Sociograms and Motivational Interviewing

My Background with Sociograms

I was first exposed to the concept of the sociogram in the late 1990s when I enrolled in a Clinical Supervision Course instructed by David Powell as part of the required coursework to become licensed as a clinical supervisor with the state of New Hampshire.
I recall Dr. Powell presenting the concept of a sociogram for doing feedback to a clinician on their group skills.  I loved the idea of creating a visual representation of what happened in group and it seemed to me a viable and easy-to-implement solution to an issue that my supervisees were struggling with:  doing individual counseling in a group context.
I developed enhancements to the sociogram which I shared with Dr. Powell a few years later.  These developments were included in the 2004 Revision of his book, Clinical Supervision in Alcohol and Drug Abuse Counseling: Principles, Models, Methods.

What is a Sociogram?


Simply put, a sociogram shows a group interaction over time.  You track who says what to whom.
On a sheet of paper you draw a diagram of the group with a circle representing each participant and a circle for each facilitator as in the example above.  Then, for each comment, statement or question you draw a line from the person who said it to the person it is being said to.  If a comment is made to the group (for example "What do people think?") then a line is drawn to the center of the group.

Test Yourself:  Sociogram A

What can you tell about how this group is functioning?  Imagine the interactions in the group, who is talking to whom, who is active, what the facilitator is saying based on the following sociogram.
I would consider this a fairly integrative group between most of the clients with two clients interacting significantly more than others.  Most of the comments from the facilitator are toward the group and not toward individuals.  I would consider this a well functioning group.

Test Yourself:  Sociogram B

Compare the first group with the sociogram below.  How is this group functioning?

You are correct if you assess that this group has very little interaction between group members.  All the interaction is with the facilitator.  This is an example of a counselor doing individual counseling in a group counseling setting.  The other members just sit there and watch as the counselor does their thing, watching and waiting passively for their turn.
In my work with the Department of Corrections I worked diligently to help counselors move from the individual counseling in a group setting approach to group facilitation.  Sociograms proved invaluable in providing feedback to clinicians on their impact on the group.

What does Motivational Interviewing look like in a group context

Unfortunately motivational interviewing in a group format is more like the last sociogram that the first sociogram above.  Participants sit around in group as spectators watching the counselor do motivational interviewing to a participant and wait their turn for the counselor to do motivational interviewing to them.
This is not surprising.  It is not easy to master motivational interviewing and much more challenging to do motivational interviewing in a group context.
A facilitator can do all the best motivational interviewing skills in the group -- flawlessly doing OARS -- but if the group members interact with each other in, for lack of a better description, "non-motivational interviewing" ways -- a group member could actually become more entrenched in keeping things the way they are and not changing. 
In addictions counseling we see this when clients get engaged in "war stories".  From a motivational interviewing perspective, war stories are really status talk.
It is not just the Facilitator and the Participants!
One way to think of group therapy is to consider the group itself as the counselor / therapist.  The group has the therapeutic impact on each other.
From this perspective, you actually have three agents in group therapy:  the facilitator, the group members and the group itself.

Using Sociograms to Measure Group Performance in Motivational Interviewing

What if instead of two colors as we used above, we used three to graph the interactions of the group:  one color for facilitator statements, one color for change talk and one color for status talk?
Consider the following two motivational interviewing sociograms (purple lines depict facilitator comments, yellow lines depict participant change talk, brown lines depict participant status talk):

Motivational Interviewing Sociogram One:

Motivational Interviewing Sociogram Two:


Clearly the second sociogram shows more change talk from participants than the first.  Note that the facilitator comments are the same in both sociograms.
The question then becomes: 
  1. what does a facilitator say to encourage change talk amongst group members? and 
  2. what does the facilitator say to encourage group members to say things to other group members to encourage change talk? (that's a meta-mouthful, I know -- go ahead read #2 again).

A Different Model for Motivational Interviewing in Groups

I propose that effective motivational intervening in a group context does not need to be a spectator sport where the facilitator does individual motivational interviewing with each person.
The facilitator can actually help the group (recall the third component of group therapy outlined above) become skilled in motivational interviewing!

Statements a motivational interviewing practitioner can say to encourage change talk amongst group members:

  • "Our purpose here is to help people figure out where they are stuck, why they are stuck and get unstuck"
  • "What are some reasons a person might want to consider doing X?"
  • "Would it be helpful if the group brainstormed some solutions?"
  • "Group, who is the only one that can decide what is best for you?"
Essentially, the facilitator is trying to help the group embrace the spirit of motivational interviewing.

Statements a motivational intervening practitioner can say to encourage group members to say things to other group members to encourage change talk:

  • "Who has a 'How' or a 'Why' question for Sam?"
  • "Bill, tell Frank what values you heard  that underscore his desire to stay sober."
  • "Group, what other conclusions could you make from Tom's statement, 'I am serious about losing weight.'?"
  • "I would like someone to sum up what Sean is struggling with."
If you can't tell, each of these last set of questions / statements from the facilitator is an attempt to elicit an OARS from either one person in the group or the group on the whole.

Conclusions for this Motivational Interviewing Approach to Group work

It seems reasonable on the surface that a group with more change talk would have a greater impact on behavior change than a group with more status talk.  It also seems reasonable that a skilled facilitator could interact with a group to (a) encourage change talk over status talk and (b) prompt the group as well as group members to respond to each other with OARS thereby increasing the level of change talk.
Applying motivational interviewing this way means that the facilitator needs to have a strong understanding of motivational interviewing (spirit) and skill in using OARS.  Then the facilitator needs to build skill in asking questions and making statements in a group context to bring out these understandings and abilities in others.
A supervisor observing the group needs to reliably discern between status talk and change talk to create an accurate sociogram of the group. Then, and only then, will a facilitator see whether what they are doing is impacting the group.

Next steps

I am already partnering with one agency to further develop this motivational interviewing approach to group work.  But I am looking for others to expand on the concept, refine the concept and ultimately test whether this concept is as viable in practice as it seems in concept.

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Scott is a member of the MINT

Scott is a member of the MINT
Motivational Interviewing Network of Trainers
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