Affirmations are positive recognition and support of a client’s strengths and efforts toward a goal. Clinicians use affirmations to relay empathy, bolster client self-efficacy, and underscore client autonomy.
Reflective listening allows the clinician to direct the course and content of the interaction. Clinicians skillfully reflect the content of a client statement to express empathy, build rapport, identify and reinforce motivational statements, and explore ambivalence.
Summarizing what has been said provides the clinician a natural transition point in an ongoing conversation. The clinician is able to once again reinforce the client’s own motivational statements and to ensure that both the client and therapist are in agreement.
The four basic clinical principles of motivational interviewing are expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy.10 (See Table 3, below.) The clinician fosters a collaborative environment in which pressing issues and intervention plans are explored. The therapeutic principles of motivational interviewing fit well with the foundation of occupational therapy, which focuses on volition and habituation in a client-centered context. Making a desired change in behavior and then sustaining it can lead to clients being satisfied with their progress towards achieving their goals.
The use of motivational interviewing can help clients to set realistic and attainable goals. In the following scenario, Amy, the occupational therapist, uses this counseling style to elicit more information from Mrs. Adams, including barriers as well as facilitators to making a change. Notice how the outcome of their conversation changes.
TABLE 3: Clinical Principles of Motivational Interviewing
Express empathy: Understand the client’s perspective without judgment.
Develop discrepancy: Motivate change by highlighting a discrepancy between current behavior and desired goals.
Roll with resistance: Avoid argument for change; involve the client in problem solving.
Support self-efficacy: Support client’s belief in their ability to be successful in change.
Scenario 2
Amy: How has your arthritis affected you lately?
Mrs. Adams: I had a lot of pain and swelling earlier this month, but I’m feeling better now. I just have a hard time gripping things, like when I try to button my blouse or cut up my granddaughter’s food. Changing Alison’s diapers is so hard right now, and I’m exhausted all the time.
Amy: You’re frustrated that the effects of your arthritis are really stopping you from doing the things you need to do.
Mrs. Adams: I’m very worried about that. I can’t let it stop me though. I have too many responsibilities.
