If we are working with a client, and it appears that they are not ambivalent about changing their behavior, don鈥檛 be so sure. It may be that someone, who is important to them, has suggested that they consider making a change. Oftentimes, it is an employer, dear friend, family member, or possibly a court of law. If they are having a conversation with you about change, it likely means that they are open to continuing the conversation and possibly making a change.
There are several situations where the client may be influenced by someone else to make a change. Consider the examples below from Miller and Rollnick:
- A parent mandated to treatment for child abuse, who sees nothing wrong with the disciplinary practices that led to referral.
- A patient being treated at a trauma center for injuries sustained in an alcohol-related crash, who blames the other driver and has no apparent concerns about drinking.
- A teenager brought to treatment by concerned parents who discovered marijuana and drug paraphernalia during a room check. The teen is incensed about being checked up on and regards cannabis as harmless.
- An overweight patient with Type 2 diabetes who cheerfully admits that 鈥渕y blood sugar hasn鈥檛 been under 200 for years鈥� and shows no inclination to make health behavior changes.
- A college student who failed the first midterm examination in an introductory course and seems unconcerned and unwilling to study differently.
- A pregnant woman who expresses no intention to quit smoking or drinking.
In these examples above, it appears the client is not motivated to change their behavior. Yet, they have brought these situations to you, and it offers you an opportunity to explore further if they might consider changing their behavior. The goal is to do this in a way that is extremely gradual and by reminding the client of their autonomy in making the decision to change. An approach that is gentle is typically much more effective than one that is forceful.
In our next blog, we will talk about how to have this conversation. If someone does not appear to be ambivalent, it may be that someone else has suggested or influenced them to consider changing some behavior in their life. And it may be that they are wanting to engage in a conversation to explore this possibility. I hope everyone is doing as well as possible and you have opportunities to use and practice motivational interviewing.
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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