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According to the President’s Council on Fitness, Sports & Nutrition, “If exercise could be packaged into a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” Yet the incorporation of physical activity into a regular routine proves difficult for many. Bringing together a field of experts, Doing Exercise Psychology uses applied theories alongside authentic client interactions to address the challenging psychological components of physical activity.
Doing Exercise Psychology helps students understand how to build connections with individual clients, strengthen the professional relationship through listening, and understand clients’ needs. The text features diverse topics, bridging health psychology and exercise psychology and demonstrating the increasingly important role of physical activity in overall wellness and health.
The first chapter is devoted to the development of mindfulness as a practitioner, while another addresses the difficulties professionals encounter with their own inactivity, encouraging self-reflection in order to be more helpful and open with clients. A key feature of many chapters in Doing Exercise Psychology is the in-the-trenches dialogue between practitioner and client, accompanied by follow-up commentary on what went right and what went wrong in particular sessions. Through these real-world scenarios, students will witness firsthand the methods that are most effective in communicating with clients. The text also explores complex questions such as these:
• What are the implications and consequences of using exercise as a component of psychological therapies?
• How can practitioners help clients with impaired movement abilities as a result of chronic conditions or illness embrace physical activity as part of their therapy or their lives?
• How can exercise be incorporated in therapies to change nutrition, smoking, and alcohol habits?
• Why are some exercise protocols that are extremely effective for some but not for others?
• How can relationships, interrelatedness, and attunement to others be vehicles for healthy change in whatever kind of therapy is being done?
The book is arranged so that information flows progressively, covering major themes early and then applying them to the field. Part I introduces the relationship-building motif by covering the variety of relationships that one might find in exercise and physical activity settings. Part II addresses specific conditions and behavior change, with suggestions for encouraging activity in those who are also working to quit smoking, reduce alcohol consumption, or modify their nutrition habits. Part III deals directly with chronic and major medical conditions that professionals will contend with on a regular basis, including cancer, heart disease, and multiple sclerosis. Part IV delves into the dark side of exercise, such as overtraining, exercise dependence, and eating disorders.
A growing and exciting area of study, exercise psychology covers all the psychosocial, intra- and interpersonal, and cultural variables that come into play when people get together and exercise. Students and practitioners who work with individuals in exercise settings will find Doing Exercise Psychology a vital resource to refer to repeatedly in their practice.
Part I. Beginnings and Basics in Exercise (and Sport) Psychology
Chapter 1. Mindfulness, Therapeutic Relationships, and Neuroscience in Applied Exercise Psychology
Joe Mannion and Mark B. Andersen
Chapter 2. Relationships Between Coaches, Athletes, and Sport and Exercise Scientists
David T. Martin and Kirsten Peterson
Chapter 3. Running Across Borders: Cross-Cultural Exercise Psychology
Stephanie J. Hanrahan
Chapter 4. Should I Consult a Psychologist? An Autobiographical Account of Physical Inactivity in an Exercise and Sport Psychologist
Tony Morris
Chapter 5. Dancing for Your Life: Movement, Health, and Well-being
Stephanie J. Hanrahan
Part II. Changing Habits
Chapter 6. Motivational Interviewing, Exercise, and Nutrition Counseling
Jeff Breckon
Chapter 7. Exercise and Smoking Cessation: Tackling Multiple Health Behavior Changes
Adrian H. Taylor and Tom P. Thompson
Chapter 8. Adjunct Exercise Therapy for Alcohol Use Disorders
Matthew P. Martens and Ashley E. Smith
Part III. Exercise and People With Chronic Conditions
Chapter 9. Using the Exercise Arrow to Hit the Target of Multiple Sclerosis
Robert W. Motl, Yvonne C. Learmonth, and Rachel E. Klaren
Chapter 10. Moving for Your Heart’s Sake: Physical Activity and Exercise for People With Cardiac Disease
Michelle Rogerson and Mark B. Andersen
Chapter 11. Exercise for Cancer Patients and Survivors: Challenges, Benefits, Barriers, and Determinants
Karen M. Mustian, Lisa K. Sprod, Lara A. Treviño, and Charles Kamen
Chapter 12. It Hurts to Move: The Catch-22 of Physical Activity for People With Chronic Pain
Melainie Cameron and Janelle White
Chapter 13. It’s About Moving: Enabling Activity and Conquering Prejudices When Working With Disabled People
Cadeyrn J. Gaskin and Stephanie J. Hanrahan
Chapter 14. Let’s Run With That: Exercise, Depression, and Anxiety
Kate F. Hays
Part IV. The Dark Side of Exercise
Chapter 15. Overtraining in Professional Sport: Exceeding the Limits in a Culture of Physical and Mental Toughness
Stephanie J. Tibbert and Mark B. Andersen
Chapter 16. The Relationship Between Exercise and Eating Disorders:
A Double-Edged Sword
Justine J. Reel
Chapter 17. Exercise Dependence: Too Much of a Good Thing
Albert J. Petitpas, Britton W. Brewer, and Judy L. Van Raalte
Mark B. Andersen, PhD, is an adjunct professor at Halmstad University in Sweden. He lives in Australia and collaborates intercontinentally with his Swedish colleagues in the areas of research, training, and supervision in applied sport and exercise psychology.
