When Confidence Meets Social Norms

When Confidence Meets Social Norms: Using Motivational Interviewing to Navigate Clothing Choices with Clients

By: JH - MHP

In community mental health, we often work with clients navigating complex intersections between self-expression, mental illness, and social norms. One of our roles is helping clients build insight into how their behavior might be received by others — without shaming them, challenging their autonomy, or invalidating their experiences.

Recently, I faced a delicate situation before a PACT team BBQ. One of our clients, who lives with schizophrenia, arrived proudly wearing a crop top and shorts. He believed he looked so strong that he needed to show off his body — particularly his stomach, which was visibly protruding. He wasn’t trying to provoke anyone or act inappropriately — in his mind, he genuinely looked great and wanted to celebrate that.

But we also knew the setting: other clients, families, and staff would be present. There was potential for discomfort, and the client might be judged, laughed at, or even quietly avoided. This wasn’t about modesty or enforcing a dress code — it was about helping the client protect his social connections and dignity.

So how do you approach a moment like this?

Enter Motivational Interviewing (MI)

Rather than instructing or correcting, we use MI to explore the client’s perspective, highlight discrepancies, and invite them to reflect on potential consequences — all while preserving their sense of autonomy.

Here’s how I broke it down:

1. Start with Engagement and Affirmation

“Hey, I can see you’re feeling really confident today. That crop top must make you feel strong.”

This is genuine. It builds rapport and tells the client: I see you. I’m not here to take away your pride.

2. Reflect and Ask Open-Ended Questions

“You like how you look in it — like you’ve worked hard for your body.”
“I wonder how others at the BBQ might feel about this outfit?”

You're inviting perspective-taking. The client may not have considered the impact of their appearance beyond themselves — a common issue in psychosis-related disorders. The goal here is curiosity, not confrontation.

3. Elicit Change Talk Through Values

“Would you say it’s important for you to feel respected and taken seriously at events like this?”
“Do you think this outfit helps people see you the way you want to be seen?”

This step explores discrepancy — the heart of MI. We help the client weigh their goal (feeling strong, respected) against how others may actually perceive them.

4. Support Autonomy, Offer Options

“Totally your call, of course — I just want you to feel confident and respected. Some folks bring a light shirt or hoodie they can throw on just in case. Would you be open to that?”

The client is still in control. You're not telling them what to do — you're inviting collaboration.

Why This Matters

Therapists in the field — especially on outreach teams — are often the bridge between the client and the world. We walk the tightrope of protecting a client’s right to self-expression while also protecting their social inclusion and mental well-being.

Clothing choices can be an expression of autonomy, self-image, or even delusional beliefs. Rather than policing those choices, MI helps us:

  • Respect the client’s internal logic.

  • Support informed decisions.

  • Avoid unnecessary conflict or shame.

  • Build trust for future conversations.

Final Thought

These moments aren’t just about outfits — they’re about empowerment. When clients feel heard and respected, they’re more likely to reflect, grow, and eventually make choices that serve both their individuality and their social functioning.

In the end, that’s what recovery-oriented care is all about.

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