PART IV Evoking Preparation for Change Merriam-Webster’s definition of evoke includes: • To bring (a feeling, memory, image, etc. ) into the mind • To call forth or up • To cite, especially with approval or support • To bring to mind or recollection • To recreate imaginatively • To cause (a particular response or reaction) to happen We’ve now established the direction we wish to travel together. Wouldn’t it be lovely if that were all we had to do? Clients become clear about what needs to happen and off they go. Our clients would shake our hands, thank us, and then be on their way.
Sometimes that happens; more often the process is complicated. Why is that? Let’s begin with the obvious answer: Change is hard. It is important to acknowledge this truth. Thinking of our own lives, we can probably identify examples of things we know need to change, have clear ideas about how to change, and yet somehow we just can’t quite make that change happen.
We should eat less, eat healthier, exercise more, get to bed ear- lier, spend more time with our loved ones, put down the electronic device, do things that are more creative, volunteer our time, take care of that mess, clean that bathroom, write that note—and despite knowing this, it’s hard to make it happen. In fact, one of my favorite quips acknowledges this reality and our foibles on this account: “Change is hard. You go first.” Yet, there are some exceptions when change is not hard or complicated. When the change is straightforward and not particularly complex, then people can move forward 255 256 Evoking with additional information from us (or someone else).
This is a bit like clients asking us for directions about the “change river” and then hopping into the raft. The current pulls gently, and so they move down stream with relative ease. Clients might need to paddle to keep the raft in the middle of the river and away from the weeds at the side, but it’s more or less a gentle float, and they don’t need more help from us on this trip. However, research tells us this process is not typically the case when attempting to make complex behavioral changes.
When the change is complex, information may be necessary, but it’s rarely sufficient to cause change (Fisher, Fisher, & Harman, 2003). For those more complex situations, clients will need a combination of information, motivation, and an ability to enact the change. Although our presence still might not be required on the trip, or might be needed for only a part of the trip, this remains a more complex and challenging river for clients to navigate. Although we’ve described the situation and hinted at what is important (i., motivation and skills), it does little to help us understand what needs to happen next for either our cli- ents or us.
To do that, we return to that familiar traveling companion: ambivalence. In Chapter 2, we introduced ambivalence as a normal part of the change process. It contains all the crosscurrents of why we think change might be a good idea and why it might be hard, as well as all the reasons to maintain the status quo and why giving it up might be a good idea. It represents two sides of the same coin.
Although ambivalence manifests behaviorally, it also happens internally for clients and is expressed in their language. Moreover, the research that Terri Moyers and others have done demonstrates that this language not only reflects what is happening internally, it also helps to create what is happening behaviorally (Glynn & Moyers, 2010) and predicts what will happen with a client (e., Apodaca et al. For these reasons, in MI we pay par- ticular attention to client language and respond differentially to what we hear. Attention to language and differential responding are the essence of the evoking process.
We can think of client language falling into three categories: talk about change; talk about sustaining the status quo, including discord; and neutral talk. Change talk indicates the person is considering the possibility of change. This is one side of ambivalence. Sustain talk indicates the person is considering the possibility of things remaining unchanged.
Dis- cord is a special form of sustain talk and indicates that the person is not just considering the possibility of avoiding change, but he or she is feeling pressure to change and is actively pushing back against us. Notice the “us.” From an MI viewpoint, discord either arises or strengthens as part of an interpersonal process; as a result, the term resistance is no longer used because it suggests that this resistance resides solely within the individual rather than in the midst of an interpersonal process. Instead, in MI we talk about discord as ambiva- lence under pressure.1 Taken together, sustain talk and discord represent the other side of the ambivalence coin. Neutral talk refers to statements that are neither for nor against change.
It is simply neutral on this account or on another topic altogether. These categories are things we already know and hear as a practitioner. For example, read these smoker statements aloud and then decide into which category each of these would fall: 1 Thanks to Allan Zuckoff for this really helpful way to frame discord. “I don’t think my smoking is that big of a deal.
“You don’t understand. I’ve tried that and it doesn’t work for me. “I hadn’t really thought about it either way. “I will quit at some point because I know it’s not good for me.” Did your practitioner ear help you know where these things fell? Here is how I would sort these statements: 1—Sustain; 2—Discord; 3—Neutral; 4—Change.
