Motivational interviewing and internalised other questions | HMA

Motivational interviewing and internalised other questions

Internalised other questions can generate dissonance and privilege other views

Internalised other questions can generate dissonance and privilege other views

Lately I have been contemplating the importance of ‘internalised other questions’ in developing motivation for change. While some may argue that this is relying on extrinsic motivation, in my view internalised other questions can create dissonance which in turn leads to intrinsic motivation. I also think that there is much more at stake for the clients we work in appreciating the importance that others place on change. But before going further it is important to define what I mean by internalised other. Internalised other is our perception of how somebody else may view a situation. In some ways internalised other is the ultimate test of empathy through being able to approximate the experience of what it might be like to occupy another’s position.

For many of the clients through their use of abusive practice towards others, they have become ‘dismembered’. Not physically but disconnected (dismembered) from important relationships in their lives. When clients engage in abusive practices they become isolated as the logical responses from others is to create distance through fear. We all know that social dislocation is associated with negative outcomes for both the person and those around them. One of our tasks is to ‘remember’ (reconnect) clients back into functional and pro-social relationships with others which creates accountability. Accountability (link to earlier blog) in its own way creates boundaries that support us to maintain social connectedness.

Internalise other questions allow us to create space to be influenced by others. Being open to influence by pro-social others (partner, family and peers) is one of the key predictors of healthy relationships. Being able to be influenced by others mitigates abusive practice within relationships in that others can provide feedback around acceptable behaviour. What is behind the idea of internalise other questions is to privilege the voice of those who have been silenced through the use of abusive practice. We all know that abuse operates in the context of power to deny, unsettle, and ultimately render silent the voice of the person/people being abused. In my view internalised other  questions challenge this notion and invites the development of relational skills which ultimately leads to increased safety and respect within relationships.

So what do internalise other questions look and sound like? Below are a number that I often use that begins to link the experience of others and begin to match motivation for change between parties. It is clearly based in a relational context.

If (name of partner or child) were sitting with us today what would their hopes be?

If (name of partner or child) were sitting with us today what would they be most worried about in terms of where abuse is taking this relationship?

If (name of partner or child) were sitting with us today what would they say needs to change in order for abusive practice to be gone from the relationship?

As you will note from the structure of the questions, the person’s partner and child are named. This privileges their identity.  ‘If they were sitting with us today’ brings their voice into the present and creates space for their voice in the conversation.  Some of you may be thinking that the person may respond by saying, “I have no idea”. This may be a truthful position to take but from a motivational frame I would be interested in ‘how interested they might be in finding out more about the position of others’. This is a test of importance, energy and interest.

Further internalise other questions can start to bridge the motivation of others with the motivation of the client. For example I might pose the next two questions:

On a scale of 1 to 100 how important would (name of partner or child) say is ridding this family of abuse?

On the same scale how important do you see ridding this family of abuse?

If there is a difference between what a partner or child might say and what the client might say, this becomes an area of great interest and further exploration. I would be keen to discover what these differences might be about. Also what would it take to align these two positions?

I have found that when we are working with restrained views, then creating conversations that are inclusive of the hope and dreams and motivation of others can help to create dissonance and increase motivation.

I would love to hear what ideas you have for the use of internalised other questions in your practice in creating motivation for change.

Published on Saturday, February 2nd, 2013, under Motivational Interviewing

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