What’s Your Motivational Interviewing Communication Style?

Tuesday, May 6th, 2014
This post was written by Patricia Donovan

MI is increasingly favored by case managers and health coaches to elicit behavior change.

There are three distinct communication styles in motivational interviewing (MI), a directive, client-centered counseling style designed to invite or elicit behavior change specifically by helping individuals to explore and to resolve ambivalence toward specific behavior change. Today, motivational interviewing is favored not only by health coaches but also by case managers and physicians. Here, the three styles are defined by Dr. Karen Lawson, MD, program director for the health coaching track at the Center for Spirituality and Healing, University of Minnesota.

Directing, which is familiar to any of us who come from a conventional, medical or therapeutic background, is about getting specific information, making informed recommendations — basically telling someone what their next step should be and what they should do. There is an important place and role for that in healthcare, and it should by no means be eliminated.

From a coaching standpoint however, when someone is truly wearing the hat of coach, I do not believe for the most part that directing should play a significant part in what they’re doing. There may be a moment or two in time where delivering concrete information that they happen to have that could be of use to a client, may be appropriate, but that should be a very small percentage of the time that’s spent in a health coaching session.

Looking at the second style, the opposite of directing is following, where you truly are with no agenda, structure, or input, openly listening and following where the client wants to go. There’s definitely a role for that in coaching; however, coaching should be 100 percent following.

The place in the middle is guiding. Health coaching done from this perspective with an MI framework is a guiding relationship.

For example, a teenager who has diabetes may have many complex situations going on. They’re often very resistant, and trying to find a way to both manage their adolescence and their diabetes at the same time. It’s very common for the physician, in a directive way, to say, “How many times are you taking your insulin? How often are you checking your blood sugar? What are your numbers running? This is what you should do to fix the situation.”

By comparison, a coach working with a client like that might be able to say, “How do you feel that you are doing with your sugar management? What do you feel you might be able to do if you would like to take that blood sugar management up to a better level? Would you like to do that, and if so, how would you do that?”

There’s still some guiding in there that occurs. It’s not only listening generically; guiding does occur, but it’s cognizant of not delivering clear, dictated instructions.

Excerpted from Health Coaching for Behavior Change: Motivational Interviewing Methods and Practice.

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