Learning how to give advice in a Motivational Interviewing consistent way can be one of the hardest things to learn. Many of us are trained to give advice and ask questions, two things we do very sparingly in MI. At first it seems like these are easiest, and they may be, but they are among the least effective approaches to helping people change behavior.
I recently trained a group of nursing students and got a lot of “push back” from one gentleman in particular. He expressed the strong belief that there is an important place for confronting people when their behavior is very high risk. His example was a patient who had an alcohol problem, and whose physical condition made drinking very risky.
I had to respectfully disagree. The truth is that most people will become more resistant when confronted and in this way the clinician’s behavior can cause resistance. I know it feels urgent in a situation in which the client is highly likely to harm themselves. It is very important to not push for a plan for change until the client is ready to hear it, and to be able to recognize readiness to change. Once we do hear signals of readiness to change, what works better than confrontation is “explore-offer-explore” in which we explore the client’s ideas about change, offer our advice and suggestions, and then discuss how that information might influence their plans for change. Here’s an example of a client whose behavior with alcohol is under discussion.
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Practitioner: So, we’ve discussed your drinking today, and it’s sounding to me like you might consider making a change. What do you think?
Client: I’m starting to think you people might be right. I’m upset that my wife is angry with me, and my daughter won’t let me come to her soccer games anymore. Change Talk
Practitioner: Sounds like your wife and daughter being unhappy about your drinking is making you think you ought to change that. What ideas do you have to make changes? EXPLORE
Client: I don’t know where to start….it all seems overwhelming.
Practitioner: I have some ideas that others have used. They might not work for you, but you’ll be the best judge. Would you like to hear them?
Client: Sure, I guess.
Practitioner: I know that you tend to drink when you get home from work, and that sometimes causes problems in the family. This is a common situation for people, and some have found that not having alcohol in the house can work. We could talk about some alternatives to drinking in order to unwind from the day. OFFER What do you think? EXPLORE
Client: I could try those things. What could I do besides drinking? Change Talk, specifically, Commitment
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In this example the client expresses change talk, specifically, commitment talk, indicating that he is getting ready to make changes. This is the signal that the practitioner can bring up the idea of a plan for change.
