In the last few blogs, we have talked about how the more change talk expressed by the client in a session, results in more desired change in their life. And in a skillful MI session, the sustain talk does not go away, but it becomes less frequent. There are some clinicians who think that once they began to hear more change talk that things will continue to progress in this way. Contrary to this belief, sustain talk usually continues but a skillful clinician is able to pull out the change talk within the sustain talk. It is not about eliminating the sustain talk but finding and focusing on the change talk.
The other question that often comes up around change talk and sustain talk is whether some clients simply express what they think the clinician wants to hear. This is often referred to as 鈥渄ubious鈥� change talk where the clinician believes the change expressed is unrealistic. In these situations, since MI does not support confrontation (because it would most likely damage rapport and trust) with statements like, 鈥淚 don鈥檛 believe this is realistic鈥� the clinician can respond by asking for more specific detail.
In MI, the clinician wants to believe what the client is expressing, and by asking for more specifics, it is an opportunity for the client to shift from being vague to being clear. Questions asked could be 鈥淗ow are you planning to make this change?鈥� and 鈥淲hy it is important for you to make this change?鈥� in order for the client to gain clarity and for the clinician to see that the client has a plan moving forward. This process can also be extremely supportive to the client as they hear themselves speak about the specifics. It becomes more real and the client can gain momentum.
If the clinician feels that the client is 鈥渟aying what the clinician wants to hear鈥� or there is some 鈥渄ubious鈥� change talking occurring, it can also be a sign that strengthening engagement may be important. This can lead the client to perhaps be more honest with the clinician and not feel the need to please and say things that the client thinks will be affirmed by the clinician.
Again, the balance between sustain talk and change talk shifts during a skillful MI session. The sustain talk does not disappear but the clinician is able to find and focus on the change talk. Next month, we will continue looking at sustain talk and change talk and provide an example of what a session might sound like in terms of moving from generalities to specifics. I hope you all have a great month and have opportunities to use and practice Motivational Interviewing!
