As clinicians, we are usually thinking about how to have the most effective conversations with our clients. And even with putting our best effort and best intentions forward, sometimes these conversations can be messy. One thing we know about MI is that there is not one formula that works for every client and that MI supports each clinician in bringing his/her own strengths and gifts to the session. And along with genuinely collaborating with our client, we know that there are a variety of communication styles that often are effective in having this conversation about change.
For example, if we were to think about a continuum of styles related to conversations about change, we would likely see on one end, a directing style, or a way of communication where the clinician is telling or giving advice to the client on what to do or how to move forward. A directing style, at times, may be helpful for someone who is attempting to adhere to a particular medication regime, or in following through on probation requirements.
At the other end of this continuum is a style of following. In MI, there is much focus on listening, asking open-ended question, and using person-centered counseling skills. And it can be easy to resist offering additional material into the session and wanting the client to trust their own intuition and wisdom. There are obviously times when a following style is the right way to engage with a client. For example, if a client comes to a session dealing with something very intense to them, or in the case of someone who may be very ill and simply listening may be the best way to be with this person.
And in the middle, there is a guiding style, and this is where MI can be so effective in the conversation about change. It is like being a facilitator or a skillful guide, where one is a good listener and offers expertise at the appropriate times. This is similar to when a child is learning a new task and we want to offer just the right amount of information and help without doing the task for them.
Below is a sample of verbs offered by Miller and Rollnick associated with the three communication styles, which occur in our everyday lives and in conversations about change:
| Directing style | Guiding style | Following style |
| Administer | Accompany | Allow |
| Conduct | Assist | Listen |
| Manage | Collaborate | Observe |
| Prescribe | Encourage | Permit |
| Steer | Support | Stay with |
| Take charge | Take along | Take in |
Again, the overall style of MI is guiding, but elements of a directing and following style may also be included when appropriate. And since MI is a conversation about change, we are attempting to find a supportive way through the many challenges that can occur when a helping professional attempts to come into a person’s process around wanting to make a change. The intention of MI is to collaborate with the client so they are able to talk themselves into the change they want and that the change is consistent with their own values and goals. And as we know, people are most influenced by what they hear themselves say and not by what someone else says.
Directing ↔ Guiding ↔ Following
Next month, we will continue exploring conversations about change and the “righting reflex.” In addition, we will also include ambivalence, where the client experiences reasons to change and reasons not to change. Have a great month and keep learning and practicing!
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.