Change counseling is most efficient and most effective when a clear focus is agreed upon. In the field of motivational interviewing recently there has been an increased emphasis on the process of focusing after research showed that inadequate focus makes sessions less effective. For us to be effective, this is part of our job.
Where there is no vision, the people perish.
In order to succeed,
you must know what you are doing,
like what you are doing,
and believe in what you are doing.
Sometimes the change goal is clear. The client easily chooses a topic or behavior to work on, and it is simple to stick to it until a plan is formed. Other times, the conversation drifts to other topics or behaviors to change. We can notice this drift and gently encourage focusing by employing the types of open questions below. Focusing may be something you do once, or you may find it necessary to attend to direction and focus throughout a session. At times, a whole session may be spent finding a focus for your work. This is time well spent because if you proceed with education or problem-solving a plan without agreeing on a focus the time will have been wasted.
Open questions to evoke a focus the client is ready for:
- What do you see yourself ready to work on right now?
- Of all these things you would like to address, which one would you like to work on first? Or …which one do you see as most important?
- What change seems doable now?
- Here is a chart with the kinds of things I often help my clients with. Which of them appeal to you?
- I hear you say you know that learning about food portions will be essential before learning anything else. Shall we do that today?
- What do you most want to go home with today?
When you hear a potential focus, reflect it:
- You like the idea of working on increasing exercise first.
- You see learning about portions as the most important thing for us to do today.
- You want to increase the variety of foods you eat and are ready to begin with fresh vegetables.
- So next we will go over your food records with a particular look at what you can learn about food and energy throughout the day.
Some clients are just not ready to focus on a specific behavior change. Your clue is resistance when you try to continue as if a specific behavior has been agreed on (Tip #9). This resistance is like rumble strips on the side of a highway. They get your attention if you drift outside your lane, just asresistance gets your attention when you push for a change the client is not ready for. When resistance comes up, shift to engaging again for a bit (Tip #115).
When a client is not ready to focus on any behavior change, this does not mean your work must stop. An appropriate focus may be clarification of values or making a decision such as whether to engage in treatment at all. These conversations can be just as useful as change conversations.
Tip #4 has additional ideas for focusing a session with a client.