Often, when we meet with our clients, no two sessions are ever the same. Each one may have just a little different flavor and that is part of what makes MI so interesting. As clinicians, we are constantly bringing our curiosities to the sessions, and being open to the element of surprise. And after we have established good rapport with our client, and are feeling that there is good engagement, we can begin to focus on what is most important to address in the session. In many cases, there are three different scenarios for us to consider and we will explore them below:
The focus is clear
When the focus in clear, it is often because the place of work has a narrowly defined purpose. For example, it could be a medical or rehab setting or it could be a setting focusing on weight loss. Even though there may be a clear focus for the session, the path taken to pursue this goal may take lots of twists and turns. A change plan, however, will often come through evoking and learning about the client’s motivation for change. The client’s motivations may shift throughout your sessions but it is likely clear about the intended outcome.
There are several options
When there are numerous possibilities, or directions to take, it is important to take time determining where you want to start. In order to get to the best starting place, several questions may be asked and discussed with the client. For example: What are some of the possible options? What is most important right now? Would starting at one place possibly resolve some of the other options? When there are several options, the key is to sort through them and decide the best place to start.
The focus is not clear and exploration is required
When the focus is not clear, to perhaps you or the client, it may require some time to determine the core issue and how to move forward. It may be helpful to think about starting very general and attempting to become more and more specific. Sometimes, the goal may be to come up with an initial focus to try, that both the clinician and client agree on, and see where it goes.
Regardless of the scenario, it is important to be reminded of the rapport that has been established and the wisdom that can come from the collaborative process. You, as the clinician, obviously know your clients best, and will be able to facilitate the session in the direction it needs to go. By trusting yourself and the process, the focus will be become clear.
We have been discussing the importance of maintaining a direction in the conversation through Focusing Scenarios and the three different situations we may be presented with in a session. Next month, we will take a closer look at these scenarios and additional thoughts will be offered on how we might move forward. 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.