We are all familiar with the collaborative approach MI offers to the clinician and client. This approach helps to “level the playing field” and reduces hierarchy in the relationship. In addition, working collaboratively can build trust and rapport. The key is to make sure the client feels the support and guidance of the clinician but to know that they will be doing the “heavy lifting” in the sessions to integrate new behaviors moving forward.
When the clinician and client have moved along in the MI processes or tasks, and are in the planning process, one specific way to work together to strengthen commitment is to discuss certain challenges or obstacles that may arise. Having a plan is a great step in the process, but we also know that it may not go exactly as discussed. Talking about several possible scenarios that may come up “out in the real world” can be helpful to the client. Please see below a couple of situations offered by Miller and Rollnick:
“Now suppose that you’re on day 4 of not smoking. You’re through some of the worst of the withdrawal, and you’re at an outdoor café with a friend who takes out a pack, taps one out and offers it to you. Suddenly, you feel a tremendous desire for a cigarette. How might you get through that without smoking?”
“Sometimes patients have told me that they just forget to take their medication, or don’t have it with them if they have meals away from home. What would work for you to be sure you take it with breakfast and dinner every day?”
As the clinician and client discuss these scenarios and collaboratively problem solve, the result will often be more change talk from the client. Another benefit that may surface from this approach includes coping strategies offered by the client with any challenges related to changing their behavior. Perhaps the client recognizes that they will need additional support from family and friends as they consider making changes.
By discussing these scenarios, the client becomes more prepared, and more trust and rapport builds between clinician and client. They can fine tune the plan moving forward and talk about when they may want to put the plan into action. In follow-up sessions, they can talk about how things are going and discuss any changes needing to be made. I hope everyone is doing as well as possible and you 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