Listening can appear to be a very passive experience, but if you really want to listen, and offer a reflection back to a client as you attempt to understand what they are attempting to communicate, it can take quite a while to become very skilled at having these reflections come more naturally. And like we mentioned earlier in the blog, the goal is to offer reflections so we not only attempt to understand the client better, but also so we support the client in exploring their own motivations, ambivalence, plans, etc. If there is good listening happening with a client, it allows for the conversation to continue with the client doing more speaking than the clinician.
In 1970, a student of Carl Rogers named Thomas Gordon used the term “active listening” to describe the experience of not only listening to what the client has to say, but also what is reflected back to the client by the clinician. MI uses the term “reflective listening” to describe this exchange. And in this regard, Gordon has helped us explore what good listening is not by describing 12 kinds of responses that are often offered to each other, but that is not active or reflective listening. Gordon calls these responses “roadblocks” because they are considered distractions to listening and get in the way of allowing the client to explore their own motivations, ambivalence, plans, etc. Miller and Rollnick talk about these roadblocks as being “self-centered” versus “client centered” with the underlying message to the client as “listen to me; I know best.” Below are the 12 roadblocks described by Gordon:
- Ordering, directing, or commanding
- Warning, cautioning, or threatening
- Giving advice, making suggestions, or providing solutions
- Persuading with logic, arguing, or lecturing
- Telling people what they should do; moralizing
- Disagreeing, judging, criticizing, or blaming
- Agreeing, approving, or praising
- Shaming, ridiculing, or labeling
- Interpreting or analyzing
- Reassuring, sympathizing, or consoling
- Questioning or probing
- Withdrawing, distracting, humoring, or changing the subject
These “roadblocks” can often prevent the client from doing the work they need to do to resolve any ambivalence and does not allow the client to explore their own reasons for change, motivations for change, and plans for change. A good example by Miller and Rollnick of the use of these “roadblocks” is below, and included in the exchange are also some of the corresponding “roadblocks” from above.
Client: I just don’t know whether to leave him or not.
Clinician: You should do whatever you think is best. (#5)
Client: But that’s the point! I don’t know what’s best!
Clinician: Yes, you do, in your heart. (#6)
Client: Well, I just feel trapped, stifled in our relationship.
Clinician: Have you thought about separating for a while to see how you feel? (#3)
Client: But I love him, and it would hurt him so much if I left!
Clinician: Yet if you don’t do it, you could be wasting your life. (#2)
Client: But isn’t that kind of selfish?
Clinician: It’s just what you have to do to take care of yourself. (#4)
Client: I just don’t know how I could do it, how I’d manage.
Clinician: I’m sure you’ll be fine. (#10)
Again, we will be spending the next several months on the topic of listening but wanted to start with these “roadblocks” offered by Gordon. Hopefully, this example has given you some insight into what distractions to listening can sound like in a session. It can also illustrate what can happen when the session moves away from being “client-centered.” Next month, we will focus on forming reflections and the importance of using statements versus questions in order to continue 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.