If you have chosen to transition your counseling style toward motivational interviewing, you may find that note-taking feels as if it detracts from being present with your client. Questions about note-taking are some of the most common ones I hear in my trainings. For many of us, taking notes during sessions is essential. Especially in an initial contact, we are gathering a lot of detail and we don’t have perfect memories. Some of us do charting hours or days later and need to rely on notes taken during the session.
The education of attention would be
the education par excellence.
We make a living by what we get.
We make a life by what we give.
Sir Winston Churchill
How to take the notes we need while not detracting from engagement?
Let’s look at the beginning of the session. Here is where attention to engagement is especially important. Review the recommendations for beginning sessions in Tip #102. Begin your session with open questions such as “What brings you here?” or “Tell me what your doctor has told you.” Notice that this will allow you to focus on the client without taking notes quite yet. When you need to shift to some closed questions, you could preface it with a summary of what you heard in response to your open questions. This might sound like, “You are worried about what your doctor said about your blood sugar and want advice from me about what you can do to bring it down. We can indeed do that today. May I ask you some questions first?” You might add, “I will take some notes to make sure we gather all the details we need to best help you.”
Notice how your client responds when you jot down notes. If you notice a slip in engagement (Tip #115), you can use a shift away from note-taking to signal your effort to reengage. This might mean putting down your pen or turning away from your computer and back to the client. You might also acknowledge that your note-taking can feel like a barrier. You could offer to explain the purpose of your notes. Be sure to explain from the client’s perspective. For example, “I want to make sure to have all the information I need to best help you.” Or, “When you come back next time, we won’t need to waste your time reminding me of what is most important to you.”
With the rare client who seems quite nervous about what you are writing, you could ask to discuss the note-taking. “I see you are concerned about what I am writing. I would be glad to let you know the purpose of these notes, who will see them and share with you what I am writing.” And, “Is there a specific concern you have?”
How might note-taking actually further the behavior change process?
We can use our notes to help us focus on a client’s change talk (Tip #69). It is useful to jot down what you hear about what matters to the client, his reasons to make changes, his strengths, etc. If you have the option to tweak your own forms, you could include a section on change talk. For example, the simple intake sheet I use for new clients has a box that I reserve for the outcomes a client wants and whatever I hear that sounds like motivations to make changes.
When your notes are primarily the client’s change talk, they may have the effect of further highlighting it because the client may notice when you jot something down. At times you might even mention that you are making a note of something that sounds important.
When forming a summary (Tips #72 and #119), you can refer to your notes of the client’s change talk. Having these items all in one place will also assist you in quickly getting on the same page with the client at the beginning of the next session.