Andersen is a registered psychologist in Australia and is licensed to practice psychology in the United States. He is the former editor of the Professional Practice section of the international journal The Sport Psychologist. He has published seven books, two monographs, and more than 170 refereed journal articles and book chapters. He has made more than 100 national and international conference presentations, including 15 invited keynote addresses on four continents. He received his doctorate from the University of Arizona in 1988 and immigrated to Australia in 1994.
Stephanie J. Hanrahan, PhD, is an associate professor holding a joint appointment with the Schools of Human Movement Studies and Psychology at the University of Queensland, where she has worked since 1990. She was a UQ Teaching Excellence Award winner in 1997 and is the co-author or co-editor of nine books, including Biophysical Foundations of Human Movement in 2013. Her work also appears in articles, book chapters, and conference papers. She is a registered psychologist in Australia and a certified consultant with the Association for Applied Sport Psychology. She has run applied workshops in more than 10 countries. She completed her doctorate at the University of Western Australia in the area of attributional style in sport.
“An invaluable resource for psychologists and fitness professionals alike, Doing Exercise Psychology is especially recommended for college library collections.”
-- Midwest Book Review
“This unique book integrates many of the traditional practices and theories of health psychology with issues typical of the sports setting. The content is well supported by current peer-reviewed literature and case study examples.”
-- Doody’s Book Review (5 Star Review)
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
Read more about Doing Exercise Psychology.
Mindfulness and Presence in Practice
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ’evenly suspended attention’ in the face of all that one hears."
Presence is the starting place for helpful and healing alliances with our clients. Freud (1912/1958) described this stance a century ago, well before the advent of mindfulness approaches in psychotherapy: "It rejects the use of any special expedient (even that of taking notes). It consists simply in not directing one's notice to anything in particular and in maintaining the same 'evenly suspended attention' in the face of all that one hears"
(p. 111).
When we are mindful, we are in this receptive, evenly suspended, and present state, as opposed to a protective state. Subjectively, we are open, accepting, nonjudgmental, and curious as we alternately observe our endless streams of thoughts, feelings, sensations, and perceptions and our clients' verbal and nonverbal communications. Neurologically, this receptivity correlates with an approach state of cortical activity (see figure 1.1, e.g., increase in activity in the left and medial prefrontal cortex), moving toward, rather than away from, difficult situations (Siegel, 2010). If we encounter internal or external stimuli we find threatening (e.g., a well-being concern with which we aren't comfortable, a story that triggers memories of our own imperfect pasts), our prefrontal, limbic, and brain-stem processes may coordinate a protective fight-flight-freeze response. Subjectively, we may experience this response as noticeable discomfort in our minds and bodies. In the case of fight or flight, our sympathetic nervous systems (e.g., increased heart rate and muscle tension, shallower breathing) are activated. In a freeze stress response, the dorsal branch of our parasympathetic nervous systems is activated, frequently resulting in a sense of deflation, dissociation, and reduced functioning. The avoidance response may also be subtle (e.g., impatience, boredom, fatigue, inattention) and even outside of our awareness.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/133/E5734_489796_ebook_Main.png
Clients may experience our shifts from receptivity to protection (or absence) in a variety of deleterious ways. The pathways for such transmissions may be objective as well as subjective. Iacoboni (2008) has suggested that recently discovered mirror neurons may contribute to our abilities to connect with others. Initial research (Iacoboni et al., 1999) found they function to detect and imitate others' behaviors, but Iacoboni has since suggested that mirror neurons may also translate detected behaviors in others as outward signs of inner states, contributing to the neurobiological reproduction of those states in the observer. Often primed by past hurts and disappointments to be socially and neurobiologically vigilant for signs of impending hurt and disappointment, clients may interpret our vigilance or absence to mean we, too, cannot handle their difficulties. And if we, the professional healers, cannot handle their difficulties, then where does that leave our clients?
Thus, it would be helpful that we (continuously) learn to mindfully uncover, expand our tolerances for, and work through our own histories of hurt, triggers, and perceptual biases and filters to increase our presence. As we expand our windows of tolerance, we regain the receptive ability to consciously and fluidly shift through arising difficult thoughts, feelings, and sensations without our mindful awareness collapsing in neurobiological or cognitive-affective preoccupation, avoidance, and other protective strategies (Siegel, 2010). With such presence, we are well positioned for the next element.
Read more about Doing Exercise Psychology.
Guiding, Accepting, and Collaborating with Clients
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes.
Collaboration
Collaboration is a guiding principle for me and for many others who use motivational interviewing (MI), and it guides my approach as a practitioner by ensuring that I do not take the expert role and make clients passive recipients of instructions for their own changes. As Miller and Rollnick (2012) described, "MI is done 'for' and 'with' a person" (p. 15). It is an active collaboration with an appreciation that clients are experts in their own knowledge about their changes. As clients rightly suggest, no one knows them better than they know themselves. With this principle in mind, I work with a genuine interest in the client and seek to create a positive interpersonal relationship that values the client's perspective and resources. I am still there to act as an active guide, not leading or coercing, but working in partnership. As an active part of this partnership, I bring expertise and knowledge about what the evidence suggests and typically what works for others in similar positions, but when it comes to clients' situations, I have to appreciate that I need their help in understanding what they already know and feel and, more important, what the clients' goals and aspirations are (Rosengren, 2009).
