How can you establish a safe and non-judgmental environment for clients in motivational interviewing?

The reason reflective listening is such a powerful tool is because when we reflect or mirror back what someone says, we provide a unique experience in which they are heard without judgment. That is, if we are doing a true reflective statement that is not actually a question, a piece of advice, or something else. Like an actual mirror, this conversational “mirror” results in the help seeker truly being seen. With an accurate reflection, the practitioner is stating that they see the other person, and what they are saying is what is important at the moment, not what the practitioner thinks, feels, and believes. Such centering helps to create the psychological safety needed for exploration and growth.

Empathy is the cornerstone of a non-judgmental environment. By actively listening and reflecting the client's feelings and experiences, you demonstrate understanding and acceptance. This approach helps clients feel heard and respected, fostering a safe space for them to explore their thoughts and feelings without fear of criticism or dismissal. Empathy builds a strong therapeutic alliance, where clients are more likely to open up and engage in the process.

Empathy isn't just about using certain techniques; it's a privilege when someone allows you to understand and reflect on what's troubling them at that moment. When you're right there with someone, trying to see the situation through their eyes, it's almost impossible not to feel empathy. As a professional, even if you think you know the situation and the best path forward, truly trying to understand creates not just a connection but also a learning experience from each conversation.

Empathy. I find that establishing a client relationship, by listening first and reflecting back not only demonstrates that you have heard what was said, but also highlights empathy, demonstrating a willingness to collaborate with them in their journey. This is a good first step in developing client trust and allows for open and honest dialogue.

I like to think of empathy as leading with curiosity. We can assume that we know what others are thinking by their words and body language. However, we don't really know until we ask.

By helping clients articulate the gap between their current behaviors and their desired goals, you facilitate self-awareness without imposing judgment. This process involves guiding clients to explore the consequences of their actions and the benefits of change, allowing them to come to their own conclusions. It's important to maintain a supportive tone, avoiding any language that might be perceived as accusatory or confrontational, to keep the environment safe and respectful.

Eine Diskrepanz ist in der Regel bereits vorhanden wenn der Klient den Rat sucht. Für einen hilfreichen, ?ffnenden Einstieg, sollte der Klient verstehen, das die empfundene Diskrepanz nicht automatisch negativ besetzt sein muss, auch wenn dies vielleicht seine subjektive Empfindung ist. Eine Diskrepanz, zu welcher man nicht den Zugang zur überwindung parat hat, wird in den meisten F?llen als negativ betrachtet. Hilfreicher w?re es diese Wahrnehmung als Reflektionshinweis zu betrachten. ?Warum will ich diese Diskrepanz eigentlich überwinden?“ ist an diesem Punkt eine gute Frage. Der Klient kann hier nochmal sein Ziel konkret Hinterfragen. Der Gewinn ist ein hohes Ma? an Klarheit, das dass folgenden Agieren deutlich stimmiger für ihn macht.

It is important to note that challenging discrepancy is often more well received by the client once you have spent some time building a solid rapport. You can challenge ambivalence and elevate the client’s motivation to change by reflecting empathetic understanding and remaining directive towards highlighting change talk and accountability.

Discrepancy = cognitive dissonance/distortions. Another way to frame this skill is by defining it as "ambivalence framing" - as therapists, we are able to implement open-ended questions and the use of stark reflections in order to help the client explore their thoughts, feelings and behaviors.

For the effectiveness of MI, discrepancy development must be subsequent to the person's belief that the interviewer both understands and cares about their goals, values, beliefs, behaviors, motives, contingent circumstances, progress and their current situation. The interviewer must also recognize that this takes place within an appropriate time frame. First order changes are those that can simply be pointed out and behavior change will be implemented. Second order changes, however, are those that involve changing the underlying values, beliefs, and extant motivations. It is not just a matter of showing the data - it is a matter of showing it in such context/manner as to have the client buy into the proposed change. That often takes time...

Resistance is a natural part of the change process. By accepting and validating this resistance, rather than challenging it, you maintain a non-threatening environment. Reflecting and reframing the client's resistant statements can help them view their situation from a different perspective without feeling coerced or judged. This approach demonstrates respect for the client's autonomy and helps in maintaining a collaborative rather than adversarial relationship.

It is important to hold space for the resistance in the therapeutic setting. By holding space for the resistance we allow our clients to feel heard and acknowledge the difficult and uncomfortable feelings that come with change work. By holding space in a non-judgmental way and validating the clients vulnerabilities, the clients begin to feel empowered to explore the potentiality for change.

