How to Avoid Conversational Traps with Clients

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?"

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.