When motivational interviewing was initially introduced, it was a way to support clients who perhaps didn鈥檛 recognize the importance of changing a behavior. For example, in the case of problem drinking the clinician was oftentimes more aware of the importance. Another situation where MI can be helpful is the situation where the client is aware of the importance of changing but doesn鈥檛 have the confidence in making a change. Below are several examples offered by Miller and Rollnick indicating a lack of confidence from clients:
鈥�I could get a better job if I got a college degree, but it鈥檚 been a long time since I was in school and I don鈥檛 think I could keep up.鈥�
鈥淚 know that smoking is bad for me, but I鈥檝e tried to quit several times and I just can鈥檛 seem to do it.鈥�
鈥淲e definitely need to communicate better, but I don鈥檛 think my family is really committed to trying.鈥�
鈥淚 would like to be healthier, but it hurts too much to exercise.鈥�
Each of these statements start off with a desire or need (DARN) to change and then there is a 鈥渂ut鈥� that is followed by a reason as to 鈥渨hy鈥� it is not possible. If a clinician hears a statement like this, they can offer support to the client. The place to begin with the statements above is to acknowledge the preparatory change talk by the client. The clinician can reflect back to the client the desire or need and then move the conversation back to the client on how they could contribute to making this change happen.
The goal here is to focus on the resources and strengths already available to the client and not looking for anything outside of themselves. After reflecting back to the client the desire or need, a good approach is to ask open ended questions that allow the client to discuss and explore possible ways to address the issue. There are numerous open ended questions to ask a client about how they can make this change happen, and here are a few suggested from Miller and Rollnick:
鈥�How might you go about making this change?鈥�
鈥淲hat might be a good first step?鈥�
鈥淕iven what you know about yourself, how could you make this change successfully?鈥�
鈥淲hat obstacles do you foresee, and how might you deal with them?鈥�
鈥淲hat gives you some confidence that you can do this?鈥�
By asking the client how they could contribute to making this change happen, and for the client to become aware of strengths and skills they possess, it is likely the clinician will begin to hear language that focuses on their abilities and their ideas for how this change could become a reality. It then becomes a process where the clinician and client explore the way forward for the client.
Next month, we will discuss additional strategies to address a lack of confidence on behalf of the client. 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
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