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. 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).

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.