When we think about the way we want to be with a client, I think we would all agree that we would like to acknowledge and recognize their inherent worth and strengths. And each client we work with will have specific strengths that we will be able to genuinely acknowledge. We also know that clients are more likely to engage with a clinician if they trust them, feel like they are being listened to, and when their strengths are being recognized and affirmed. And consistent with MI practice, it is often more important to have the client share their own strengths and efforts. We have talked about this in previous blogs about the power of having the client hear themselves speak, not only about the change they want in their lives, but also about their past successes, resources, and strengths.
When we consider offering an affirmation to a client, it is helpful to remember that an affirmation is not the same as praise. An affirmation focuses more on the person and their strengths rather than on the behavior. And as we have talked about giving a reflection, and starting with the word “you,” it is similar when we offer an affirmation. The reason is because if we start with the word “I” the expression is really more about the clinician than the client (and sounds more like praise than affirming). Again, affirmations focus on paying attention to, recognizing, noticing, and/or acknowledging the strengths and efforts of the client. Some sentence starters include:
“Your concentration on…
“Your aspirations to…
“Your follow-through on…
“Your ability to…
Another way for a client to feel affirmed is by reframing an experience they had, where they may have felt like they did not do as well as they wanted, but where some progress was made. Miller and Rollnick offer this example:
“You’re feeling really bad that you didn’t stick to your plan and instead drank on two days this week, and you’re thinking that you blew it. What strikes me, though, is how different this is from where you started. Two months ago you were drinking every day of the week, and 10-12 drinks a day. This week you had a drink one day and two the next, then went back to your plan. In other words, even this week your alcohol use was down by 96%, and you went right back to your goal of not drinking at all. How about that!”
Lastly, a clinician can also acknowledge to the client a skill or attribute the client has demonstrated. The examples below can give you a sense of what this may sound like:
“You really had to focus and prioritize your time to accomplish this goal.”
“Even after being rejected for several jobs, you persevered and got a job.”
“You took your time in making a decision to start exercising and it seems like it really paid off.”
“You really committed to this goal, as it has been six months now since you had a drink.”
All of these examples can give you an idea of how it sounds to affirm a client by focusing on their strengths and efforts. Again, it is important to use the word “you” instead of “I” to make sure the client knows the acknowledgement is about them and not the clinician. Also, it can be helpful to remember that affirmations are more about the person than the behavior and you can always use the client as your guide to see if these affirmations appear to be meaningful. Next month, we will continue with another of the core communication skills: Summaries. I hope you all have a great month and have opportunities to use and practice Motivational Interviewing!
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.