Climbing the Wall of Change Talk
There’s no greater feeling as a practitioner when you hear your client arguing for change instead of you trying to convince them of change.
- I think I could quit smoking in the next 3 months
- I really want to lose 10 pounds
- Drinking is not the celebration I thought it once was
So how do you generate those types of conversations and as we say in MI “shift away from the jaws of ambivalence?”
There are many ways to navigate conversations and finding the way that works for you is important, but here are a few tips to get your started:
- Remember to drop your own agenda. If you feel strongly about your client losing weight, or quitting smoking they will sniff it out and may feel some judgment, resulting in more “discord” or “sustain talk.”
Discord speaks more to your relationship with the client and sustain talk is about the target behavior. Both are highly responsive to the practitioner’s style. Discord might sound like “you don’t understand me.” It’s about your relationship with the client and requires you repair the relationship to continue the conversation.
Sustain talk is when you take a side and the client takes the opposite one. If you suggest quitting smoking they will tell you the reasons it is not possible. Sustain talk is status quo language that continues the focus on the problem.
- Empty your mind and completely focus on the client with presence, interest, and curiosity.
If you have other things on your mind it can cloud your ability to guide the conversation towards change, and be able to actually “see” the change talk. Change talk often comes intertwined with sustain talk, which is the nature of ambivalence.
Embedded change talk statements can sound like this:
“I don’t really want to stop smoking, but I know that I should” or  “I’ve tried before but realize this is important.”
You as the practitioner could respond in a few ways:
- You don’t really want to quit  (which can lead to discord)
- You don’t think you can quit  (which can lead to sustain talk)
- It’s pretty clear to you that you ought to quit  (embedded change talk)
- Recognize change talk and reinforce it. The more change talk gets reinforced the easier it is for the brain to get on board with behavior change. If the client states it, and you reinforce it, there is a double-reflection to the brain to increase motivation and importance of the change.
One common myth about behavior change is it takes a long time. One or two MI conversations in which the practitioner is skilled in guiding the conversation towards the possibility of change can dramatically shift behavior.
Although learning the language of Motivational Interviewing takes time, it saves time besides going a long way towards both satisfying conversations, and gratification in your practice.
