When a client is contemplating making a change, there is almost always going to be some ambivalence between changing and doing things the same way. There will be the benefits of changing (pros) and the negatives of changing (cons). Sustain talk is when the client wants to keep things the same related to a particular behavior. In previous blogs, we talked about the importance of reflecting back to the client when we hear change talk, in order to encourage more. With sustain talk, it is similar in that the more the client talks about keeping things the same the more likely they are in talking themselves out of changing. Therefore, when sustain talk is being spoken by the client, it is best to use a strategy or technique that is MI consistent and that moves the conversation towards change.
A couple of MI techniques that are used to respond to sustain talk are Straight Reflection and Amplified Reflection. In Straight Reflection, the clinician offers a simple reflection or a complex reflection that can often produce change talk. An example from Miller and Rollnick is below:
Client: I don’t think that anger is really my problem.
Clinician: Your anger hasn’t caused any real difficulties for you.
Client: Well, sure it has. Anyone who gets into scraps as much as I do is bound to have some consequences.
You can see how the client responds when the clinician offers a Straight Reflection. And how this may lead to further exploration of the client’s anger and changes of behavior. Another MI technique used to respond to sustain talk is by offering an Amplified Reflection. This response is intended to produce change talk from the client because it is an overstatement of what the client has shared. Miller and Rollnick offer this example:
Client: I think things are just fine in our marriage the way they are.
Clinician: There’s really no room for improvement.
Client: Well, I mean things aren’t perfect, but I’m happy enough as it is.
Clinician: Things just couldn’t possibly be any better in your marriage than they are right now.
Client: I’m pretty satisfied, but I guess both of us aren’t.
An Amplified Reflection is considered an overstatement of what has been expressed by the client. The clinician provides a reflection of what the client is sharing and “takes it up a level” to encourage change talk. In this example, the continued dialogue will likely include aspects of the marriage that need to change.
Responding to sustain talk can be an opportunity for the conversation to move in the direction of change. Again, it is very common for sustain talk to be present in your interactions with clients since we know that ambivalence is a stage that must be explored in order for change to occur. Clinicians have this awareness and can have numerous MI techniques at the ready to acknowledge the sustain talk with a Straight Reflection or an Amplified Reflection to likely move the discussion towards changing behavior. Next month, we will begin looking at how best to respond to discord. 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.