Making profound change is not easy. We know that obstacles to making healthy changes will arise. It is natural for us to focus on these obstacles. We want to help our clients and see ourselves as problem-solvers, so we look for the problems. The client may focus on them, too. Anticipating and addressing them are essential; when and how we do it matters.
Start by doing what is necessary, then do what is possible,
and suddenly you are doing the impossible.
Saint Francis of Assisi
If you don’t like something, change it.
If you can’t change it, change your attitude.
Maya Angelou
Let’s look at the four processes of Motivational Interviewing described in more detail in Tips #114-118. Ideally obstacles are worked on in the planning process, the final MI process. This assumes you have engaged with the client. He has the sense that you get his situation and his goals. You have also focused on a particular behavior change and you have evoked what this change will do for him. He has agreed that it is important to work on this change at this time. You are then ready to move on to the planning process. It is in this final process that obstacles to making a change are best addressed.
Notice how it can be tempting to jump into addressing a client’s obstacles prematurely. For example, when beginning to discuss what specific change the client might wish to focus on, you may hear an obstacle pop up, such as “But I can’t exercise because I have bad knees.” Or “Forget it, I’m not going to cook extra on the weekend. My husband hates leftovers.” It is tempting to respond right away with your suggestions. Since you do not have buy-in yet to focus on this change, you will likely get resistance.
It will work better to put off finding solutions with something like, “If we found ways to exercise without stressing your knees, you would be fine with working on that.” Or “In order to choose focusing on cooking extra on the weekends, we will need to promise to search for ways it can work for your whole family.” In this way, you stay with finding out what changes the client believes will get her what she wants and carefully choosing one or a few specific changes.
Once you have agreement to work on a particular change, you may want to address obstacles right away. For many, this does not work well. It focuses too much on the obstacles and keeps them stuck. Instead, ask for action. The client likely knows better than you what the next steps are.
• What do you see yourself doing now?…this week?
• I’m wondering how you might be able to do that.
• What’s the first step for you?
• How might you go about that?
• What is possible at this time?
Many clients will bring up obstacles naturally in the course of discussing the details of a change. To address them, you can use the MI manner of giving advice. (Tips #5 and 147) For example: “You know that your husband will object to food that looks like leftovers. What ideas do you have for handling this?” Then, if you have a suggestion, ask permission, offer it and ask for a response.
If you and the client are getting stuck and not feeling creative dealing with obstacles, it can be useful to evoke efforts and strengths:
• What’s going well for you with your diabetes now?
• How were you able to not purge for a week?
• What has allowed you to make changes in the past?
Finally, some clients seem to avoid talking about obstacles or don’t easily anticipate them. If you suspect the client may be doing this, you could deliberately bring it up. After summarizing (Tips #72 and 119) the client’s larger goals and his specific plan, you could add: “I’m wondering what could get in your way of this plan.”