An important tenant of MI is that we do not tell others what to do. Who wants to be told what to do, anyway? Even kids don’t like it. Telling others what to do is often rude and disrespectful.
Let me be very clear, however. If your job as a health care provider is to prescribe medicines and tell patients how/when to take them, of course you do that. In the case where you must explain the possible outcomes of not changing and that’s your job, you must do so. There are certainly other times we must give our patients or client information, which can sound like telling them what to do, and you must do these things as well. .Just don’t use these opportunities as a threat.
An alternative to directing is guiding the patient in the direction of positive change. The idea here is to help the other person come up with their own solution to the problem. The spirit and techniques of MI are designed to do just that.
One way to make suggestions or share information is using “wiggle words”. For example, instead of “here’s what you should do”, you could say:
• Perhaps you could consider….
• Others have found it helpful to ….
• What do you think about….
• One option is…
• Here’s a thought…..what do you think?
These phrases are a step to one side, so to speak, of actually telling the other person what to do. They send the message that the patient has choices, and that the decision about if, when and how to change is theirs alone.
Now, I understand that there are patients and families who expect you to tell them what to do. This can be generational or social and cultural. If that’s the case, by all means go ahead and give your opinion. My suggestion is to be clear that it’s your opinion, and not exactly what the patient should do.
Remember that the guiding style is the one we use most often in Motivational Interviewing.
