As we have learned, MI has been developed to strengthen a person鈥檚 motivation for and commitment to making a particular change in their lives. And our role as counselors, is to guide them in making a choice. However, we are also aware that making a choice is always left up to the client. And what if we are presented with a situation where we believe it would be ethically wrong for us to encourage our client to make a particular choice or to move them in a specific direction?
Examples of these situations could include:
- An adult considering donating a kidney for a relative who needs a transplant.
- A woman pondering whether to have an abortion.
- An adolescent considering whether to use condoms when having sex.
- A homeless man who is comfortable with life on the street.
- A woman mandated to treatment after a third conviction for drunk driving.
(Miller and Rollnick, 2013)
In scenarios where we have the intention to avoid influencing the client鈥檚 decision, there are ways to practice staying neutral.
Choosing neutrality
A good place to start is to consider, whether, we as counselors, can impact a client鈥檚 decision. The answer is 鈥測es鈥� that interpersonal influences can and do make a difference when a person is making a decision and that we often underestimate how much our behavior is influenced by external factors (Bargh & Chartrand, 1999; Bargh & Ferguson, 2000). We can think about this in terms of how our attitudes, choices, and values can be influenced by advertising, marketing, and politics (Cialdini, 2007).
The next step is to determine whether we plan to counselor with neutrality or if we plan to encourage the client to move in a particular direction. If we plan to counsel with neutrality, it is acceptable and important to let the client know. The reason is because, as many of us know, making a significant decision can be stressful and uncomfortable. The ambivalence a client may experience can be unpleasant, and by letting the client know that we plan to be neutral, that it is normal to feel uncomfortable when making a challenging decision, that we will support them until they have made their own decision, and then help them move in the direction they have chosen, is typically very affirming, honest, and helpful. Miller and Rollnick (2013) offer these essential elements of informing a client about counseling with neutrality:
- That you want to help the person explore the dilemma that has him or her stuck.
- That you intend to remain neutral yourself with regard to what the person should do until they decide.
- That exploring a dilemma like this can be uncomfortable, or upsetting, which is one reason people get stuck in ambivalence.
- That you want to help them work through the dilemma and discomfort, make their own decision, and move on as they choose.
Since we know the client will likely experience some discomfort, an MI approach that can be used when this arises is to name what is happening, reflect what is happening, normalize what is happening, and be present with what is happening. An example could sound something like this:
Client: I really don鈥檛 like to be in this situation. I just don鈥檛 know what decision to make.
Counselor: This is a really difficult position for you to be in.
Client: Yes, but I know that I have to make a decision.
Counselor: And what you are feeling is perfectly normal, and I鈥檓 sorry it is uncomfortable.
Client: It just has been so long for me to decide and I still don鈥檛 know what to do.
Counselor: It feels like a long time and you are still feeling confused about what to do.
Client: I really want this to be over and I know I will feel so much better once I make a decision.
Counselor: You would really like to make a decision and move on with your life, and I want to help you get through this.
We also know that some clients would prefer that we make the decision for them. Perhaps by asking, 鈥淲hat would you do if you were in my situation?鈥� When this occurs, it is often an attempt by the client to escape the discomfort of ambivalence. And as much as we may also want to relieve the client of their distress, and we have chosen to remain neutral, we can simply acknowledge, reflect, and normalize what is being experienced and remind the client of the choice we have made to remain neutral.
Again, a great topic to discuss and I hope some of these thoughts will be added to your own as you think about particular situations where you choose to counsel with neutrality.
For more information about Motivational Interviewing or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.