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When MI was originally developed, the purpose was to support a client in strengthening both motivation and commitment to making a change. And even though we are present there with the client, the ultimate choice of whether to make a change is up to them. In some situations, it may be appropriate to ask questions that may facilitate a client towards a particular path, and other times, it is appropriate for clinicians to stay neutral because it is unclear towards which direction the client should go. The goal of the clinician in these situations is to keep balanced and work to not favor one side of an argument over another.

As a clinician, and in working with a variety of clients and scenarios, there may be some situations where we feel the need to influence a client鈥檚 decision, and other situations where we feel it would be unethical to do so. See below the many scenarios offered by Miller and Rollnick that may be encountered with clients. Reflect on whether you would feel the urgency to direct them in a particular way or whether you would feel more inclined to allow them to explore their ambivalence and possible options:

A couple who want help deciding whether to try to adopt children.

An adult considering donating a kidney for a relative who needs a transplant.

A woman pondering whether to have an abortion.

An adolescent considering whether to use condoms when having sex.

A man who has been injecting 鈥渟peedballs鈥� (heroin and methamphetamine).

A woman deciding whether to leave her husband who has been physically abusive.

A homeless man who is comfortable with life on the street.

A woman considering whether to enroll in a study you are conducting.

A man who uses self-asphyxiation by hanging to heighten sexual orgasm.

A woman mandated to treatment after a third conviction for drunk driving.

A soldier who in boredom and despair periodically plays 鈥淩ussian roulette.鈥�

A caller to a crisis hotline, pondering suicide by jumping from a building.

A sex offender contemplating new victims.

For some of the scenarios presented, it may be very clear on how you would respond, and for others, not so clear. In either case, the range of situations experienced by clients can be extremely varied. And how we respond as clinicians may also be varied. We may feel a professional or ethical obligation to encourage the client to make a choice in a particular direction or it may feel like it would be unethical to possibly influence a client. And some of the scenarios may fall into a gray area where it is unclear how you would respond.

In the next several blogs, we will discuss ways to consider being with clients when our goal is to stay balanced and not nudge the client in a particular direction. In some ways, it can be extremely difficult to stay neutral. But we know about the importance of ambivalence in behavior change and in allowing the client to explore topics that may be challenging or uncomfortable with the belief that they can make choices that are best for them. I hope everyone is doing as well as possible and you have opportunities to use and practice motivational interviewing. Take good care!