How many of you know people who do everything their doctor tells them to, no questions asked, just because “they’re the doctor”? Even in less extreme situations, most interactions in healthcare settings have a flavor of that dynamic where the provider or counselor is the expert and the patient or client is a recipient of their knowledge and instruction.
Motivational Interviewing is effective because it does NOT have that dynamic. In MI, the client is the expert because only they know their life, their behavior, and their motivation for change. But often clients aren’t used to being treated this way, and enter their sessions ready to be told what to do.
But what happens when the counselor DOES have information that he or she feels would be helpful to the client? Information about medication adherence, or ideas about things other clients have tried that might work for this client? There is definitely a place for that sort of information exchange, but MI has a specific technique that helps counselors share this information without turning into the expert, and the client into a passive participant. The technique is called Elicit-Provide-Elicit.
First, the counselor elicits from the client what s/he already knows. This helps identify gaps or errors in the client’s current knowledge but also helps avoid that awful scenario of telling the client something s/he already knows—THAT breaks rapport!
Then, after asking permission, if the client is interested, the counselor provides the information that might be helpful to the client.
And finally, after providing the information, the counselor elicits the client’s reaction to the information. Maybe this is something that the client has tried before. Or maybe the client totally didn’t understand what was said, or maybe there is a major barrier to trying the idea you mentioned.
In simple form:
• “Elicit”: Find out what the client already knows
• “Provide”: Provide additional information as appropriate
• “Elicit”: Ask the client for their reaction
Again, times when this technique may be particularly useful is when:
• You think the client is misinformed
• You think the client lacks information
• You’re thinking of an idea that might be useful to the client
• The client is asking for information
An example of how this information exchange may flow is below:
• Client: I have to take medication every day now…it’s a lot to figure out.
• Counselor: What have you tried before or what do think might work for you? [ELICIT]
• Client: Maybe taking the medicine with a meal
• Counselor: Okay, so maybe taking the medicine with a meal…and I work with a lot of people here in the clinic, would you mind if I shared with you some of their strategies?
• Client: Sure, I am open to hearing any ideas.
• Counselor: What I have heard works for other clients is taking medications: first thing in the morning, before bed, before brushing your teeth, at meal time, using a pill box, using an alarm on a watch, or just anything related to your daily routine. [PROVIDE]
• Counselor: Do you think any of those ideas that worked for other people may work for you? [ELICIT]
• Client: I really think setting an alarm on my watch will work since I always wear my watch….
Using these steps helps make sure that sharing information doesn’t become an irrelevant lecture—it maintains the involvement and rapport with the client while uncovering useful information.
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu