Is there space for accountability in MI?

A past training participant reached out to pick my brain about how keeping clients accountable fits (or doesn’t fit) with MI. She expressed frustration about clients trying to place the blame on us (providers) for what’s not working for them. 

This happens, doesn’t it?  “I’m coming to you to help me and you’re not making my problem go away,” we hear, as we watch a client not taking action steps to do their part. So frustrating!!

How do we keep that responsibility for change in the hands of clients, rather than us?

Let’s first look at accountability to WHAT.

The problem may be that clients are not being accountable to program rules or expectations. Or, accountable for the goals they set for themselves. 

Let’s talk about situation #1 first: A client is not being accountable to program rules or expectations.

This is such an invitation for me vs. you or program vs. client.

Tug-o-war!

I remember when I coordinated a supported-housing program for people experiencing homelessness, there were constant invitations from clients who were not following housing or program rules to get into power struggles! I would need to talk with a client about a rule violation when they allowed others to live with them who were not approved (risking their housing!).

Using MI, we can apply the Elicit-Provide-Elicit process.

This keeps it from being a me-versus-you conversation.

Elicit: “What do you recall about program requirements?” “What do you imagine happens when you aren’t following them?” “What concerns do you have about the stability of your housing?”

Listen carefully to your client’s response and reflect it to them. “You want to be there for your friends, and you also remember the rules about unapproved guests.”

Provide: Then, if you need to, you can provide info here. You may need to review program requirements or rules. Or, you may need to give information about timelines, rules around what happens when expectations are not met. 

Then, we elicit again!

Elicit: Ask the client, “What do you make of all this?” “What do you want to do?” “How can we be helpful to support your housing right now?” “What thoughts do you have about setting some boundaries with these friends?”

When we elicit first from a client, and discuss the program in relationship to their goals or values, we help the client own the problem. 

Stay tuned! Next week, I am going to address “accountability” issue #2: When clients aren’t accountable for the goals they set for themselves!

Motivational Interviewing Tip of the Week: When our clients are struggling with accountability to program rules and expectations, don’t tell them what they already know or argue for the rules- see if you can elicit them! Using the elicit-provide-elicit MI tool, try eliciting what they remember or know of the rules (then reflect it!), provide a little info, then elicit what they would like to do about the dilemma. Remember, we don’t want to own our client’s problems, we want them to! We are here to support and collaborate, not to wrestle with them over rules!

You can check out the full conversation about this topic in our Facebook group here.

Watch my full video here!