When we think about Motivational Interviewing and addressing the common issue of ambivalence, and how best to support the client in creating the change they want in their lives, the first place we often start is by seeing if their current behaviors are aligned with their values and goals. As clinicians, we are exploring with our clients any discrepancies that exist and seeing what the client wants to do. If the client states that their most important value is spending time with their children, and we learn that over the course of the past week the client spent a total of one hour with them, we may want to talk more about this discrepancy. Oftentimes, this can be an opportunity for the client to take some time to really think about their behaviors and values, and whether they are aligned.
There are obviously many ways to respond to a client when you, as the clinician, perceive a discrepancy between the client’s behaviors and their values. One approach could be to confront the client and have them clearly see how their values they talked about previously were not consistent with their current behavior. Using the example earlier related to the client stating that they value spending time with their children, the clinician could say:
“You say you want to spend time with your children, but only one hour a week with them does not seem to be aligned with your values.”
“Do you understand how much of an impact this could have on your children?”
“If you do not spend much time with children you may not have much of a relationship with them at all.”
It is unlikely you would say these things to your client, since most of us, if approached this way, would become defensive and feel like we were being judged, attacked, and not supported. A better approach to navigate this discrepancy is to go back to using the OARS techniques and perhaps starting with some open-ended questions. These may sound something like this:
“Tell me more about how you spent your time during the week, and how you made decisions about spending time with your children?”
“As you think about the time you spent with your children this week, how do you feel?”
“How would you like things to be moving forward related to spending time with your children?”
These may be questions that allow for the client to respond in a much more open and neutral way. If the client feels that they are in a safe, non-judgmental, and supportive environment, it is much more likely for them to express themselves honestly and in way where they want to consider changing a behavior that is not consistent with their values. Also, it is likely that the client is already aware of the discrepancy that exists. The use of the OARS techniques can not only support the client, but can also allow them to continue exploring and reflecting on their discrepancies without feeling defensive.
Once the client is able to explore their discrepancies, and work through their ambivalence, they may be ready to consider making a plan about how they want to move forward. Again, many of you are familiar with the SMART acronym related to setting goals (Specific, Measurable, Attainable, Relevant, and Time-bound), but it is so important that the change occurs gradually in order for it to be sustainable over time.
In our recent series of blogs, we have been discussing how to engage with the client and support them in a very supportive and non-judgmental environment. We will continue next month with our “conversations about change” and shift our attention to focusing and establishing a clear direction for our conversations. 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.