How can you build trust with a client who has experienced trauma using motivational interviewing techniques?

Reflective listening is a key MI technique. For instance, in sessions with clients dealing with trauma, instead of probing or interpreting, it is essential to mirror back the client’s statements to show understanding. Over time, this empathic listening can encourage the client to share more openly as they will feel safe and understood. MI’s emphasis on reflective listening is crucial in creating a safe space where the client can feel heard and validated. Thus, empathic listening can provide the emotional space needed for a client to open up on their own terms, especially critical for those grappling with trauma.

100% autonomy support! The caveat is that trauma can mess with a person’s embodiment / knowing what they need / want. But that doesn’t mean the practitioner tells them, it means we teach needs, needs frustration, needs satisfaction and then check in on this often to support a client to reconnect to self. I personally love using motivational interviewing and internal control psychology together (self determination yes but more often for me choice theory) Super powerful!

Really paying attention to the person who is sharing their story and be able to reference and affirm their experiences is key. Simultaneously, you're building trust and making them feel heard at the same time.

There are several types of reflections, but one that may be especially useful for clients with trauma histories is "affective reflections." While mirroring back what was said, you can add what you assume to be the emotion accompanying their report. For example, "So, the day didn't start well, and kept getting worse. By the time you arrived here, you must have felt overwhelmed."

An example I've seen work with several clients is listening empathically and encouraging them to explore their goals. Often times trauma can induce a sense of helplessness and uncertainty. Listening empathically allows for more relevant feedback and assistance with client's verbalizing feelings. Exploring goals provides opportunity for empowerment. This almost always helps with addressing the feelings of helplessness.

Confrontation is never the way to build a trusting working relationship. You want to acknowledge the clients struggle and challenges and engage them in a conversation that encourages, inspires and empowers them to want to create goals for themselves and motivated to accomplish them. You want the client to invite you in to help them get where they are trying to go.

One thing I've found helpful is to also assist clients in exploring negative beliefs that they may harbor about themselves, and their ability to change, that may be contributing to their resistance to change. Sometimes this resistance can present as procrastination, or self-sabotage, in working toward their therapeutic goals. Navigating and helping clients address issues such as fear of failure, self-doubt, or erroneous beliefs that they are somehow not worthy or capable of change, can assist clients in experiencing empowerment and becoming "unstuck." In my experience, this often facilitates a renewed sense of motivation, and encourages clients to continue working toward their treatment goals, with greater confidence.

A key component of MI is being able to develop discrepancy with the client. Discrepancy illuminates for the client their feelings regarding a particular behavior they are contemplating changing. In the end the client is in charge of their behavior and it is their choice which direction they choose to go. The MI practitioner’s job is to help the client sort out their reasons for change and help them make sound decisions.

This is especially important when clients show resistance or dissonance. Using MI techniques by asking open-ended questions can encourage the client to explore their feelings rather than defend them. I usually use open-ended questions such as: What brings you here today? or How would you like things to be different? This approach allows the client to speak freely without feeling judged. The idea is to ask the right questions so the client can start arguing why it’s a good idea to change versus not change. The MI approach of non-confrontation allows me to navigate around the client’s resistance and facilitates a more open dialogue, essential for building trust with clients who have trauma histories.

When I work with clients I ensure that they are determining what the agenda is, that we are here for their goals, and that they have already begun the steps to self-sufficiency. Even needing/accepting help along the way is a way they can re-establish control, as it's their desire to ask for and receive assistance. Helping clients think through their choices and letting them determine their next steps puts the power to change in their hands.

In my sessions, I emphasize fostering self-efficacy among my clients through a strengths-based approach. I assist each client in recognizing instances of personal growth and triumph by encouraging them to share their stories. These narratives serve as a beacon, illuminating their resilience, capabilities, and potential to drive their own transformation. I've observed how this approach can reduce feelings of hopelessness and empower clients to take proactive steps in areas where they once felt powerless.

