All clients will voice their reasons to not make changes. This is normal. It simply shows us that ambivalence is present. In Tip #101, I described sustain talk, and in #174, I explored some effective ways to respond when we hear it. Here, we look at another, more advanced, way to respond.
Even the largest avalanche
is triggered by small things.
Vernor Vinge
If one is truly to succeed
in leading a person to a specific place,
one must first and foremost
take care to find him where he is
and begin there.
Soren Kierkegaard
First, a brief review on sustain talk. As a general rule in Motivational Interviewing, we don’t try to elicit sustain talk. This is because the higher the ratio of change talk to sustain talk, the more apt the person is to make the change. So, we elicit change talk, not sustain talk. This is also the reason not to use the decisional balance. This pro/con exploration can be useful when someone is trying to make a decision that has no clear “right” answer. In our conversations with clients, there is usually a tilt toward making healthy changes.
In MI, we mostly side-step sustain talk, only reflecting it a bit to show the client we are listening or to link it to some change talk, reflecting the ambivalence (Tip #55). We reflect change talk in order to amplify and evoke more of it.
Here is the one way to reflect sustain talk that can evoke more change talk. It is used when a client is voicing a lot of sustain talk. The counselor forms a complex reflection (Tip #171) with a gentle exaggeration or simplification. For example, “There is no room to make changes in how you are eating.” “Your health is not being affected at all by your eating habits.” Often, a client will then argue the other side a bit, and you will hear some change talk that you can reflect and/or ask for elaboration. This type of reflection is best done with a light touch. It is easy to overdo it or to be misunderstood. It would not be in the MI spirit if there was a tone of sarcasm or if it sounded dismissive. This technique is tricky and best left to after you have developed ease with complex reflections.