Motivational Interviewing: Conversations about Change: The Righting Reflex and Ambivalence

As a helping professional or clinician, there are times when we witness our clients making choices that we believe are not in their best interests and will not support them in reaching their desired goals. And in many cases, it can be extremely challenging to allow these behaviors to continue without wanting to “step in” and help them see a different path.  This is called the “righting reflex” when we, as clinicians, want to steer our clients in a direction that we believe will serve them “better” and will reduce any additional suffering or stress.

The skillful clinician, however, is aware that most clients who want to make a change in their lives are usually ambivalent about doing so. Clients can see both sides of the argument and can often get stuck in this part of the change process. For example, a person who has experienced a heart attack likely knows it is not in their best interest to smoke. And at the same time, they may also tell you how much they enjoy smoking and how it “calms” them down. It continues to be a part of the human experience to both want something and not want something at the same time.

If we are in a session with a client, we may often hear both sides of the argument in the same sentence (change talk and sustain talk). A client may say, “I need to stop smoking (change talk) but I have tried everything and nothing has worked (sustain talk). This can be a challenging place for the clinician and client to be, especially if it lasts for a long period of time. And if the client hears us, the clinician, providing arguments to stop smoking, how best to do it, and how important it is to stop, the client will likely have a tendency to argue for continuing to smoke. This type of response from the client can often get labeled as being in “denial” or “oppositional” when it is a normal response.

Instead of the clinician offering reasons to change, the preference is to have the client talk themselves into the change they want, even though they are ambivalent. By continuing to focus more on the desired behavior, the counselor can skillfully support the client in talking about their reasons to change versus not changing. And when a person has the opportunity to speak about changing, they tend to lean in that direction since they believe themselves and their own opinions more than anyone else’s. It is also likely that our clients are having these same conversations inside themselves so it can be validating to verbalize these thoughts and feelings to a clinician.

Again, the “righting reflex” can set up a dynamic where the clinician is arguing for change and your client is arguing against it. Instead, what is preferred, and what is most likely to receive the desired outcome, is when the client is verbalizing their own reasons for change that may also be associated with their attitudes, beliefs, and values.

We will continue exploring conversations about change next month and focus on the potential tensions that can exist.  In addition, we will also include a basic definition of MI. Have a great month and keep learning and practicing!

Compassion-is-the-wish-to-see-others-free-from-suffering-Suffering-Compassion-Quote-by-Dalai-Lama                      

For more information about Motivational Interviewing or related services, contact Steve Bradley-Bull, LPC, by phone, (919) 812-9203, or by email, unc.cfar.mi@gmail.com.

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