There may be many reasons why a client wants to maintain the status quo and not change their behavior. The client may be very clear as to why they do not believe making a change is in their best interest. In some situations, there also may be little or no ambivalence about change. How do we, as clinicians, work with these clients? One approach that has been effective, is to explore with a client whether they are aware of how their behavior may be affecting other people who are significant in their lives.
Oftentimes, coming at this situation from a different perspective can be helpful. To discuss with the client how they think their behavior is impacting other people may allow them to let go of their current 鈥渟tance鈥� and consider things in a new way. An example of a session with a client provided by Miller and Rollnick give some insight into how this conversation may unfold:
INTERVIEWER: Why do you imagine your wife is worried about your drug use? What do you think concerns her?
CLIENT: She鈥檚 someone who always comes down on the safe side of every issue. But my drug use is my choice, and it鈥檚 none of her business.
INTERVIEWER: She鈥檚 not as much of a risk taker as you are.
CLIENT: That鈥檚 definitely true. She doesn鈥檛 like anything that鈥檚 even remotely risky, and I guess she thinks my drug use is risky.
INTERVIEWER: Why do you suppose she thinks that?
CLIENT: Well, for one thing it鈥檚 illegal. She鈥檚 worried I鈥檒l get caught and get in trouble or lose my job or something.
INTERVIEWER: But that鈥檚 really none of her business.
CLIENT: No, now there I can see where she has some grounds for concern, losing my job and all. That would affect her.
INTERVIEWER: So if it could affect her negatively, it鈥檚 reasonable for her to worry.
CLIENT: Yes, I guess so.
INTERVIEWER: But if it鈥檚 just affecting you negatively, that鈥檚 not her concern.
CLIENT: Well, she鈥檇 be worried about that, too.
INTERVIEWER: Because鈥�
CLIENT: Because she cares about me. She鈥檚 our family smoke alarm.
INTERVIEWER: Of the two of you, she鈥檚 the one who watches out for things that might hurt you, even before it鈥檚 serious. She鈥檚 cautious.
CLIENT: And I鈥檓 not. I鈥檓 a go-for-it kind of guy.
INTERVIEWER: You鈥檙e opposite in that way.
CLIENT: Yeah, I guess opposites attract, you know.
INTERVIEWER: It鈥檚 one of the things you appreciate about her.
CLIENT: But I don鈥檛 think she appreciates my risk taking.
INTERVIEWER: Like using illegal drugs.
CLIENT: Yeah
The clinician is essentially using all open-ended questions and reflections. By using these basic MI skills, the clinician is able to facilitate the client in seeing things not only through his eyes but also through the eyes of someone that he cares about, and who cares about him. This conversation between clinician and client also begins to produce some change talk by the client that will hopefully lead to some behavior change.
In our next blog, we will continue talking about strategies that may be effective in working with a client who may be less motivated to change. We will discuss asking the client what they want their lives to look like and how it relates to their goals and values. 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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