In many situations where someone is attempting to change a behavior, there is often discomfort. Even though most of us know, that once a change is made, we often feel much better. This process of making a change can be extremely difficult. The client can get stuck and go back and forth on whether to make a change or to maintain the status quo. I would imagine we have all been there and can relate to being in this place. And I would image, as clinicians, we have been there numerous times with our clients and know it is simply part of the change process that one must go “through” and not “around.”
Therefore, how can we, as clinicians, support our clients when they are in this place of exploring their ambivalence and attempting to make a change in their lives. One strategy that you most likely have heard before in learning basic MI skills is to acknowledge and reflect it. Since the client may be experiencing a great deal of discomfort, it is important to express to the client that it completely normal to feel this way until the client decides what decision to make. A situation like this can also create some discomfort for the clinician but using a strategy like reflecting what is true can be beneficial for both client and clinician. This example below from Miller and Rollnick gives us an idea of how it may sound:
Client: Oh, I just don’t know what to do. I hate this!
Clinician: I know this process is really difficult for you. The temptation is to just
turn away and stop thinking about it.
Client: But I know that won’t help either.
Clinician: Yes, that’s so. What you’re feeling is perfectly normal, and I’m sorry
this is so uncomfortable for you. It’s been distressing for quite a while.
Client: Yes! It seems like a year. I just don’t know what to do.
Clinician: I do understand how confusing this feels, and I want to help you get
through it. It’s hard but you can do this, and we’ll take as long as you
need with it.
Client: Oh, I don’t want it to take a long time. I want this to be over.
Clinician: You’d really like to make up your mind and get on with your life.
This passage details the discomfort being experienced by the client and the skillful strategy of reflective listening used by the clinician. It could be understandable for the clinician to want to take away the client’s discomfort, but the clinician knows the client must go through this challenging process and can offer emotional support. The client states how much they “hate” this process and the clinician acknowledges that what the client is experiencing is “perfectly normal.” In this exchange between clinician and client, by naming the challenging parts of behavior change, both are making sure they go into the difficulty and not take any shortcuts.
In the next several blogs, we will continue discussing how the clinician supports the client when they have chosen to remain neutral. It can be a challenging experience for both the clinician and client but is a needed process for the client to make sure they have resolved their ambivalence. I hope everyone is doing as well as possible and you have opportunities to use and practice motivational interviewing. Take good care!
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.