Don’t worry if your categories looked a little different. Chapters 9 and 11 will provide additional informa- tion about these categories, which will help fine-tune your sensitivity to these language cat- egories. For now, it’s enough to discover these are things you’ve already heard and known, but might not have put into words. With this information about ambivalence and language in mind, let’s consider four ideas.
First, the path we select determines the conversational direction we travel. Second, this conversation is mutually influencing. Third, the conversation itself helps organize cli- ents’ experience. Finally, the conversation does not just describe the experience, it helps create it.
We’ll take each of these ideas in turn. The first idea seems like common sense. Of course, your path will determine where you end up. Yet, it’s easy to lose track of this simple idea in our busy work situations.
We feel compelled to gather particular bits of information or solve certain problems. In this process we may become reactive rather than intentional in choosing where we will focus our atten- tion. Or we become intent on collecting the data and not hearing the client’s story and the paths it suggests. Part of the art of becoming a proficient MI practitioner is becoming inten- tional in which conversational paths we choose.
The second idea builds on this first one, and also extends it. Again, it is no surprise that conversations are mutually influencing. We are traveling together, and what each of us does affects the other. What might be less immediately evident is that clients influence our use of MI and in ways we might not predict.
Zach Imel has done some very interest- ing research that suggests there is significant variation in our use of MI based on clients. Of particular interest is that we tend to be less proficient in our use of MI when clients are less challenging (Imel, Baer, Martino, Ball, & Carroll, 2011). It seems we might be more inclined to the righting reflex at these times and less likely to use evoking. Thus, as the client begins moving toward change, we need to be mindful of staying within that MI spirit and using those OARS+I to evoke within the client the processes that will sustain the change effort.
Third, much as the narrative therapists have taught us, we help clients to organize their experiences in a manner they can use. This idea becomes especially important as we think about our task as practitioners. If we simply return to clients what they’ve told us—in the manner they’ve told us—we haven’t helped them organize this experience. This might be why surface-level reflections are a useful but limited tool.
Deeper reflections and summa- ries, as well as affirmations, well-targeted information and questions, help clients see and understand their situation in a new light. They see a possible way forward. Fourth and finally, the conversations between clients and practitioners might not just describe the experiences, but also create them. Here we slip into metacognition or thinking 258 Evoking about thinking.
An example is helpful in describing this concept. Read these two statements aloud: “That is a problem.” “That is a challenge.” As you read these two statements, did you find yourself reacting to each of them dif- ferently? Most people experience a difference and noticing this difference is the essence of metacognition. That is, how we think and talk about an issue affects how we understand the thing itself. With regard to client change, then, what we choose to respond to and how we respond to it affects not only the path we’re traveling, but also our understanding of what the path is and where we’re going.
It makes us ever more mindful that language matters and that we want to be intentional in how we use it. Keeping these points in mind, let us return to our river of change metaphor and those three elements: where, what, and how. With regard to where we are in the river, we are at the point where the client has identified a direction toward which he or she would like to travel. Notice that it is the client who chooses that direction, not the practitioner.
That is the outcome of the focusing process and the point at which we begin this process. Our goals in this situation are to help clients remain focused on this direction, to evoke their reasons for why they have selected this direction, to evoke what they are moving toward, and then to help them commit to that change. In this section of the book, we target our core skills to evoke and reinforce change talk, to soften sustain talk, and to “defuse” discord. Let’s see how that might show up in our continuing conversation with Russell.
Evoking with Russell The conversation with Russell continues to move forward. Read the counselor statements and decide which skill you think is being used. Under the “Russell talk category,” indicate whether you think the language is moving toward change, moving away from change, or hovering somewhere in the middle. Use those labels: “moving toward,” “moving away,” or “in the middle.” Later we will talk about the specificity of change talk.
For now, just keep in mind whether the client’s language is moving toward change in the topic under discussion (e., marijuana, parenting) in each client response. In the next chapters we’ll get more detailed about this information. Counselor skill category/ Russell talk category C: So, let me step back and summarize what we’ve talked about. You’re not sure this marijuana stuff is worth talking about, but you’re here.
There are some things you would like to see change, and perhaps the most important of those things to you is finding tools for managing things with your daughters. How does that fit? R: No, I am certain. Marijuana is not an issue for me, and I think it’s a waste of time talking about it. C: You want to focus elsewhere—like on your kids and being a good parent.
C: One of the things that I would find helpful is to understand where this commitment to being a good parent comes from. Yeah, why not. I had great parents.
