What is an “Itchy Topic?”
Something that makes you or your client uncomfortable, like you have an itch!
Steven Rollnick, co-creator of Motivational Interviewing (MI), came up with the term “itchy topics” to refer to when we need to have a conversation with a client about something that we know there may be some avoidance, resistance or touchiness around.
An itchy topic is relevant to the clients treatment, but the client may have reticence to talk about.
We often times need to talk about the hard stuff with clients! Itchy topics are the hard stuff! If we are doing MI well, we are helping clients both feel good (empowered, listened to) AND address the hard stuff
Here are a couple of tips for approaching itchy topics with clients!
- Approach with an Attitude of Curiosity: Set aside your judgement, and get really curious about this dilemma for the client. I have been reading Lori Gottlieb’s book, Maybe You Should Talk to Someone (she’s a therapist writing about being a therapist and going to her own therapy). She used the phrase, “no memory, no expectation,” when entering a session with a client. If we come into each session with clients without preconceived notions about how a client is doing & what will be accomplished today- essentially, drop our expectations- we can TRULY be curious about how THIS client is doing TODAY in relation to the topic at hand.
- Share Your Concern Directly: Remembering to embody the ‘attitude of MI’ (curiosity, empathy, positive regard), give direct voice to your concern. Example: “I’m not sure how you are feeling about this, but I am concerned about the increase in your drinking since we last met. I’ve heard you reflect on how drinking more contributes to depression for you, as well as impacts your motivation. What do you think about these concerns?” When we speak from a place of compassion & empathy, AND our client feels the safety of the therapeutic relationship, hearing our concern can be a powerful motivator for insight and change. It’s important to elicit from your client how your concern lands for them! It’s not about us, it’s about them!
- Make a Statement of Autonomy: It never hurts to throw in a reflection of choice to your client. Whether a client changes or not is up to them! (It’s their dilemma, not YOURS! Stay out of Tug-O-War! – I have a whole post on this!) “Of course, whatever you decide to do is up to you.” “It’s up to you to decide about doing something, or anything, about this right now.” (Sometimes I think of Robin Williams in Dead Poets Society teaching his students, “You are the captain of your soul!”) And it’s true! Our clients are the captains of their lives!
Motivational Interviewing Tip of the Week: Notice how you typically react to “itchy topics” with clients. Do you avoid? Or on the other end of the spectrum, do you confront? Consider ways you can bring up itchy topics using MI spirit and tools! Increase your curiosity about the topic, share your concern directly, or remind your client that the decision to pursue change is up to them!
