In the last few blogs, we have been discussing the balance between change talk and sustain talk and how a skillful clinician can find the change talk to focus on. However, in the case where the client is offering 鈥渄ubious鈥� change talk, where it does not appear that they really mean what they are saying or the likelihood of the plan being implemented is unlikely to occur, the strategy is to facilitate the client in moving from generalities to specifics. The focus of the clinician is to become very interested in any specifics shared by the client.
If the client is not offering many specifics about the plan to change or to move forward, the clinician can begin asking questions to help the process along. An approach for the clinician could be to ask for more clarification, or for more details about the motivations and proposed plan including the who, why, and how, and a timeline for this to occur. In addition, it is important to keep in mind the spirit of MI and being curious and supportive and not judgmental or trying to 鈥渃atch鈥� the client in being deceptive.
Below, please find an example offered by Miller and Rollnick of how a part of session may sound in terms of moving from generalities to specifics:
Client: No, I really am going to quit drinking. I want to.
Interviewer: Why would you want to do that? [Evocative question: Reasons]
Client: I just am going to do it, that鈥檚 all.
Interviewer: Great. And what I鈥檓 curious about is why you鈥檙e so keen to do this when drinking has been pretty important to you.
Client: Well, my family wants me to quit. It gets me when my kid says, 鈥淧lease Daddy, don鈥檛 drink tonight!鈥� Really tears me up.
Interviewer: It鈥檚 pretty hard to say no to your child begging you like that. You care about your kids. [Reflection] What else? Why else would you choose to quit? [Evocative question]
Client: Well, my doctor said that I should.
Interviewer: What do you think?
Client: I know she鈥檚 worried about me, those blood tests and all. She said my liver is crying out for a break.
Interviewer: How important is that? [Evocative question: Need]
Client: Well, I don鈥檛 know too much about it, but I think if you kill off your liver it鈥檚 not coming back, and really bad things happen.
Interviewer: You鈥檇 like to stay healthy. [Reflection]
Client: That鈥檚 why I鈥檓 going to quit.
Interviewer: What would a first step be?
The focus for the clinician is to ask questions in order for the client to become more specific about their motivations and plan. Moving forward, the plan will become concrete the more the client hears themselves talk about their desire, ability, reasons, and need. And by speaking about the specifics, and not generalities, change is more likely to happen and makes the client more accountable. Also, when this process is done in an environment where there is curiosity and trust, more truth will likely come from the client.
Again, the balance between sustain talk and change talk shifts during a skillful MI session. And a strategy to support this happening is by having the client focus more on the specifics. By creating a supportive environment and having the client hear themselves talk about the change they want in their lives, the more likely this change is to occur. Next month, we will begin looking at the how we respond to change talk, in order for more of it to keep coming and to strengthen it. 聽Again, 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 or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.