When a client is in the process of making a change, and exploring ambivalence, it can be extremely intense. They may clearly see the benefits of the change but also the amount of effort that may be involved. The client may feel that it is just easier, and safer, to maintain the status quo. I trust many of us have been there with our clients. And as much as we may want to offer some suggestions, or point them in one direction or the other, there are some situations where we believe it is best for the client to make their own decision.
If a client is experiencing a great deal of discomfort in this process, one way for this intensity to be relieved is to ask the clinician directly for advice. The client may ask the clinician to point them in a specific direction or ask the clinician what they would do if they were in 鈥渢heir鈥� shoes. It is a tough place for both the clinician and client to be, and it is understandable for these situations to come up in a therapeutic setting. As the clinician, if we have decided to remain neutral with our client, then what would be a good way to respond to our client in an MI consistent way? Below, Miller and Rollnick have offered some language to support our clients but also refrain from offering advice:
You would really like for me to make this decision for you, and in a way I wish I could. I am not you, though, and this is a choice that is definitely not mine to make, or even to point you in one direction or the other. The decision is yours. The way out of this dilemma is to make the tough choice and begin moving in that direction. What are you thinking and feeling at this point? Do you seem to be leaning in one direction?
Again, as clinicians, we may want to share our thoughts or suggestions with a client through some MI consistent approaches. And there may be times we feel it is best to allow the client to make their own choices. When this is the case, the example above acknowledges the feelings being experienced by the client and the choice the clinician has made to remain neutral. And notice at the end of the example how the clinician offers some open-ended questions about what the client is thinking and feeling and where the client is currently at with their decision. By asking these questions, it reminds the client that they will be making their own choices that will allow them to move forward.
In the next couple of blogs, we will continue discussing how the clinician supports the client when the client is experiencing a great deal of ambivalence. It can be a challenging process for both the clinician and client but is needed for the client to make sure they have explored as many of the thoughts and feelings as possible. 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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