How can we accept our patient/client’s decisions not to change behavior when we think those changes are crucial?
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.
Five years ago I went through the Wellcoaches certification program and this is where I was introduced to MI. The concept of accepting your clients choice of whether to change a behavior or not was not addressed. However, I intuitively realized that it was not my choice of whether they choose to make any changes. This freed me up, opened up space, for both me and my client. I verbalize to my clients that they always have a choice and one of the choices is to do nothing. I’ve had many of them say, “thank you for saying that.” The irony is that most of them decide to move toward the positive change, albeit, in small steps, but isn’t that what MI is about! Love your work Dr. Ellen! Thanks for the posting.
Thanks, Bonnie! I know that Wellcoaches includes some MI training as part of their program, and I’m very pleased about that. I too find that by accepting their choices about change/no change that we free them up to decide to actually make positive changes. Sounds counterintuitive, but it really does work.
I like how you emphasized that it is “your problem; seek help” I have always wondered how some folks will take on others issues as if it was theirs not realizing that the client is going to do what they do regardless of how you think or feel. Thank you for reinforcing what I always believed to be true.
Ken:
Great point. I think that many clinicians “take on” others’ issues because many of us are taught that we ARE responsible for whether or not they change. Of course, we are NOT responsible, since no one can make another person do anything they don’t want to do. Threatening, cajoling, nagging, etc don’t work!