Facing an Overwhelming Opportunity – How to use Motivational Interviewing in a Counseling Setting

Motivational Interviewing (MI) and Facing An Overwhelming Opportunity

Speaking from personal experience, I felt overwhelmed when I began to get serious about Motivational Interviewing (MI). The topic gave me energy and encouraged me with all the possibilities. I just knew this was my future. I was immediately hooked and couldn’t wait to learn more. This desire to understand Motivational Interviewing was coupled with thousands of questions, limited time, and very few clear answers. In short, I had no idea how to complete my deepest desire, and that is what left me feeling overwhelmed.

This feeling of the unknown, along with excitement, is something I suspect many of my clients experience after our first session. I am often the first Health At Every Size professional they have ever met. And when a client says, “This wasn’t what I was expecting when I booked this appointment.” I know the opportunity can feel overwhelming if there isn’t a clear plan.

To start, it is helpful to recognize on one hand, the feeling of being overwhelmed can feel pretty depressing, like a weight on the chest or a sense of drowning, and on the other hand it can feel positive and exciting. These two extremes are typical of most people’s experiences and as a result, we experience a mixture of both fear and excitement when looking at any change situation.

Complex reflections are a way to show the conflict and to label the experience of having many emotions at one time. These reflections are helpful to highlight the emotions not at the extremes, but rather a mixed bag of feelings.

If you are new to complex reflections, start with a Double-sided reflection. A double-sided reflection is when you present both the struggle and the desired outcome (Here is a tip, start with the struggle or conflict). In this situation, the struggle is feeling overwhelmed. Then, you would present the desire, which here would be the desire to learn more about motivational interviewing. On page 129 of Motivational Interviewing in Nutrition and Fitness, Dawn Clifford and Laura Curtis offer a chart of the many types of complex reflections. They explain, “It contains the client’s sustained talk and change talk usually with the conjunction and between the two.” Here is an example, using myself as the client, Megrette.

Megrette: “I am struggling. I love MI and I want to learn more about it. I loved taking the three-day class and I just feel like it is a great fit for me and my counseling practice. I want to get into MINT, and but I just don’t understand what to do next. I love MI, but I need to study it more and get really good at it. ”

You: “You are frustrated that you don’t know the steps to learn MI and you would like a clear way to advance your understanding and practice.”

Megrette: “Yes, I really want to have a path and a plan, so I can use MI all the time at work.”

You: “Learning how to advance your MI practice is what you would like to focus on.”

Megrette: “Yes, I would really like this.”

If you are like me, with the above wish – to understand MI is what is in your heart, at the end of this article is a list of excellent MI teachers.

Now, let’s understand why this dialog was effective. In the above scenario, Megrette presented a lot of fears and wishes. If it is helpful, underline the fear and circle the wish/desire. Once you can recognize these two aspects of a conversation, the next step is easy.

Imagine you are holding a fear in your left hand and a desire in your right hand. You are going to show your client the fear “On one hand [insert fear] and on the other hand [insert desire].” This is a double-sided complex reflection. It is a great place to start if you are new to using reflections. The benefit of seeing both sides is you have twice as many opportunities for change. Many clients want to work to reduce the fear they are experiencing as well as explore new learning opportunities. The ah-ha moment for me was more I understand a client’s desire, the better I could have the client identify ways to meet it.

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