Understanding Sustain Talk
Sustain talk, characterized by a patient’s reluctance or inability to change, includes several key aspects:
- Expressions of a desire to maintain the current state.
- Lack of confidence in the ability to change.
- Perceived benefits of not changing and the costs associated with change.
- A lack of urgency to address issues.
Macy’s Resistance to Change
Macy’s interactions provide a clear example of sustain talk, particularly in her relationship with her mother. She doubted her ability to effect change in this relationship, feeling that efforts would be one-sided and ultimately futile.
Implementing Strategies to Address Sustain Talk
Envisioning Change
The therapist attempted to encourage Macy to envision a positive change in her relationship with her mother. However, Macy’s response, “I can’t,” highlighted the dominance of sustain talk in her mindset.
Motivational Interviewing Techniques
Reflective Techniques
- Simple reflection: Recognizing and validating the patient’s feelings, e.g., “It’s hard for you to imagine.”
- Amplified reflection: Exaggerating the patient’s sustain talk to provoke reconsideration, e.g., “There’s no way you can imagine feeling anything different.”
Running Head Start
This approach involves listing out potential excuses or reasons for the sustain talk, thus bringing these issues to the forefront. It’s a method of acknowledging the patient’s perceived challenges in a comprehensive manner.
For example, “You feel blamed already, and like one more thing to do, and it seems pointless if your mom won’t change anyway.” Simply naming their frustrations can soften sustain talk by validating the underlying emotions.
Combining Reflections with Other Strategies
The therapist employed a combination of simple and complex reflections along with strategies like “Running Head Start”. This approach aimed to acknowledge Macy’s feelings of unilateral effort in her relationship and the implications of making changes.
Complex Reflections
These deeper reflections aim to interpret and uncover the underlying meanings in the patient’s statements, offering insights beyond the surface level of the conversation.