Affirming is one of the fundamental Motivational Interviewing skills. It supports engagement, encourages the client to further explore the change process and builds confidence. To form an affirmation, find an effort the client is making or a strength you notice and reflect it back to him. It’s often that simple. Tip #63 (in Practice Workbook, Vol 3) has more basics on affirming and some examples. In this Tip, we look at ways to craft affirmations to make them most powerful.
We want our sessions to leave the client with
more of themselves and less of us.
Sometimes it’s good just to see the world around us
and be glad for what is here.
The best affirmations are short and sweet. For example, you may say, “Good for you. You’re practicing noticing your appetite level and keeping the food records and making note of when you eat when you are not hungry.” Here is a shorter version: “You followed through with the plan you made last week.” This leaves out the cheerleading “good for you” statement and has the advantage of stepping back and pointing out a positive characteristic you see in the client, follow through. This wording also reminds the client that the plan was hers, not one imposed on her.
Search for positive characteristics that support change. Here are a few examples of strengths that you may notice:
• Good at using the Internet
• Committed to family
• Good observer
These strengths may be subtle and only implied. You can go out on a limb a bit. For example, your client may have noticed one situation in which it is typically difficult for him to eat well. Calling him a “good observer” may be a stretch. However, this encourages him to see himself this way and to do more useful observing. Another example is when a client shares a change already made. A simple reflection might be “You joined the gym.” To turn it into a reflection, switch to “You took that important first step of joining the gym.” Using “important first step” implies he is someone who makes steps and will continue to do so. Some affirmations may seem like stating the obvious. Don’t assume client sees himself this way. If you go too far out on a limb, the client will pull you back.
One way to form affirmations is by taking something you see or hear and “labeling” the client. For example, “You are someone who … wants to be around for his family, … follows through when he makes a plan, or … uses his calendar to accomplish things.” Or use this format: “You are a … sort of person.” Or perhaps, “You see yourself as…”
Often our clients complain about how hard change is. It can be natural to reflect what you hear, to show empathy. Ideally, we reflect very little, if any, of this negative talk. In order to show the client you are listening, you can turn your empathy into an affirmation. When you say something like “Wow, you do have a busy life.” Or “It is hard to try to make changes when you see how far you need to go.” These are reasonable reflections that would likely contribute to engagement. To tweak them into affirmations to support change, try these: “Given your packed schedule, it’s impressive that you came in today.” Or “You see yourself as having a long way to go; sticking with this shows your commitment to making healthy changes that will pay off.”
Tweaking affirmations in this way takes practice. A recent participant in my training workshop shared that she has practiced by taking a moment after each session to carefully form an affirmation she could have made. Sometimes she asks a colleague to help her brainstorm. Doing this in the quiet of your office will increase your chances of doing them in a session.