I’ve been an MI trainer for 8 years. When I first began learning the techniques of MI as a clinician, and then learned to run my own trainings, I thought I knew all I needed to know about MI I’ve since learned that something new comes up in almost every MI training that I conduct. Participants ask questions and make interesting comments that I’ve never considered. I find it very exciting that there’s always something new to learn!
One example is the importance of the clinician’s choice of language. Words mean different things to different people in different contexts. In MI, the use and understanding of language is a key element of the process and technique. MI practitioners develop a keen sense of the meanings of words and the inflection with which they are stated.
When we ask a questions the voice goes up at the end of the sentence to indicate that it’s a question:
“You think there’s nothing you can do to improve your health?”
When we make a statement, the voice drops at the end of the sentence.
“You think there’s nothing you can do to improve your health.”
The same words stated with a different inflection can have different meaning. A simple difference, but a big change.
I learned about another such distinction this week as I conducted a training for the patient education liaison staff of Genzyme, Inc. Their job is to help patients with rare metabolic disorders to get into preventative treatment using Genzyme products which are given by infusion. Patients often are resistant to such treatment because of the inconvenience and because it is necessary for a lifetime to prevent serious physical complications from these disorders.
We were discussing the use of “transitional summaries” in MI. Such language is used when the patient begins to express a desire to make a plan of action for change. The clinician makes a summary of what the patient has said, and asks a key question to move the conversation forward into planning. A commonly used key question is “Where do we go from here?” A participant asked why it’s not stated “Where do you want to go from here?” She said it is, after all, the patient’s plan, and the clinician should be emphasizing the patient’s ownership of the plan.
I’ve been using this example in trainings for years, but will now change my choice of words and use this as an example of how a small change can make a big difference in meaning.
