Change is of course happening all the time, change is either easy, difficult or even near-impossible depending upon the nature of the change and the readiness of the person, people or organisation involved. We, individually, go through life changes which are not always volitional- aging is the key example- and obviously changes such as this go better for us if we are good at adapting and adjusting. There is an old adage about having the strength to change what you can and having the sense to accept what you can’t… but before we fall too deeply into the depths of all the things that cannot be changed- let’s talk about what happens when change is possible but not necessarily easy.
Very often when it comes to affecting the volitional behaviours of your customers or clients those people are at least to some extent ambivalent about change. Ambivalence is that see-saw where people feel at least two ways about an issue they face. I may, for example, agree with you that smoking is bad for me, beat myself up about it, try to hide the behaviour from my children, but still I smoke. Maybe I smoke because it relieves stress, maybe I see it as an alternative to ‘losing it’ maybe it keeps my hands occupied, gives me a reason to go outside and chat with a colleague- perhaps it has always been there for me as a friend- transpose this to drinking alcohol: ‘I really should cut back, but when I get in after a long day- it just takes the edge off’ and: ‘it changes my head space’. Exercise is another classic: ‘I should do more, feel better when I do it, but, I haven’t got the time, it’s too hot…’
To be clear all these behaviours, whether the example is adding a behaviour (exercising) or taking one away (alcohol) have ambivalence attached to them- if you are not ambivalent then you have probably changed that behaviour already…
In these examples (I am using health behaviours for illustration only- but of course this idea relates to any volitional behaviour- which car should I buy? Do I stay or leave? And obviously some behaviours, and our potential influence over them, need greater/lesser degrees of ethical consideration) each person will have an alternative feeling about their behaviour: ‘It causes cancer, makes my clothes smell bad, I don’t want my children to be negatively affected by my behaviour…’ which represents the other or positive side of a client’s ambivalence.
So how do you help resolve this ambivalence in a client? A good way of thinking about this- is that people really don’t like being told what to do- and in psychology their response to your telling them off is referred to as ‘reactance’ essentially that if what I say is perceived as telling you off- you may well respond with reactance- you defend yourself against the perceived attack- I say: ‘you really ought to cut down on your drinking’ and you say: ‘Yeah, I really should, but actually I…’ followed by all the reasons you should keep on drinking! So first off we could avoid this by overtly and clearly asking the client for the reasons they like to drink, i.e. what is good about it? and then listen to them, carefully, acknowledge the reasons they express, before going on to ask them if there is anything not so good about the booze? What happens here is the individual explains both sides of their ambivalence- and we side-step the reactance. We can then choose to reflect back- starting with the negative: ‘there are some good reasons to drink, it takes the edge off, alters your head space after a busy day’ and then: ‘you also have some not so good concerns about drinking; hangovers at work, concerns your colleagues can see you’ve had a heavy night, concerns about your health…’ what this does is present back to the client and in a specific order- i.e. the reasons to maintain the status quo followed by the reasons for change- and of course we tend to respond to the last thing we have heard- and as this is a ‘reflection’ the person is listening to- i.e. a reflection of what they have just said themself- they are effectively arguing themselves into changing and we are facilitating that argument.
Professionals starting out in this approach to helping change the behaviour of their clients often begin with concerns about how reflection might work (‘won’t it sound like i’m parroting them?!) you discover, however, that the people we often warm to the most- are also naturally the most reflective when they speak- and this is something which can categorically be learnt. On the note of learning- I think you would be forgiven for suggesting empathy is an inherent personality trait of a person, rather than a learnable facet such as say: learning to drive, but empathy can be learnt through learning the approach and skills involved in Motivational interviewing- and we have recorded this learning, tested it and published the results in peer reviewed science journals ( Increasing empathy in trainees ).
Motivational Interviewing then, is about resolving a client’s ambivalence, via a core set of learnable skills and serves as a frontline approach in healthcare, drugs and alcohol, substance abuse work as well as promoting physical activity, adherence to treatment regimens and as a highly effective tool for teacher-student and professional-customer communications.
Dr Trevor Simper is an MI trainer, coach, researcher and University lecturer and delivers Motivational Interviewing Training in Perth. If you would like to read more about Trevor and his workshops on Essemy click this link.