June 30, 2016 by Kathleen O'Connor
When I first began learning about Motivational Interviewing (MI), I was confused and a little hesitant about how it could possibly work with clients who were undecided (that is, ambivalent) about change. In particular, my first impressions were that this approach was based on letting the client arrive at decisions themselves. How frustrating would it be for me, as a therapist, if I felt I had information that could help them make a decision and wasn’t able to share it because I had to let the client come to their own realizations? How annoying would it be for the client to invest in coming to see a therapist, only to spin their wheels further when they received no new information or advice?
As it turns out, my concerns were easily addressed by learning more about MI and seeing it in practice. While MI is all about remaining client-centered, those practicing it CAN give advice – in careful, measured ways. While the MI approach outlines all kinds of ways of doing so, one that I thought was especially interesting involves asking permission – mostly because it’s not something I ever did in my pre-MI life. For me, a typical conversation with a friend (or client) might have gone something like this:
Friend: Ugh, I’ve been trying to get down to a healthy BMI forever. I just can’t seem to lose those last 20 pounds.
Me: Well Friend, it’s your lucky day – I have SO MANY ideas for you!!! How about running?? You can come running with my group on Tuesday nights, it’s lots of fun and super easy to get there right after work if you just push yourself! Or swimming, a new pool just opened up nearby – let’s check it out!! Or yoga!! I know you said you tried that last summer, but it doesn’t hurt to try again. I also have lots of ideas about food – I’ll email you some recipes!!
What do you think are the chances of this friend taking me up on any of those suggestions? Probably not great! I can’t imagine this friend would have walked away from our conversation feeling great, either… or felt like they could bring up this topic with me again and feel like I was actually someone they could talk to.
So let’s see what MI has to say. According to this approach, you can give information or advice if the client asks for it or if you ask for permission – and in these cases, you still don’t have free rein to go on and on as much as you’d like. Check out page 57 of this document for a nice summary of the MI’s approach to providing information and advice in ways that are respectful, keeps the client’s needs in mind, and reduces the chances of defensive responding, thus keeping the lines of communication open.
How do I see these points as being relevant to pediatric obesity? First, anyone who’s tried to give a teen advice on, well, practically anything will know how teens often react when the well-meaning adults in their life give suggestions as to how they can and should change some behavior/attitude/etc. Additionally, weight can be a difficult subject for many to discuss – and as a society in general, we’re already bombarded with endless advice as to how we should be exercising, eating, dressing, posing for photos… the list goes on and on. Those two factors – typical teen characteristics PLUS the issues around giving advice about weight, specifically – make MI’s stance on information/advice giving especially useful to consider.
What do you think about MI’s position on information/advice giving, both in general and as it relates to (pediatric) obesity? If you’ve tried these techniques and noticed anything about the results, especially with any teens in your life, we’d love to hear it!