The concept of developing discrepancy has been used since the very beginning of motivational interviewing. It can be a very strong motivational factor for many clients as they consider changing a behavior. The idea is to explore the client鈥檚 current behavior and where they would prefer to be. For example, one client may want to integrate more exercise into their daily routine and someone else may want to reduce or eliminate their alcohol consumption.
Even though there is often a desire to change, making the change occur and integrating a new behavior into a daily routine or lifestyle can be challenging. For example, a client wanting to stop smoking may be well aware of the harmful effects, but having time to explore their current thoughts, feelings, and behaviors around the topic may be extremely difficult.
And as most of us know from personal experience, changing any behavior does not usually happen on the first try. Why does it usually take a while before a change can occur? Miller and Rollnick have talked about several reasons why this may be the case. For the three examples below, there is the Roadblock for the client and the Way forward for the clinician:
Roadblock for client: The client鈥檚 current behavior and the desired goal may just feel too distant. The goal may feel unreachable or does not seem possible to achieve.
Way forward for clinician: The ideal situation for the clinician here is to find and agree on a goal that feels reasonable. Perhaps deciding on a goal that is not too small where it wouldn鈥檛 feel important enough and a goal that does not feel too large where the change seems beyond their capabilities.
Roadblock for client: The client does not feel they have the confidence or ability to reach their goal.
Way forward for clinician: For a discrepancy to be motivating, the client must have some confidence in being able to increase or decrease a behavior. The clinician and client can confirm that there is reasonable confidence to move forward on achieving the goal.
Roadblock for client: The client can feel extremely guilty or ashamed about their current behavior(s) and it could feel easier to not experience these feelings.
Way forward for clinician: The clinician can normalize to the client the discomfort that may be experienced and the benefits of exploring these feelings and potential impact of behavior change. Reminding the client that you will be with them throughout this journey can be very supportive.
These roadblocks to change can be easily understood by all of us since we most likely have been there. The key is to normalize these experiences to our clients and validate the strengths and resources they possess. In addition, it is important to find a behavior goal that is reasonable and where there is some confidence on behalf of the client. And probably the best experience for both the client and clinician is simply to have the conversation and explore where the client is at and where they would like to be.
In next month鈥檚 blog, we will continue exploring the concept of 鈥渄eveloping discrepancy鈥� and how it is used in motivational interviewing. I hope everyone is doing as well as possible and you have opportunities to use and practice motivational interviewing. Again, Happy New Year and 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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