In MI training, we emphasize asking permission, before you offer unasked for advice or change the subject. The obvious question, then is what happens if the client’s answer is NO?
Here’s an opportunity to make a real connection with the client. A simple response is “Thank you, I really appreciate your honesty with me.” This can often be very disarming, since most people won’t expect that response.
There could be many reasons people answer “no”. They may feel angry, frightened, or resentful at having to talk with you in the first place. They may truly believe that they don’t want to change that behavior ever. Here’s a sample conversation in which this approach is used:
—————————————————–
Health Care Professional: I have some ideas about how you could go about improving your blood sugar. Would you like to hear them? (Asking Permission)
Client: No! I’ve had about enough of you medical people trying to tell me what to do and get me to change my life. I like my life the way it is. (Sustain Talk)
HCP: Well, thanks for being so honest with me. It sounds like people have been trying to get you to change a bunch of things and you’re fed up. (Complex Reflection)
Client: That’s it exactly. I love food, and don’t want to give up my favorites! I know you think I should stop eating sweets and fried stuff, but I just love those foods. (Sustain Talk)
HCP: You have some real favorites and have been told never to eat them. (Simple Reflection)
Client: Yah, that’s true.
HCP: Would there be anything that might happen that would make you think about making changes to your diet? (Open Question)
Client: Well, my Dad had diabetes, and he became blind and had pains in his fingers and toes. I’ve always said if anything like that happened, I’d make some changes. (Change Talk)
HCP: So, certain things related to diabetes would have to happen to your body for you to think about making changes. (Simple Reflection)
Client: When you put it like that, it sounds kind of silly for me to wait till then. (Change Talk, Weak)
HCP: So, what do you think you’ll do? (Open Question)
Client: I don’t really know where to start. I’ve been given so much advice for so long and ignored most of it.
HCP: Could I give you a few ideas and see if any of them sounds like something you could try? (Open Question; moving towards change)
Client: Yes, as long as you won’t try to make me do anything! (Change Talk, weak)
HCP: You won’t hear anything from me about trying to make you do anything. This is your life, and any decisions about change are up to you. And you know what? When people make their own plans and their own decisions about change, it usually works out a lot better. (Affirm Autonomy)
—————————————————–
In this scenario, the client began angry and defensive at being TOLD what to do. In the end, after just a few interchanges, the client expresses change talk, which is exactly the goal. She went from not wanting to hear anything about change to moving towards change in her own way and at her own pace.
