How can you balance building client confidence and acknowledging ambivalence and resistance to change?

1 Reflect and affirm

One of the core skills of MI is reflective listening, which involves mirroring back what your client says, with or without adding some meaning or interpretation. Reflective listening helps you show empathy, validate your client's feelings and experiences, and clarify their goals and values. It also helps you identify and respond to their ambivalence and resistance, which may manifest as statements of desire, ability, reasons, need, or commitment to change. When you reflect your client's ambivalence or resistance, you can also affirm their strengths, resources, and efforts to cope or change. Affirmations help you build rapport, boost your client's confidence, and reinforce their positive aspects.

2 Elicit and explore

Another core skill of MI is eliciting change talk, which is any speech that indicates your client's motivation or readiness to change. Change talk can be elicited by using open-ended questions, asking for elaboration or examples, exploring the pros and cons of change, using scaling questions, or summarizing what you have heard. Change talk helps your client articulate and resolve their ambivalence, increase their self-efficacy, and move toward action. When you elicit change talk, you can also explore it further by asking for more details, clarifying the meaning, linking it to your client's values or goals, or reflecting the implications or consequences of change.

3 Roll with resistance

Resistance is a natural and expected part of the change process, and it can be seen as a signal that your client is feeling ambivalent, uncertain, or threatened by change. Resistance can take various forms, such as arguing, interrupting, denying, ignoring, or withdrawing. Instead of confronting or correcting your client's resistance, you can roll with it by using simple reflections, shifting the focus, emphasizing your client's autonomy and choice, or reframing the situation. Rolling with resistance helps you avoid a power struggle, maintain a collaborative relationship, and invite your client to reconsider their views or options.

4 Plan and support

The final stage of MI is planning, which involves helping your client develop and implement a realistic and achievable action plan for change. Planning should only occur when your client is ready and willing to change, and it should be guided by your client's preferences and goals. Planning can involve asking for permission, exploring options, setting SMART goals, identifying potential barriers and solutions, reviewing past successes and failures, arranging follow-up or support, and obtaining commitment. Planning helps your client translate their motivation into action, anticipate and overcome challenges, and monitor and evaluate their progress.

5 Review and reinforce

Throughout the MI process, it is important to review and reinforce your client's motivation and confidence for change. You can do this by using summaries, which are brief statements that highlight the main points of your conversation, such as your client's ambivalence, change talk, action plan, or feedback. Summaries help you check your understanding, emphasize the positive, consolidate learning, and prepare for the next step. You can also use feedback, which is any information that you provide to your client about their behavior, outcomes, or resources. Feedback helps you acknowledge your client's efforts, celebrate their achievements, address their concerns, and suggest areas for improvement.

6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?