The goals of MI are to reduce ambivalence about behavior change and increase intrinsic motivation to change health behaviors. It is the consumer, not the provider who is the main advocate for change. When the provider argues for change, the consumer is more likely to take the position of not changing. The first step in the engagement process in MI is determining what target behaviors the consumer is concerned about and might be willing to explore. It is the consumer, not the provider, who determines what behaviors are on the behavior change agenda. This is a key principle of MI. Remember, “It is not a change goal until the consumer says it is” (Miller & Rollnick, 2013, pp. 22–23). So initially we need to focus the conversation with the consumer to identify the target behavior(s) to be discussed, then set the agenda in a respectful and consumer-centered way.
Here are some possibilities of target health behaviors that might be the focus of attention in an MI conversation:
- Reduce alcohol intake to 3 drinks per day
- Don’t drink and drive
- Stop smoking marijuana
- Stop smoking cigarettes
- Use an e-cigarette instead of smoking a tobacco cigarette
- Check blood glucose 3 times per day
- Lose 5 lbs over a month
- Take blood pressure medication as prescribed
- Take medication for bi-polar or schizophrenia disorders as prescribed
- Walk 2 miles 3 times per week
- See a counselor to discuss alcohol intake
- See a behavioral health professional to discuss ways to reduce stress
- See a therapist to discuss non-pharmaceutical ways to combat depression
- Go to PCP for a physical
- Stop heavy drinking cold turkey on own
- Take Suboxone instead of abusing narcotic pain killers
- Go to the dentist for a check-up and teeth cleaning
- Stop watching TV in bed to address insomnia
As you can see from this list some of these behaviors might not be on your agenda for what you think might be the “best” course of action for a consumer, however, it is up to the consumer to decide what target behaviors are on their change agendas? What are some other health behaviors that you might see arise as potential targets for change in the work you do with consumers in your treatment context?
Resistance to change is more likely to show up in conversations when clinicians pursue their own agendas for behavior change. Here are some question to reflect on when exploring this shift from a clinician-generated agenda for change and a consumer/client-generated agenda for change:
What is it like for you to see a consumer/client continue to engage in health risk behaviors that you know are causing harm and suffering?
How is it to be transparent about your own agenda for consumer/client behavior change?
What do you notice about the discrepancy between the consumer/client generated behaviors and the clinician generated behaviors?
How does focusing the conversation on clinician generated behaviors (which puts the clinician in the center) increase resistance and disconnection from the consumer/client?