I Was Often Wondering What To Say Next20 November, 2012
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Wondering What To Say Next

When I started using MI in diabetes care after my first training, I used open ended questions and struggled with simple and complex reflections.  I found myself in interviews punctuated by silence.  People answered yes or no to my reflections.  Although some interviews went better than others, I knew I wasn’t making progress using MI.  MI competency seemed distant.  I felt disheartened.

It seemed I didn’t know what to say next. I was frustrated because I was motivated by good intentions to work effectively with people who were struggling or neglecting with diabetes self care. 

After speaking with and reading about people who used MI well, I clearly saw my problem.  I was too preoccupied with what I was doing. In learning valuable new skills I wanted to do everything right.  Instead, I was preoccupied with interviewing skills.  A good intention became a barrier in listening to patients. This took me out of the game.  If you can’t do reflective listening, MI becomes dilute.

I realized also I wasn’t doing reflections.  I heard yes or no answers because my reflections were questions:

1)      You want to do something about forgetting to take your medications?

2)      You want to do something about forgetting to take your medications.

Rather than “doing MI,” I was “murdering reflections.”  Look at the simple reflection above.  If you say those same words with an upward inflection example 1 is a question.  Say example 2, a statement, is done with downward inflection.  To appreciate the difference try saying aloud each of them.  Although they contain the exact same words there is a dramatic difference with inflections added at the end of the sentence.  Questions go upward.  Statements go downward in tone.

Listening allows us to understand people.  The foundation of MI is to elicit peoples’ ideas and thoughts about change while accepting their autonomy in decision making.  That process is facilitated by reflective listening, using reflections rather than questions to elicit ideas, feelings and information.

MI competency is not about the “right thing to say next.”  It took me a while to learn that.  But once I was able to listen reflectively, I understood the person’s mood, facial expressions and body language and words.  All of which added emotion to what I heard.  That’s what really helped me to use reflections that captured understanding and empathy. It encouraged people to tell me more about their challenges with diabetes and how they could and would improve their diabetes self care.

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