Acceptance
To allay the fears of many practitioners, acceptance does not mean one necessarily agrees with or approves of clients' actions or attitudes toward change. Personal approval (or disapproval) is irrelevant here; rather, one appreciates the absolute worth of clients in what Carl Rogers described as unconditional positive regard (1980). This stance can be a challenge for many practitioners, and masny health professionals whom I have trained are often fearful of too much client involvement in their own change. Practitioners may worry that the client might give them the wrong answer when asked about strategies or options, but respecting the clients' own potential for growth can be helpful in supporting their change. With this fear and lack of trust in the client, the default position of the expert trap can emerge, where the practitioner takes the lead in advising and problem solving in the change plan phase. Acceptance, however, in the context of MI, links closely to self-actualization (Maslow, 1970) and places trust and respect in the client.
Read more about Doing Exercise Psychology.
How to Avoid Conversational Traps with Clients
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change.
Before we consider the application of motivational interviewing (MI) and its components, it is worth exploring some of the traps to avoid in consultations in order to support the development of an MI approach. Miller and Rollnick (2002) suggested that early in a consultation, avoiding these common pitfalls is important for creating an empathetic, respectful, and fruitful relationship that is a partnership toward change. Examples of these traps are provided in the following section, and alternatives are considered in a later section as we explore an MI approach.
Question - Answer Trap
It is easy to fall into a pattern of short questions and even shorter responses that is not dissimilar to typical short health consultations where the primary aim is diagnosis and prescription. This survey approach, where a long list of questions are presented with a view to gaining a short and concise, often numeric, response, tends to elicit no more than limited content, and client responses are not likely to provide any context, feeling, or perceived consequences. Typical "yes" or "no" responses tend to emerge that can have the client feeling restricted and submissive, and the practitioner satisfied but unaware of the larger picture of deeper context and meaning. As Miller and Rollnick (2012) pointed out, this approach can have a negative consequence in that the client is learning to give only short answers with no elaboration, and it subtly implies a mismatch in power between the (now passive) client and (expert) practitioner. In physical activity and nutrition settings, readers can imagine (and have perhaps even experienced) the impact of this approach.
Practitioner (P): So, what have you come to the session for?
Client (C): I need to lose some weight and become healthier.
P: Have you tried to lose weight before?
C: Yes, but it didn't go so well, and I soon put the weight back on.
P: How much weight did you lose?
C: About 20 kilograms.
P: And is that the kind of amount you are looking at losing this time?
C: Possibly, although I'm not sure I am going to be successful.
P: Are you married?
C: Yes, but we are separated.
In this exchange, we can begin to see the impact of asking a number of closed questions in a row, and the practitioner is not taking any of the opportunities to elaborate and understand what has happened, the context, emotion, feeling, or effect of previous experiences. If we are going to engage and understand the client, then being aware of the roadblocks that occur with the Q-and-A trap is important. As something to bear in mind as we move forward, consider the final question asked by the practitioner. What do you feel would be a more effective and helpful alternative to the question "Are you married?" Surely, a more effective alternative could be "Who in your life may help support this change?"
Expert Trap
Similar to the Q and A problem, this trap can subtly emerge and create an impression of the passive client and the expert practitioner who conveys a sense of knowledge and answers to all the questions being posed. Although the practitioner is being nothing more than enthusiastic and knowledgeable, this trap can present a sense of control and reduces the likelihood that clients will explore and resolve ambivalence for themselves. This trap can also sound like fixing and solving problems, which is fine, and positively encouraged at suitable times, but in the early stages of the interaction, it is important to avoid prescribing answers when the underlying position of the client is one of ambivalence. When practitioners fall into this problem-solving trap, their desperation to help the client actually limits their understanding of the extent of the client's concerns and issues.
P: So, what activities have you tried?
C: I used to cycle, but I struggled to find the time to fit it in after work.
P: Why don't you cycle to work instead, then?
C: I tried that once, but I had to take lots of spare clothes with me.
P: Why don't you take some spares next time you drive and leave them there?
C: I could, yes, but I don't really want to leave my clothes lying around at work. Anyway, the shower facilities aren't very good, and it takes time.
As we can see here, contrary to the aim of the interaction, trying to fix with expertise, enthusiasm, and ideas is actually increasing client resistance, and the typical "yes, but . . ." response is emerging - a key indicator that it is time to shift approaches. Motivational interviewing highlights the need to use the client as the resource and to value that it is actually clients who are experts on what their situations, motives, or barriers to change actually are. Falling into this expert trap negates this opportunity and paradoxically reduces clients' likelihood to engage in the change process. This need for close collaboration is an important facet of MI.
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