In our most recent blogs, we have been discussing how to engage with the client and guide them in a supportive and non-judgmental environment. And when we engage with the client in a genuine manner, this often leads to a smooth transition into the next process in MI: Focusing. Both engaging and focusing are related, but the clinician can be very engaged with the client, and enjoy some stimulating and energetic conversation, but still be without a focus. The focusing process seeks to maintain a direction in the conversation and where an agenda may also be established. It is also common to make adjustments as you go and to see this process as ongoing rather than occurring just one time.
For example, if a client was referred to you by the court system related to a domestic violence situation, the court would likely want the client to focus on preventing recurrence. A parent, however, may have many agenda items they would want to explore, discuss, and focus on due to the numerous feelings this incident may have brought up. Some of these items offered by Miller and Rollnick include:
- Embarrassment and need to preserve self-esteem
- Anger about invasion of privacy
- Fear of future violence
- Problems in the parents’ relationship more generally
- Consideration of whether to stay in the relationship
- Reluctance to discuss alcohol or drug use in the home
- Concern about legal consequences and loss of freedom
- Desire to protect the children from adverse effects
- Fear of having children taken out of the home
Oftentimes, it appears that the focus is clearly established, like in this example, domestic violence recurrence. It may, however, be an opportunity for the client to explore many different feelings that have surfaced related to the incident. The clinician’s task then, is to perhaps begin by discussing some of these agenda items before finding and maintaining the direction of the session, or series of sessions. As in any helping relationship, it is eventually important to have a direction to focus the conversations. And once there is a direction, some more achievable goals can be identified.
We have been discussing the importance of maintaining a direction in the conversation and where an agenda may also be established. Again, you are likely to know your clients best and have a sense of the best direction to take the conversation. And like it was mentioned earlier, adjustments may need to be made along the way, so remember to see it as an ongoing process that may change. Next month, we will talk more specifically about some styles of focusing that may support you in establishing the direction of the conversation. 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.