5 Tips for working with the Precontemplative client!

The Precontemplative Conundrum!

If you are like, “Precontem…what?” check out my blog post on Stages of Change here. 

In short, “precontemplation” refers to the stage of change when clients aren’t wanting to think or talk about change. They might even be arguing against it.

Working with clients who are stuck in precontemplation may be the hardest thing we do as helping professionals. 

It can be crazy-making to be sitting with someone who clearly needs to change, who may even be suffering a lot of the consequences of NOT changing, yet they aren’t willing to work with you to make a plan to change. 

It can be like sitting with someone who has a nail in their head, complaining about headaches, but not willing to talk about the nail. 

This video (It’s Not About the Nail) is one of my all time favorite videos related to precontemplation. 

I squirm every time I see it. It makes me want to yank that nail out of her forehead already to get to the solutions. I love fixing, problem solving, and providing solutions.

But I can’t yank a client out of precontemplation. 

Think about when you kinda deep down might know something might a problem, but are super defensive about even talking about it because it’s so tender and vulnerable and maybe it’s easier not to talk about it or even blame external things for the issue? If someone comes at you with efforts to fix, problem solve or provide solutions, you probably don’t want to hear it.

Trying to push or pull someone out of the precontemplation stage

1. Can be disempowering to them
2. Usually ends up damaging the relationship
3. They learn not to talk to me about it anymore (or worse, won’t come back) 
4. Creates more pushback from them, and accidentally strengthens their stance on not changing

So kind of the opposite of what we want.

But it’s so hard!!! It is so hard to sit with someone who is suffering and just stand by and watch.

And sometimes, we are sitting with people who aren’t yet ready to talk about change for a while. Like, years. 

(Take a deep breath)

But there are some things you CAN do! 

1. Check your ‘tude. Can you revisit the MI spirit of Acceptance with this client? They are stuck, not yet ready to see or talk about it, and struggling. We can’t force someone to be ready. Access your compassion for the individual, remember change is hard and they are well protected around it. There’s a reason (or many reasons!) they aren’t ready yet!
2. Affirm the decision is up to them. Right?! Because it IS! Whatever they choose, they will be living with the outcomes. Remember to ‘drop the rope’ in the behavioral tug-of-war game and honor their autonomy. 
3. Acknowledge they aren’t ready yet. Reflect to them where they are, without judgment. This change may not be important to them yet. This might sound like, “Change is hard. You aren’t ready to make this change yet.” 
4. Talk about what they are willing to talk about. What change might be important to them now? “This change isn’t your top priority yet. What are other things that are more important than making this change right now?” “If you focused on something you would like different in your life, what would that be?”or  “What change(s) are you interested in discussing?”
5. Explore positive aspects of change. In order to do this, STAY OUT OF YOUR RIGHTING REFLEX! This means don’t warn, threaten, take the stance on what they should do, tell them they are in denial (and it ain’t a river in Egypt). What you CAN do is encourage them to consider the positive aspects of making the change. “If you were to ______, what might some of the benefits be?” “How would things feel/look/etc. when _____ isn’t an issue any longer?”

Our goal is to stay in relationship with our clients when they are stuck in precontemplation.

I think of it as ‘keeping the door cracked open’ so they know they can come back to talk to you about this issue when they are a little more ready because they know you won’t judge them, won’t push them, and won’t lecture. 

Motivational Interviewing Tip of the Week: When a client is precontemplative about change (not thinking about the need for it yet!), there are some tools we can bring! First, check your attitude toward the client and see how you can increase your compassion and acceptance. Next, consider acknowledging their autonomy and exploring what they are willing to talk about. Finally, if your client is up for it, explore what the benefits of making that change might be if they decided to embark on that journey. Good luck!

Watch my full video here!