I got a question recently about adapting Motivational Interviewing to other cultures, especially with Hispanic clients in a WIC clinic. The dietitian had noticed that some clients didn’t seem to understand the idea of setting a goal. She asked if it would be better for the clinician to state a few things that the client might want to consider working on and then ask for feedback.
What people really need
is a good listening to.
Mary Lou Casey
People are more willing to change
when they know they are completely
free not to change.
Faithfulness to the MI skills and spirit almost always takes into account any cultural differences. We acknowledge the client’s perspective, whatever it is, and use her words, especially in the engagement phase.
What is likely happening is that these clients are in the earlier stages of change, and therefore, setting a behavior goal would not make sense to them. The simplest way to assess for this is to ask the client about the importance of the topic or behavior at hand (Tip #76). If it is low, you can either ask permission to do some education about the consequences of the current situation and/or back up to find something the client considers more important.
Another way to look at this is to attend more closely to engagement (Tip #115) from the beginning of the session. Getting on the client’s page with her may support the emergence of a client-centered concern that can be turned into a behavioral goal.
All of this is an invitation to take the risk to do MI more consistently. This includes noticing and letting go of the Righting Reflex (Tips #65 & 151). I noticed in this dietitian’s question that she wanted to suggest some potential behavioral goals. This is usually linked to the clinician’s desire to tell the person what to do or even to try to force her to do it. When this Righting Reflex pops up, it is a sign that the clinician really cares about the client and has ideas about how she can gain better health. Let’s break that into its two parts. First, wanting to help this person is a wonderful impulse; internally acknowledge it as an asset. Then, take a deep breath, remind yourself of the power of MI, and recommit to using it.
The other part of the Righting Reflex is the information we want to give to this person. This can be conveyed in an MI-consistent manner (Tips #59 & 147). Once a client shows some concern (i.e. importance to make a change is at least moderate), we can ask permission to provide suggestions about how to move forward toward what the client has acknowledged matters to her. For example, “You know your doctor is concerned about your child’s weight, and you want to be the best parent you can be. I could share with you what some other moms do to help their kids grow up healthy.”
Finally, remember that it is a useful MI session whenever there is a deep conversation about the client’s (or family’s) health. Ideally, this leads to setting a specific behavioral goal. But it might not, if the readiness is not there. Pushing in each session for a goal increases resistance and makes change less likely.