When we think about all the things that are going on with our clients, it is often easy to understand why they may come into a session and feel threatened or vulnerable. At the same time, it may not always be the client that is feeling vulnerable or stressed. It could be the clinician as well. If the clinician and client agree to enter into a collaborative therapeutic relationship, it may happen when there is disharmony. Therefore, the clinician needs to be aware if they are contributing to this harmony and not assume it is the client. And it is good to know that even if there is disharmony in the relationship, there are many ways to address this situation.
Signs from the client that there is disharmony in the therapeutic relationship includes possible interruptions made in the session, defending themselves, seeing the clinician as not being supportive, and/or not engaging in the session. Signals from the clinician that there is disharmony is the therapeutic relationship includes arguing for change, providing solutions, becoming frustrated, or being distracted. Again, regardless of the situation, it is important to be able to identify this tension in the relationship and determine the best way to move forward.
If it appears the disharmony is related to how the clinician is feeling, it is important to become aware of this and either take some time or some action. If action is needed, an apology can always be helpful and models healthy communication to the client. Also, it acknowledges that you and the client have entered into a collaborative therapeutic relationship. If it appears the disharmony is related to how the client is feeling, there are several MI consistent responses to share with the client in order to regain the balance. Miller and Rollnick have provided an example of the different ways this may be communicated in a session:
Client: How old are you? How can you possibly understand me?
Reflection: You鈥檙e wondering if I鈥檒l really be able to help you.
Amplified Reflection: It seems like there鈥檚 no chance at all that I could help you.
Double-sided Reflection: You鈥檙e looking for some help, and you鈥檙e not really sure if I鈥檓 the right person to provide it.
There are several ways to address 鈥渄iscord鈥� in a therapeutic relationship. In this example, it is important to reflect what the client has shared and offer an opportunity to explore what is present for both the clinician and client. If there is good rapport between the two involved, there is likely to be some good discussion about honest feelings and ways to improve the relationship.
Again, the key is to become aware that there is disharmony in the relationship and then being able to take steps to move forward in a productive way. We also understand that it could be the clinician contributing to this 鈥渄iscord鈥� in the relationship and have talked about the importance of good self-care for the clinician. And being able to be honest with our clients when we need to take responsibility for our feelings and actions can be a great way to model healthy communication. Next month, we will begin discussing the importance of confidence in being able to change a behavior. 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