If the client resists the therapist because they feel judged, progress will not be made. If there is empathy and unconditional positive regard, rapport and therapeutic alliance can be formed. From this safe, therapeutic holding space, the client can explore their behavior. We don't want there to be conflict between the therapist and the client, because that will trigger defenses. Triggering defenses can do harm to the client. We want the conflict to be within the client, rather than between therapist and client. Conflict within the client manifests as cognitive dissonance between their behavior and their values. These values can be highlighted and the client can change their behavior to fit their values, creating positive change.

The art of navigating resistance during therapy sessions is of utmost importance when it comes to establishing a secure and nurturing environment. It is crucial to remember that the lives being explored and examined within these therapeutic spaces are not our own, but rather belong to the individuals seeking guidance and support. By embracing this understanding, we can foster an atmosphere that encourages personal growth and self-discovery.

Allow yourself to be completely comfortable with and curious about your client’s ambivalence. When we can hold space for our clients however they show up, they feel safe and cared for, and this provides a non-judgemental space for people to change.

Encouraging clients to recognize their own strengths and abilities reinforces their confidence in making changes. This support is crucial in a non-judgmental environment as it shifts the focus from what clients are doing wrong to what they can do right. Highlighting past successes, acknowledging efforts, and celebrating small victories are ways to bolster self-efficacy, making clients feel capable and motivated.

In my experience promoting self-efficacy in motivation interviewing is paramount. Clients need to know and feel empowered, heard and understood. Following the lead of the client tailors their treatment and reminds them of their goal, ownership is important. Many of our clients have never truly had agency.

Validation then challenging. Validate the obstacle that the client perceives to be in their way. It’s there for a reason! Validate it and understand it. After we gain a sense of the obstacle’s origin and the client’s perspective of it, we can begin to challenge the obstacle. This way we learn to overcome the barrier while providing understanding, validation, and support for our client.

I believe it's crucial to communicate to clients that experiencing a desire to revert to old patterns is a natural part of life. Instead of being self-critical and demoralized, it's important for them to acknowledge and validate their emotions. By identifying the underlying reasons for returning to these old patterns, they can gain insight. Reminding clients of their past successes in self-improvement reinforces the idea that, just as they've worked on themselves before, they are capable of doing so again.

Validation validation validation! Most of the time, our clients know they are not okay with the "status quo", and want something about their life to change - they just may not always know what to do from there. Supporting a client's autonomy and self-efficacy can be such a simple task such as a summarization while staying curious. This can look something like "I've heard these points (a, b, and c), I'm curious which one of these subjects seems to be the most important to focus on, or if there is another subject that seems more relevant to you?". From here a conversation and the use of more motivational interviewing skills will organically move towards change-talk.

The first thing I do before I start a session or a class is to do a brief grounding exercise. I need to “come” to the session grounded to be able to be present and listening deeply. I also keep 2 things near me at all times in sessions: 1) a mini Cheshire Cat to remind me to be curious and 2) a finger puzzle to remind me to let go of the outcome. And occasionally I may need a second “helping” of grounding esp in highly emotional sessions so will invite a client(s) to do a quick grounding exercise with me to help us all calm our nervous systems. This is also MI-consistent as we’re attuned to our client’s undercurrents - what they’re NOT saying with words. ??

Others are speaking about meeting people where they are at, so here is a process I adopted that helps me do that and keeps me from trying to “fix” my clients or starting off over-controlling. I start the session by putting on my “curiosity cap”. I take a breath and try to forget my agenda or outcome expectations. My intention is to fully clear my mind so I can walk in and be fully present without the agenda. It is a way of being that I find helps people feel safe, and it helps me experience more joy and less burnout. I believe it’s from the place deep curiosity that we can build a truly safe place for people to be heard. I am more directive when there is a safety issue involved, but I am still safety planning with curiosity.

With motivational interviewing, it i important to keep in mind the deterministic nature of our thoughts, emotions, beliefs, and habits. This means that while we may be able to recognize the discrepancy between our values and our behavior, changing our response is challenging if we are not constantly making an effort to remain aware of our patterns in order to disrupt them. Because much of our current behaviors are "determined" by prior behaviors, a commitment to a practice of self-awareness and intentional action is a pre-requisite.

Meet the person where they are at. One of the biggest factors why clients tend to fall of the "therapy wagon" is because they do not see results off the bat. This is a tool that you can use to remind them, that it is alright to be where we are right in this moment. Focusing on the direction they're taking & the steps that have been taken, can help facilitate the sense of urgency a client may have. At the end of the day, we cannot cross bridges we have not arrived at. Sometimes, we as clinicians, want to facilitate a conversation a client is not ready to have and may be confronted with resistance. Always return to where they are at, and what they are willing to work with - little by little you will arrive to your journeys destination.

We should consider cultural differences especially when clients are reluctant or there may be biases towards counseling. We should respect those differences and adapt our communication when applicable.