Key elements to successfully practicing MI are being able to judge what change talk intensity to use with your clients, to further their commitment for change. Forward-moving reflections can also be helpful to guide your client towards change talk, when they are generating mostly sustain talk.

A word about reflecting change talk intensity

When the client uses strong change language, the aware practitioner uses similarly strong language to reflect it back. For instance, if the client says, “I am so fed up with this cough!”, and the change goal is to change their smoking habit, which reflection sounds most helpful:      “You have been coughing more than you’d like to” or “You are really tired of coughing everyday!”?  Which do you think reflects most accurately the client’s level of intensity? What about “You’re sick of feeling like you’re coughing your lungs out every day!”? Here, the practitioner is increasing their enthusiasm of the client’s statement in their reflection. Of course, if the client is emitting sustain talk, the competent practitioner will attempt to do exactly the opposite, that is, reduce the intensity of the client’s statement. For example, if the client says, “I’ve tried everything to stop smoking and nothing works!”, the practitioner might say, “You’ve tried some things, but none have been successful as yet”, reducing, rather than increasing, their enthusiasm for their sustain talk.

Forward-moving reflections:  starting the motion and keeping it going

Once the practitioner has the basic idea of how to create a complex reflection, they can turn their attention toward moving the reflection forward, even a little bit.

Moving forward is a way of intensifying the client’s change talk. If we continue with the above-mentioned example, which statement is most likely to move the client forward? “You are really tired of coughing everyday!” or “You are really tired of coughing everyday and you’re thinking you’re ready to do something to stop it.”? Adding the suggestion that the client might be ready to move forward when the language is already indicating that can be helpful. If the client’s language is less strong, reinforcing it and adding a somewhat less strong “motivator” is called for. For example, the client says, “I am tired of waking up with this cough”. There is little available energy in the statement to suggest that the client is change-ready, so the reflection would be more exploratory: “You would like to wake up without that cough and you’re beginning to think about ways that it might happen for you.” It is a very gentle call for action, a flute, rather than a trumpet.