In a conversation about change with our clients, we are aware that ambivalence is a normal part of the process and we expect to hear some sustain talk. When we hear our clients using sustain talk or wanting to maintain the status quo, or stating that they don鈥檛 think they can change, how do we respond? The key is to acknowledge what the client is saying and not add anything that would likely increase more sustain talk. Then, follow up the reflection with an opened ended question for more exploration. And even though we know there will likely be continued sustain talk throughout the session, what usually shifts in a session is the ratio of change talk to sustain talk. Basically, what will happen in a skillful session is that the amount of sustain talk becomes less frequent in the conversation.
So, when we hear sustain talk, we want to respond to the client by reflecting back the sustain talk and encourage more exploration with an open-ended question. By responding in this way, the client will feel like what they are saying matters and that they are not being 鈥渢alked out of鈥� maintaining a certain behavior.聽 Ironically, this process is very similar to how we, as clinicians, respond to a client when we hear them express change talk.
Below, please find an example of statements made by clients from Cathy Cole Training, including a statement, reflection, and an open-ended question:
This is one way to respond in an MI-consistent way when we hear sustain talk. There is not a specific response when we hear sustain talk from the client, but if we acknowledge the statement made by the client and follow it up with an open-ended question, it is likely to keep the client engaged in exploring the possibility of change and increasing more change talk than sustain talk.
Another strategy that can be helpful when we hear sustain talk by the client is to emphasize autonomy as much as possible. For example, if a client states that they do not want to quit smoking or does not want to exercise, we can emphasize that it is certainly their choice and that they can鈥檛 be forced to change their behavior. As a clinician, we can also express our curiosity with the client in terms of what they will decide to do, 鈥淚 am curious about what you will end up doing.鈥�
Again, another strategy that can assist us, if we hear sustain talk. And next month, we will focus on the therapeutic relationship and what happens if there is disharmony in the collaborative alliance.
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.