In counseling situations where there is a change goal for the client, there is likely ambivalence too. Therefore, the clinician has a decision to make. Should the clinician remain neutral or support movement in a particular direction? A different approach would be needed for the clinician in each situation. In motivational interviewing, the clinician is often attempting to strengthen the client鈥檚 motivation for change. However, if the clinician makes the decision to remain neutral, what is the approach that would be most effective and maintain the spirit of MI?
I鈥檓 sure we have all experienced ambivalence in making decisions, so we know how unpleasant it can be. To be thinking about both sides of a significant change in one鈥檚 life, and a change that could have long term consequences, can be very stressful. And to be with a clinician who is remaining neutral and where there may be limited movement in one direction or the other can also be intense. If the clinician is deciding to be neutral, it is best to let your client know. Miller and Rollnick have come up with some essential 鈥渆lements of informing鈥� the client of this decision. They include:
- That you want to help the person explore the dilemma that has him or her stuck.
- That you intend to remain neutral yourself with regard to what the person should do until they decide.
- That exploring a dilemma like this can be uncomfortable or upsetting, which is one reason people get stuck in ambivalence.
- That you want to help them work through the dilemma and discomfort, make their own decision, and move on as they choose.
And here is a passage of how they think it might sound:
I can see that you鈥檝e really been struggling with this dilemma and feeling stuck. That鈥檚 very common in a situation like this. Thinking about either alternative is uncomfortable, and so it鈥檚 tempting to try not to think about it; but that鈥檚 uncomfortable, too, because nothing is resolved or changed. What I suggest we do is to explore both sides of this dilemma rather thoroughly. I want you to know that I intend to remain completely neutral about what you should do and not advise you one way or the other, but just help you take a good close look at what your choices are. You may find this process uncomfortable-people often do-but I think that鈥檚 what you need to do to get unstuck. I will work with you and support you until you decide what you want to do, and then help you move in the direction you鈥檝e chosen. Do you have any questions about this process I have described? Shall we proceed?
By taking a look at this example from Miller and Rollnick, we can see how their 鈥渆lements of informing鈥� are included. Expressing to the client that you want to work with them on their dilemma and acknowledging that it is and will likely be uncomfortable. The clinician lets the client know that they are going to remain neutral, and that they are going to support them moving forward once a decision has been made. Again, the key is to inform the client that you are planning to remain neutral while you continue to maintain the spirit of MI.
In the next several blogs, we will continue discussing how the clinician supports the client when they have chosen to remain neutral. Again, there are many approaches and we will take some time to discuss them. 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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