When there is change talk being expressed by the client, and we, as clinicians, reflect this back to the client, what often comes next is more change talk. And the more we reflect change talk, the more we will receive it. If the client is speaking about change and there is both sustain talk (wanting to continue behaving in a similar way) and change talk (wanting to behave in a different way) the goal is to focus on the change talk and not on the sustain talk. Again, reflect more of what you want to hear. By following this strategy, the client will be more likely to talk about how they want things to be moving forward and less about continuing in the same way.
Oftentimes, there is change talk and sustain talk being shared by the client in the same sentence. This is due to the fact that many of us experience a great deal of ambivalence when we are considering a behavior change in our lives. We are definitely excited about the possibility of changing a behavior but the concern of doing things differently or of letting go of the familiar can be devastating. Therefore, when the client is speaking about changing, we need to make sure we jump at the opportunity to reflect it back.
The passage below offered by Miller and Rollnick provides an example of someone wanting to make a change in their life but also feels like it is just too difficult to accomplish:
“By the time I get home from work I’m already tired. I get supper ready and help the kids with their homework, and by the time I get them to bed I’m exhausted. I know I need to get more exercise, but there’s just no time to fit it in!”
It would be easy for the clinician to talk about how important physical activity is and ways to fit it into their schedule but the response from the client would likely be more sustain talk (or reasons why integrating physical activity into their routine would be too difficult). The key to the statement made by the client is that they expressed change talk and so the focus by the clinician needs to go there. The client mentions the need to get more exercise so it should be reflected back to the client. The clinician could also follow up with asking the client to imagine themselves exercising and what type of exercise would it be? And the clinician could also affirm that health sounds really important to the client. Again, there may be change talk and sustain talk being expressed by the client. And the clinician can be very skillful by pulling out the change talk within the ambivalence.
Miller and Rollnick offer a couple of other examples below: statements made by clients and reflections provided by the clinician that focus on either change talk or sustain talk:
Client: I was worried there at first, but I don’t think I really have diabetes. The doctor said it was “borderline” or something like that, and I feel fine.
Sustain talk: You feel fine.
Sustain talk: You don’t think you really have diabetes.
Change talk: You don’t want to develop diabetes: that worries you.
Client: It’s just such a hassle to take all those pills. I’m supposed to remember to take them four times a day, and half the time I don’t even have them with me. And I hate how they make me feel. I guess there’s a good reason for it, but it’s just not possible for me.
Sustain talk: There’s no way for you to do it.
Sustain talk: Having to take all that medicine is a real hassle.
Change talk: You know it’s important to take them.
These examples provide us with a glimpse of how sustain talk and change talk can be heard in the same sentence or same paragraph. And our goal is when we hear the change talk, to make sure to reflect it back to the client. And again, if we reflect change talk back to the client, we are likely to hear more.
Reflective listening can seem quite challenging at first, but with practice, like with most new skills we are attempting to learn, it gets easier. In today’s blog, the discussion on reflective listening reminds us of the importance of listening for the change talk in our conversations with clients. Sometimes, it can be subtle but change talk is often present. Next month, we will spend time discussing the last of the OARS: Summaries. 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.