MI News: When to Stop the Conversation About Change
Motivation News
Published by Cathy Cole, MSSW, LCSW Member, Motivational Interviewing Network of Trainers, Inc.
August 2011
http://www.cathycoletraining.com (MI training since 1995)
We sit together~
My thoughts you reflect
And hope springs forth Cole, 2007
Newsletter Feature Article
When to Stop the Conversation About Change
Onsite Training Opportunities
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** Register now for the last Introductory MI training for 2011. September 24-26, 2011; workshop limited to 15; multiple opportunities for practice! The last advanced workshop is November 5-7, 2011, limited to 10, all practice.**
Please visit the Workshops section of the web site: [cathycoletraining](http://www.cathycoletraining.com
All trainings take place in Carrboro, NC, a charming town adjacent to Chapel Hill, NC. The closest airport is Raleigh Durham. Workshop fees are $595. I have a student rate of $350. Please email me prior to registration to obtain this rate.
Introduction to Motivational interviewing: limited to 15; September 24-26
Advanced MI Training: all practice, limited to 10; Dates: November 5-7
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About My Workshops:
I have provided MI training since 1995, following my training to teach MI. My teaching approach is very pragmatic, focusing on the core concepts of MI and allowing the learning to progress from direct practice. I am privileged to be a member of the Trainers Emeritus Committee for the Motivational Interviewing Network of Trainers, Inc. after serving as a trainer for the 2010 Training of New Trainers. I continue as an active member of the MINT Professional Issues Committee and the Veterans Administration National MI Dissemination Project.
Life is not good without MI!
I have elected to limit the size of my workshops in order to maximize the opportunity to provide learning that can both address the concepts and practice of Motivational Interviewing while at the same time assist in the application of MI to each participant's work setting.
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Newsletter
This letter may be forwarded to anyone you feel could benefit as long as it is forwarded in its entirety. Past newsletters available via web site cathycoletraining
Welcome to Motivation News, a newsletter devoted to clinical information on the use of a Motivational Interviewing (MI) approach to change. The authors of this approach, William Miller, PhD and Stephen Rollnick, PhD, in a newly evolving definition of MI, state it as "a collaborative, goal oriented method of communication with particular attention to the language of change. It is intended to strengthen a person’s motivation for and commitment to a target behavior change by eliciting and exploring an individuals own arguments for change." (Miller and Rollnick, 2010)
This collaborative approach to working with clients has wide application in mental health, the justice system, addictions, health care and health education. Information in this newsletter is taken from various source material from the Motivational Interviewing Network of Trainers and specifically from the book Motivational Interviewing, Preparing People for Change; Miller and Rollnick, 2nd edition, 2002, Guilford Press. Additional source material: Motivational Interviewing in the Treatment of Psychological Problems, ed. Arkowitz, Westra, Miller, and Rollnick, Guilford 2007; Motivational Interviewing In Health Care, Rollnick, Miller, and Butler, Guilford, 2007; Building Motivational Interviewing Skills, Rosengren, 2008; Motivational Interviewing with Adolescents and Young Adults, Naar-King, et all Guilford 2010.
When to Stop the Conversation About Change
As a reminder, the goal of MI is provide the client the opportunity to decide if they would like to move ahead with addressing some specific change. Once that decision is made then the mechanism/plan for change can be determined. So when does the conversation end if the client is saying no for any number of reasons? And why might we decide it should end?
An example from my own practice of working with clients with histories of trauma comes to mind. There has been full exploration of the impact of trauma in the person's life and full discussion about the consequences of the various avoidance behaviors that are involved. Values have been elicited and a discussion held on how the avoidance behaviors either help or hinder living consistently with those values. Therapy possibilities have been discussed to provide sufficient information for the person to know what is available.
Still the decision not to work on trauma remains, generally out of fear of moving out of the comfort zone of avoidance.
At this point there is nothing more to discuss and as a therapist, it is only ethically responsible of me to decide if ongoing conversation is helpful. Continuing the discussion begins to have a circular nature to it and puts the client in the position of arguing even more for not moving ahead toward change.
How to handle the termination of the conversation and possible therapy contact is critical and involves the coming alongside approach.
Coming alongside is the recognition that at this point in time the client is clearly saying they are not ready. Noting this and stating this is honoring client autonomy so it is actually quite respectful. How we deliver this information is very important.....without judgement, without pressure, with honesty/transparency.
Clearly what one says would vary according to the clinical setting and a couple of examples are provided:
Trauma scenario: "I appreciate the time and willingness you have shown to fully explore this very difficult area of your life and to fully consider whether you wish to do specific therapy work on the impact of your trauma. What seems clear to me, and I want to make sure I have this right, is that despite the consequences of the avoidance behaviors that have evolved based on the impact of the trauma, you are saying that AT THIS POINT IN TIME you are not ready to do specific trauma work. I certainly respect that and at this time do not plan to schedule further sessions. Should you decide you would like to do specific work in the future, please recontact our agency." This is informed consent and allows the client to exercise autonomy.
Medical scenario: "Just to summarize, we have been discussing your smoking, all the things you gain from smoking and all the down sides for you...health, impact on the chronic illnesses we are treating you for, effect on your family. I hope I have also been clear about my recommendation from the professional perspective on the potential benefits from making some changes. At this point, you are saying that you do not wish to make any changes in this area and I respect that. As your physician I will check in with you at each visit to see if you have made a different decision or if you need to clarify any information about the impact of smoking but will always respect what you say."
I hope you can sense the respect that exists for both the clinician and the client. We are avoiding the righting reflex, completely respecting the client. The client gets the opportunity to take responsibility for choices.
Feels like a win/win on all sides for the relationship.
Keep practicing!
(919) 967-9653 — 
cathy@cathycoletraining.com© 2009 Cathy Cole Training, Inc.