A very important idea in MI is that we must accept our client’s decisions about if, when and how they will change. This might include not making any changes, or not the ones we feel they must make for their safety and future health.
When I first learned about this idea as part of MI, I was very distressed. I work with young women with eating disorders, and for many of them, their behavior is very high risk. How can I possibly accept the decision of a very low weight client with anorexia to not gain weight? Or, a client with bulimia to continue bingeing and vomiting and using laxatives? I thought this concept meant that I couldn’t care about what happened to my clients. That’s not what it says or means.
Of course we care about our clients. That’s why most of us become health care providers; we want to help others. The point here is that we don’t get to decide whether or not they will make the changes in their behavior that we think are very important. If you’ve got a problem with your patient’s decision about whether or not to change you have the problem, not your client. My job as a nutrition therapist is to help my client make the decision that’s right for her, and for me to accept that decision. If I’m unhappy with her decisions, I need to get myself help for my feelings about this.
I highly recommend peer or professional supervision about this sort of thing. I belong to a peer supervision group, made up of other eating disorders treatment professionals. We review cases with each other once a month, and support each other in exploring our (often uncomfortable) feelings about how our clients use treatment.