When discussing potential changes, I utilize MI by offering options and asking the client what feels most aligned with their desires. This way, the control is firmly in the client’s hands. Respecting autonomy through MI techniques such as offering choices allows trauma survivors to feel empowered, fostering a safer and more collaborative therapeutic environment.

Don't be surprised if, regardless of the clarity or choices, your client demonstrates ambivalence. At this point, you can respect autonomy by reflecting both sides of their thought process, especially if they seem stuck on high center. That might look something like this: "On the one hand, you love the product and all the options. On the other hand, your company is so new, every purchase seems risky." By acknowledging the parameters of their ambivalence, the client can metaphorically step back and feel more in control of what might have been flooding their thoughts.

When coaching an individual, I like to always have a couple of options for them to have agency in choosing what they might like to do next. At the same time I am also motivating them and challenging them to continue to grow, self-reflect, and be confident in their next steps!

Regularly acknowledging the hard work and courage clients display allow for a more nuanced and compassionate therapeutic relationship. Using MI affirmations to express genuine compassion can validate the efforts of trauma survivors, providing a more balanced and healing interaction.

I've found that cultural humility and curiosity closely parallel the significance of compassion. Engaging in thoughtful questioning and displaying a sincere interest in their challenges undoubtedly strengthens the foundation of trust within a relationship. Practicing active listening and posing open-ended questions conveys that you're not only listening but genuinely eager to delve deeper into their hardships. This approach helps individuals feel validated, heard, and, ideally, understood.

Often clients who have experienced trauma have a history of people trying to control, manipulate or coerce them. Because they may not be accustomed to having their opinions or autonomy respected by those around them they may be triggered by someone acting as an authority figure. By collaborating on goals you acknowledge that they are the experts in their own lives and reinforce your role as their supporter. Not only does this allow you to avoid resistance as they protect their autonomy but it's essential in building a trusting relationship. Tapping into motivation inspired by one's own values and priorities is the most powerful way to encourage action.

When setting therapeutic goals, I use MI by eliciting the client’s own motivations for change. Then we work together to align the treatment plan with their personal values and preferences. MI’s client-centered approach facilitates a collaborative goal-setting process, resulting in more engagement and trust from the client, particularly important for those with past traumas.

When setting goals, we always end sessions with a commitment to what is possible and how to act on it next. I then can use my role to hold the individual or client accountable for their growth and continue to check in as need to provide assurance or motivation as the person works towards their goals and action plan.

This is tied directly to respecting autonomy. While I might envision one outcome of a planned change, your client may be envisioning something very different (and often much simpler). For example, if I say, "You mentioned feeling indecisive. How would your days be different if you were more decisive?" I may be thinking of how their performance at work will improve. My client may be thinking of how much less stressful their mornings will be, because they are not running late after agonizing over what to wear. While getting to work on time will likely improve their performance, their performance is not why they came to see me. The client wants to address their anxiety, and the immediate payoff the client wants is less stressful mornings.

Sometimes clients who have experienced trauma may begin to feel flooded, no matter your MI skill level. If you notice your clients physiology or behaviors changing, such as flushing neck or face or perhaps they begin white knuckling their chair, it's okay to stop and ask them if they'd like a break. Saying something like, "I've noticed over the last five minutes you may have started feeling a little uncomfortable. Would you like to take a short break, walk down the hall for a bit, or could I get you some water?" This could help them reset their emotional regulation.

I would like to add that a person needs to have a safe space to share their pain with a person who is able to sit with them in this space without jumping in to give advice, or wanting to “fix the problem”. Most importantly is in the sharing and being heard. There will be time to offer more.

Get to know the person before attempting to work with their trauma. How have they managed so far? What are their strengths? What's their window of tolerance for emotional material? It's not uncommon for trauma survivors to push themselves, and/or shut down. It's helpful for them to know 'the slower you go, the faster you get there', a saying in the trauma field that means going slow helps the person learn the skills they need to go further and deeper. Also, make sure they know how to say 'stop' before you both begin to go into trauma work. If they can't say 'stop', work out another word or signal for them to use, so they can feel empowered.