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Planning for Positive Change

In each of three previous posts, we looked at Motivational Interviewing (MI) as having four key processes and reviewed practice exercises targeting the first three processes:  engagingfocusing and evoking. In this article we examine the fourth MI process: planning.

Commitment language is predictive of behaviour change, and is distinct from preparatory change talk in that it embodies implementation intentions. Consider the following example:

commitment language continuum

Reference: Miller and Rollnick, 2012: 290

 

What’s the hurry?

Practitioners often rush toward action planning prematurely, resulting in clients’ reactance and disengagement. Learning to recognize – and strengthen – commitment language signals to us when it is appropriate to move toward the planning process in MI. Also, remember that the four processes are recursive. In other words, even when we hear strong commitment language, clients may still experience ambivalence (evoking process)  and decide to re-examine their goals (focusing process).  And, as always, we need to continuously engage and re-engage with the other person (engaging process).

 

Strategies to Strengthen Commitment

Here are some strategies to strengthen clients’ commitment for change:

  • Engaging in a supportive and collaborative working relationship
  • Focusing on clear goal(s) for change
  • Linking the person’s values with their goals
  • Evoking the person’s own motivations for change
  • Developing a specific change plan
  • Determining what step(s) the person is ready, willing and able to take.

 

MI commitment language

 

 

We can’t force a plant to grow, but plants are likely to thrive under the right conditions. What about human growth and realizing our potential? Motivational Interviewing provides the “right conditions” in which people can become ready, willing and able to make positive change.

 

Reflective Practice Questions

Consider a challenging client – one who does not seem to be making progress. Based on your understanding of the four processes of MI (engaging, focusing, evoking, planning), where do you think you need to be with this client? Are there avenues for small, incremental change that you could focus on to evoke commitment language? What might these be?

Come up with a reflection or a question that would evoke commitment language.

 

camera lens

 

Focusing means strategic centering with a collaborative goal

 

In a previous article, we looked at Motivational Interviewing (MI) as having four key processes: Engaging, Focusing, Evoking and Planning.

Motivational Interviewing is directional – not directive. There is a horizon, something that we and the client are committed to working toward. However, finding and collaboratively agreeing on goals can be a challenge! This week’s intentional practice looks at the process of working with your client to jointly identify an agreed-upon goal. Below are two brief case scenarios. With a partner, you will each take a turn with one of the scenarios as a departure point for a follow-up session with a client with the intention of setting an agenda for change. The skills for intentional practice in this activity are to:

Practice a focusing conversation using the skills of MI – with special attention to those noted above. How can you practice these skills to guide the client toward focusing on a meaningful and collaborative goal? Take five minutes and then switch roles. After you have both had an opportunity to practice, take five minutes to debrief and share feedback with your learning buddy.

 

Case Example 1:

You are meeting with your client, Akilesh, for a follow-up appointment. In your initial session, you learned that he has been under a great deal of stress due to impending lay-offs at his work place. To make matters worse, his wife is in her first month of maternity leave with a reduced income. His mother’s health is failing, and his older son has been acting out at school: hitting and spitting at other children in his class, and on one occasion, his teacher. Finally, at the end of your first session, Akilesh “came clean” with you and acknowledged that he smokes 10-15 cigarettes per day.

 

Case Example 2:

You are meeting with your client, Elina, for a follow-up appointment. At the end of your initial session, Elina reluctantly agreed to come back and see you again. You suspect that in addition to appeasing her cardiologist by attending the referral appointment with you last time, she is now coming back for this second appointment because she wants to appease you. In the previous session, Elina acknowledged that she would probably be healthier if she quit smoking, but stated that smoking is a profound pleasure for her. She shared that she has already made so many changes, she just can’t see herself giving up her cigarettes.

 

Reflective practice questions:

Was your “righting reflex” triggered by anything in the case example, or by any of the client responses in your role play? To what extent were you able to maintain MI Spirit throughout the conversation?

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