exclusive to the extent that they could only be used by professionals with many years training and experience – and therefore reached but a small proportion of the population that needed help. Consequently, behavioural approaches, based on learning theory, very quickly replaced such methodology in the 1970’s and onwards – particularly in educational settings.

Behavioural approaches are based on the assumption that behaviour is learnt: and so tackling inappropriate behaviour became an exercise in teaching the young person to learn appropriate behaviour which replaces the inappropriate behaviour.

Such a rationale has had, and continues to have, a major positive impact on the methods used by the helping professions when engaged with ‘disturbed’ or ‘disturbing’ young people.

However, over recent years, it has become accepted that behavioural approaches can be somewhat limited with regard to tackling effectively the complexity of the problems that are addressed. Why? The answer to this question is as follows. Pupils function within three modalities, thinking, feeling and behaviour. Consequently some problems presented by pupils require the intervention to address feelings and thinking as opposed to merely addressing behaviour – for sometimes addressing behaviour alone is insufficient - see McNamara, E. (2004).

The methodologies that are currently being developed and used to redress the shortcomings of the behavioural approach are referred to as ‘cognitive-behavioural approaches’. It has been accepted that i) how people think can effect how they behave and ii) sometimes the focus of intervention should be on changing the way people think in order to effect change in their behaviour.

There are a number of principles that underpin cognitive-behavioural approaches. Perhaps the most important of these is that the intervention should be seen as a collaborative endeavour between the ‘helper’ and the ’helped’.

For such an assumption to find expression in reality requires that the person, young person in our case, wants to be helped ie is motivated to change.

When such is not the case, then attempts can be made to elicit motivation by using the techniques of motivational interviewing (McNamara, E. 1999). However, some young people present as particularly resistant to the idea of change, be they drug addicts, pupils engaging in serious disruptive behaviour or other groups. Such groups are often referred to as ‘hard to reach’.

This book addresses the problem of hard to reach children and young people. Chapter 1 describes the theory and practice of Motivational Interviewing (MI). For if the powerful positive effects of Cognitive–Behavioural approaches are to be harnessed then a necessary pre-requisite for them to effect change is for the person to be helped to actually want to be helped ie to be motivated to change. In many situations such is not the case – and then the initial the ‘problem’ facing the helper is to elicit motivation to change. The first chapter of this book describes how this can be achieved.

When the person to be helped is very resistant to the notion of change, some common sense approaches that people might use can actually have the opposite effect to that intended ie they might consolidate resistance. These approaches are referred to as “roadblocks to change”. This is such an important issue that a chapter has been devoted to how one can respond effectively to resistance on the part of the young person. The strategies used deliberately do not confront the resistance head on but accommodate it to a degree – to the extent that it is recognised as being valid and may even be partially agreed with. However, such recognition and partial agreement is accompanied by an alternative perspective or a reframing of the words of the young person – a response which may encourage the young person to look at their situation from a different and potentially more productive perspective. These techniques are termed “rolling with resistance” and are addressed in chapter 2.

In Chapter 3, Cathy Atkinson describes her work with children and young people in educational settings. She describes how MI can be used to help ‘nudge’ initially reluctant young people through the stages of change by facilitating them to explore and challenge their own ideas and beliefs about behaviour which is of concern to others and sometimes to themselves.

Chapter 4

Government legislation in recent years has resulted in parents being referred to help agencies. Such parents include those given Parenting Orders, those having children referred to Youth Offending Teams and so on. Some, perhaps many, of these parents are reluctant to engage with the professional members of these teams. In chapter 5 Vanessa Wood and Abbey describe how they engage with such parents. They include four illustrative case studies of working respectively with reluctant, resigned, rationalising and hostile parents.

Mawuli Amesu, in Chapter 6, brings our attention to the similarities between the theory and practice of MI and Solution Focused Counselling (SFC). He then goes on to illustrate ways in which techniques from MI and SFBT (Solution Focused Brief Therapy) can be integrated to help children, young people and their families work through the process of change.

When working within the MI paradigm, judgements are made by the counsellor as to which stage of change the client is at. Such judgements are substantially made on the basis of what the client says and how they say it, although client non verbal behaviour is also of account.Sometimes children and young people find it hard to put into words their thoughts, feelings, beliefs and judgements. Vanessa Wood and Abbey Rice describe how they have circumvented such problems by a developing Questionnaire approach to this aspect of MI. They describe their work in Section 1 of Chapter 7.

In Section 2 of this chapter Martin Hughes and Vicky Booth describe how they have addressed this problem by developing card sorting assessment strategies derived from Q-Sort Methodology.

The contents of Chapter 8 are novel in that the focus of the three sections moves away from a focus on the clinical application of MI in therapeutic settings.

In Section 1 Stuart Duckworth describes how he utilised the stages of Change Model to facilitate a school staff self assess where they where as individuals and also as a staff group where with regard to five priority areas identified for staff development.

Jonathan and Patricia Lunt, in Section 2, then report on a retrospective evaluation of a Project to facilitate the staff of a school for SEBD (Social, Emotional and Behaviourally Disturbed) acquiring and using MI skills.

Finally, in Section 3 Joe Duffy and Patricia Davison describe the way in which they have integrated MI strategies into a consultation model within the context of school-based behaviour management teams.