Motivational Interviewing Skills Blog: Where Change Talk Falls Short

Motivational Interviewing is a style of conversation that typically takes place between professionals and their clients (or patients, students, employees, participants, etc.). Using this style of communication, the professional will present the client with opportunities to advocate for positive behavior change (also see: What is Motivational Interviewing?).  In other words, using Motivational Interviewing skills, we invite clients to articulate their own goals, voice their own reasons for making changes, and to develop their own strategies for achieving hopeful outcomes, even when the client is unsure or ambivalent about doing so.  For example, rather than telling a person, “You should exercise more because you’ll feel better,” we might, instead, ask the person, “What do you think you’ll get out of it, if you begin to exercise?” Decades of research show that a small shift in the way we communicate with people can make a big difference (Miller et al, 1993; Rubak, 2005; Lundahl et al., 2010; Van Buskirk & Wetherall, 2013).

Whether you work in healthcare, education, social services, or the criminal justice system, it can be powerful to present opportunities for your clients to voice their own intrinsic motivations for change, rather than imposing your own ideas about why change is necessary and possible.  When clients voice their own ideas about making changes in their lives, we typically call that response, “change talk.”  It sounds like this:

·         I will think about taking my medication because my doctor says it’s important.

·         I know I would feel more energy, if I started to exercise.

·         I guess I’d probably learn more about myself, if I spoke to a therapist about this.

·         I think I could practice some healthier coping mechanisms, rather than exploding with anger.

·         It’s really important that I prioritize my homework, before I watch TV. 

These statements advocate FOR positive changes.

We find that we can help people resolve their ambivalence about making changes if we first help them uncover change talk and voice it aloud. 

But what if the topic of conversation is not “behavior change” per se?  Can Motivational Interviewing skills still be applicable?  Of course.  People may feel hesitant (or “stuck”) in a lot of situations that have nothing to do with a need to behave differently.  Consider these examples of potential ambivalence:

·         “My husband passed away 3 years ago.  I want to be happy, but I’m having trouble healing from the pain.”

·         “I was in a bad car accident.  I’m having constant nightmares and I don’t understand why I’m going crazy.  People tell me it’s normal, but I don’t think it is.”

·         “I’m not sure if I should major in history or anthropology.  I’m so torn.”

·         “I don’t know if I want to a second child with my wife.  I can see it both ways.”

Ambivalence lurks in unlikely places.  People may be ambivalent about accepting help, or about believing a story they’ve read in the news.  People may be ambivalent about how to heal or grow from a painful experience, or ambivalent about accepting a diagnosis.  Even when the topic isn’t exactly “behavior change” (in the classic sense), change talk still exists, but we might reframe it as client self-advocacy.  Our jobs as practitioners is to present the client with opportunities to advocate for themselves to heal, grow, or take steps forward.  How the clients respond may sound a lot like classic change talk, even though their speech isn’t necessarily focused on change. 

In the ten years that I’ve spent training sexual assault and domestic violence victim advocates across the globe, I’ve received so much push-back on the concept of “change talk.”  On hundreds of occasions, I have been asked, “Kate, why are we so focused on behavior change?  The victim is not the one who needs to change.”  Touché. 

While it may be true that survivors of abuse are not the ones who need to change their behavior, survivors are the ones faced with uncertainty and ambivalence about how to move forward after a traumatic experience.  And they don’t need someone telling them what to do, or how to do it.  Motivational Interviewing would, instead, offer them the chance to be their own advocate. 

References:

·         Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A Meta-Analysis of Motivational Interviewing: Twenty-Five Years of Empirical Studies. Research on Social Work Practice, 20(2), 137-160.

·         Rubak, S., Sandbæk, A., Lauritzen, T., and Christensen, B. (2005).  Motivational Interviewing: a systematic review and meta-analysis.  British Journal of General Practice, 55 (513): 305-312.

·         VanBuskirk, K. A., & Wetherell, J. L. (2014). Motivational interviewing with primary care populations: a systematic review and meta-analysis. Journal of Behavioral Medicine, 37(4), 768–780. doi:10.1007/s10865-013-9527-4