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Motivational Interviewing Offers 3 Different Communication Styles

A skillful practitioner can shift flexibly among the three different communication styles: directing, following and guiding, as appropriate to the client and situation, explains Dr. Karen Lawson, program director for the health coaching track at the Center for Spirituality and Healing, University of Minnesota.

Within motivational interviewing (MI) there are three different communication styles. 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.

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 they may be 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.


Source: Health Coaching for Behavior Change: Motivational Interviewing Methods and Practice, April 2009

Related stories:

Motivational Interviewing Helps Patients to Say ‘Yes’ to Behavior Change

Care Transitions and the Continuum of Care

Health Coaching for Behavior Change: Motivational Interviewing Methods and Practice

In this 35-page report, a physician and a health psychologist from the field of integrative medicine affirm how training in motivational interviewing, self-management and even spirituality and healing can enrich the health coaching encounter.

Health Coaching for Behavior Change: Motivational Interviewing Methods and Practice is available from the Healthcare Intelligence Network for $117 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.

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IMPORTANT NOTICE: This information is designed to provide accurate and authoritative information on the business of healthcare. It is distributed with the understanding that Healthcare Intelligence Network is not engaged in rendering legal advice. If legal advice is required, the services of a competent professional should be retained.

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