I like this John Hanley quote because it seems to encapsulate the engaging process, or initial and ongoing process in motivational interviewing (and many other forms of clinical conversations). As a clinician, I need to be synchronized with how my client views what they are up to, and what they have in mind for making changes. I need to work with my patients from a collaborative partnership since they are the only real experts on their thoughts, feelings, and actions. This is true even when their thoughts don’t mesh with what they express they might want. My expertise is not in providing knowledge, or giving advice go right here. It is in understanding how to elicit my client’s best view of themselves, and to listen and help them craft a plan of action they can live with in their path toward a better self. The patient’s expertise is knowing their world. And even when it’s not evident, people are motivated by increasing their own sense of competence, relatedness, and autonomy [Deci and Ryan].
“People don’t care how much you know until they know how much you care.” It sounds so self-evident. Don’t all providers and helpers naturally deploy this style? To insure patients feel supported and cared for, before giving advice? Before assuming you know best and jumping in with a solution? The answer to all these questions is no. We all jump in too soon for a lot of reasons. In a Motivational Interviewing I try to practice adherent manner, but I’ve unintentionally found scads of ways to miss that my client and I are not on the same page. I’ve often not seen that we don’t agree on what their next step might be. But I relearn this the hard way, when they come back a week or two later, and they didn’t think about what we talked about in the same way, or didn’t prioritize like me.
Making and sustaining changes for one’s health is hard, and important. And I easily miss how important and how confident someone is in their change journey if I assume I know best and jump to my agenda. Focus, planning, and commitment for change waxes and wanes when true personal change is on the line. But I guarantee, no one listens to you as a clinician unless you can create and sustain a type of caring engagement. Once they know how much you care, they might want to know what you know.
More about Importance and Confidence in MI next time.