April 2016

Dear Friend,

April is the month in which Passover occurs.  It’s my very favorite Jewish holiday.  The theme of the celebration is “exodus from slavery”.  It’s a great opportunity to think about how you are “enslaved” in your life and where you feel free.  What does freedom mean to you? How would you like to change your life to break free from the things that enslave you?  My family gathers at my home for the annual festival dinner, called seder to tell the story of the exodus from Egypt, and freedom.

I treasure having my family come from near and far to be together for this celebration.






 

 

Reconciling the Tension Between Being Client-Centered and Directive

An important concept in Motivational Interviewing is the notion of being “client centered”. This means that we are interested in the client’s needs, wishes and goals, and want to have them focus on what’s important to them. We assume that the client in the “expert in their own life”. However, we also emphasize that MI is directive in nature. MI is most appropriate in settings where there is a preferred outcome, for example dietary change, smoking cessation, increasing physical activity, or taking medication as prescribed. This sets up an automatic tension between the conversation going where the client wants and where the clinician feels it should go. How do we resolve this delicate balance?

A key element of the guiding style used in MI is the process of focusing, which refers to the clinician gently steering the conversation. It boils down to “What are we talking about here?” The clinician’s job is to help the client decide what to focus on in the conversation. This is often a negotiation, and thus the “tension”. For example, in dietary counseling, there might be a number of changes that could be discussed. First of all, what is the goal of the conversation? If the client wants to lose weight, the conversation could be about increasing fruit and vegetable intake, eating less fried or fast food, or drinking less soda and more water. The client may think that the soda issue is most important, but the dietitian might think that more fruits and vegetables would be the best goal. The conversation is a negotiation, in which both parties have an interest, but the client’s ideas are paramount. However, skillful use of MI can steer the client towards what the clinician feels is most important.

This is what is meant by people are the “expert in their own lives”. The client knows best what he can actually do, and what he is ready to change.