What we do and say at the beginning of a session matters. We set the tone. Embodying the spirit of Motivational Interviewing from the very beginning makes the rest of the session smoother.
Failures are finger posts on the road to achievement.
What light is to the eyes – what air is to the lungs –
what love is to the heart, liberty is to the soul of man.
Robert Green Ingersoll
We all know that at times our clients react to something we say and get resistant or argue with us. Nothing useful happens as long as this is occurring. Here we look at how to begin follow-up sessions in the spirit of MI so that this reactance is less likely.
In other Tips, we’ve looked at what resistance is and how to best respond when we sense it (Tips #9, #103 and #130). Here is one way to look at what we call resistance. People prefer freedom and choice. A natural response when it feels like freedom is being curtailed is to do something (anything!) to somehow restore freedom. That can look to us like arguing, getting quiet, refusing to do what we recommend, changing the subject, coming late to appointments, etc. We can inadvertently trigger this reaction.
Let’s look at the very beginning of a follow-up session. A common open question might be “How did your week go?” For some clients, this will simply serve as an opening to bring up what they need to discuss, and you are off and running in a collaborative process. For others, it will trigger an internal process of judging themselves, ending with what looks like resistance. Here is an example of what may go on in a client’s head: “Oh, God, it was terrible week. I forgot most of the things she told me to do. I didn’t even keep the food records after Thursday. I don’t know if I can do this, and she keeps saying I have to do the food records.” What you might hear: “It wasn’t so good. It was really busy at work, and I don’t know about these food records. It’s just too hard to do them.”
For clients who tend to go in this direction, it will be more useful to begin a bit more slowly with simple engagement focused on the client. This might be as simple as “Hi” and then reflecting what you hear. The format below may be useful.
Normalizing the degree of readiness to change:
For follow-up sessions, when there was a specific behavior plan at the last visit, you may feel like asking, “How did making your lunch go?” or “So did you join the gym?” If the client did not move forward with the plan, this will feel like pushing and freedom will feel curtailed. What you will notice next is reactive statements such as, “I don’t think that will help,” or changing the subject.
A format that is less apt to bring up reactance:
1. Suggest a range of responses they may have had to the last session: “Some people after a first session find that they forget what we talked about or found they were not ready to move ahead yet and some people jumped in and did everything.”
2. Ask where they would put themselves in that range: “Where would you say you are?”
By adding this first step, you acknowledge that some people haven’t made changes. This normalizes it and makes it more comfortable for the client to own that. You two then have more freedom to explore further.