Fully accepting the autonomy of our clients is an essential element of the spirit of Motivational Interviewing. The client is the boss of herself and her family. The ultimate choices are hers. It is not your job to force her to do anything. You are there to support the client as she considers making lifestyle changes. When you attempt to force someone to do something whether in language or coercion, it doesn’t work and even backfires. The natural desire to assert freedom causes the person to react in ways that we see as resistance.
The person most in control is
the person who can give up control.
Fritz Perls
For to be free is not merely to cast off one’s chains,
but to live in a way that respects
and enhances the freedom of others.
Nelson Mandela
In MI, we strive to not only accept the client’s inherent autonomy but to also actively support it. We do this with the language of choice:
- “It’s up to you.”
- “You might choose to…”
- “I’ll make some suggestions and you get to choose any or none of them.”
Within this model you still have a job to do, including:
- Keep an eye on the big-picture overall health goals that you and other members of the team hold.
- Give your opinion about how best to conduct the session.
- Offer clear information and advice. (See Tip #59 for more on providing advice while supporting autonomy, in Practice Workbook, Vol. 3)
It’s easy to slip out of autonomy support:
- When you become worried about the client’s health.
- When you see what seems to you simple and easy changes that will head the client toward his health goals.
When you notice yourself slipping in this area of the MI spirit, take a deep breath and remind yourself that it is the client’s life and that he is in the driver’s seat, not you. You could say something out loud such as, “It’s up to you.” Or “You are the one who knows what’s best for you.” When you make this shift, you are acknowledging that you do not have a power that you never had anyway.