One of the core Motivational Interviewing values is supporting the client’s autonomy. In addition, our job is to direct the session toward changes that will serve the client’s best interest. How do we find the ideal balance between accurately following the client and directing the session? The answer is to strategically listen, reflect, summarize and ask.
You are a midwife, assisting at someone else’s birth.
Do good without show or fuss.
Facilitate what is happening
rather than what you think ought to be happening.
If you must take the lead, lead so that the mother is helped,
yet still free and in charge.
When the baby is born, the mother will rightly say,
“We did it ourselves!”
Tao Te Ching
The ability to ask the right question is more
than half the battle to finding the answer.
Thomas J Watson
You draw a road map by carefully listening for change talk (Tips #69, and #132) throughout the contact. Many counselors find it useful to jot down the key change talk as it emerges. The client’s own change talk then forms the stepping stones you use as your guide. As you hear them, you affirm or reflect these elements and then ask for more (Tip #121).
Train yourself to listen selectively for change talk while mostly sidestepping the sustain talk (reasons to not change). One common mistake that counselors make is to get hooked by the sustain talk and ask to explore it. This gets the session off track.
When you feel you and the client are lost, stuck or not moving forward, this may mean you are not offering enough direction. It’s time to summarize (Tip #73). Your summary includes all of the change talk you have heard so far and invites the client to step back and see the big picture. Summaries are strategic. You gather things the client actually said or implied. You don’t add your arguments for change or make anything up. You leave out much, if not all, of the sustain talk. After offering this context, you ask a key question.
Your key question (Tip #120) will direct the client’s attention to making a choice or taking the next step. For example, “Of all these things you would like to address, which one shall we work on first?” or “What will be your first step toward these goals?”
When you are directing too much, clients will tell you. If you observe carefully, you will hear resistance language or silence or shorter answers. You have lost engagement and need to roll with the resistance (Tip #103). By doing this, you remind yourself and clients that the choices are theirs, that it is their life to live. Then you return to reflecting the change talk you have heard until you sense engagement is regained.
Your guiding function in MI is a delicate balance between carefully following the client and directing by being selective about what you reflect and what you ask. Throughout you can use feedback from the client to sense when you are tipping to one side or the other.