Reflecting on a Client Encounter
Learning Motivational Interviewing is likened to learning to play a musical instrument—it takes time and practice. Attending one or two MI trainings does not make for a skilled MI practitioner. One of the ways we learn is by reflecting on our client interactions. If you have the ability to record and listen to your encounters, even better! Here are some things to ask yourself when you are feeling stuck or just curious about what’s going on in your clinical practice.
1. What are the client’s personal motivations to change? Did I hear change talk?
Change talk is client speech in favor of change. The more change talk you hear, the more likely people are to change. One of the founding principles of MI is that people are more influenced by what they hear themselves say than by what other say to them. If your client is spending more time defending against change than offering reasons and ideas for change, it is a signal to change strategies.
2. Who did more of the talking?
I was trained to dominate the conversation and overwhelm people with too much information. The primary skill we work on as MI counselors is listening. We want our clients to talk more than we do because they are influenced by the reasons they themselves discover for change than those coming from the minds of others (Pascal’s Pensees). Develop a repertoire of evocative open-ended questions and ask them to see if the answer is in the room. Your job is to ask the right questions, not to provide the answers. Research shows that much of the advice we have to offer people has already been thought of and rejected by them.
3. Did the interaction feel more like dancing or wrestling?
The conversations we have with our clients can move them towards change or away from it. Paying attention to the quality of the energy between you and your clients provides great insight into whether or not what you are doing is helping or harming the change process. When the energy feels like a wrestling match, it is a signal to change strategies. Avoid labeling the client as “non-compliant.” In MI, we believe resistance is an observable behavior, not the trait of a human being. The Mayo Clinic’s Victor Montori, MD, says “Perhaps people in their ‘non-compliance’ are trying to tell us something.” Client resistance is highly correlated with the style of the counselor. Change what you are doing and the energy will shift too.
4. Who was the more motivated person in the room?
You never want to be the more motivated person in the room. If you are the one presenting the reasons, ideas, and strategies for change, change is unlikely to happen. There is little research to show that when you are dominating the conversation—when you take over the conversation with your enthusiasm—people change. From a MI perspective, the role of a helping professional is to explore the possibility of change—not to ensure that it happens. Notice your reaction to reading that. What are you more and less likely to do when you see your role in this way? As providers, we must embrace the different possibilities, besides action, for defining a successful encounter!
5. What was happening in my heart and mind as I talked with the client? Was I focused on connecting or correcting?
A few years ago, Stephen Rollnick posed a slightly different version of this question at a conference in Portland:
When you sit across from someone who is deeply troubled, are you in your heart and mind focused on connecting with them or correcting them?
We don’t become skilled practitioners of MI until we to get good at sitting on our hands and resisting the righting reflex—the strong urge human beings have to direct, fix and/or get someone to face up to reality. People want to be heard, seen, and understood, and until they know that you “really get it”, they don’t care what advice you have to share with them. You may have heard the quote “People don’t care how much you know until they know how much you care.” Empathy fuels connection. Spending most of your time focused on fixing a person is what Brené Brown would call an empathy failure. Empathy is the most powerful element of effective interventions. Give it generously!
We hope you find these questions useful in your practice. If you are interested in learning more about Motivational Interviewing, Dana’s upcoming trainings are listed here.