“You know that I don’t believe that anyone has ever taught anything to anyone. The only thing that I know is that anyone who wants to learn will learn. And maybe a teacher is a facilitator, a person who puts things down and shows people how exciting and wonderful it is” ― Carl R. Rogers
The concept of “educating” our clients comes up frequently in my MI workshops. I often begin by asking, “How do you go about working with your clients/patients to effect change?” The answer is often “I educate the patient…..” I get that’s what my colleagues think, because that’s how I was trained, too. My job, I was taught, is to teach the diet and if you do that with enough enthusiasm, people will of course do what you tell them to do. As I’ve said many times in workshops, that almost never worked. The concept of “educating” is just so condescending! It’s the “I’ve got the answers and I’ll fix you right up. Just do what I say”.
My experience is that no one wants to be told what to do. Not even little kids. We need to find a different, better way to work with our clients, and MI has just the thing. We work as a guide, helping people find their own answers to the problem. Here’s a scenario in which the client is being told what to do.
Clinician: Well, the best thing for you to do is to quit smoking now. Your cough will improve, and so will your overall health. (Advice without permission) You’ll have more energy and better breathing. Let me tell you how to do it… (Providing a plan without the patient’s permission)
Patient: I know, I’ve heard all those things about the advantages of quitting. It’s just so hard! I’ve tried lots of different ways, and something always gets in my way. I just start smoking again.
Clinician: Well, you’ve just got to DO it, now’s the time to quit! Just pull yourself together and focus on quitting.
How would you feel if you were that patient? Not too great, I’ll bet. Here’s an alternative scenario, one without the “education” of the patient:
Clinician: I understand you’re concerned about your cough and your future health. I’m guessing you know that your smoking is probably related to those things. What do you already know about the benefits of quitting?
Patient: I get that the cough would improve (Change Talk), but there’s just so much of my life wrapped up in smoking. My friends all smoke and we have a few beers together and smoke. Besides I’ve heard that quitting is awful. (Sustain Talk)
Clinician: Even though you know that quitting might improve the cough, it’s hard for you to picture your life without smoking (Double sided reflection). Also you’re worried about what quitting might be like. (Simple reflection)
Patient: Well, I’ve heard horror stories about the trouble people have when they try to quit. And besides, I really like to smoke (Sustain Talk). Still, I HATE this cough! (Change Talk)
Clinician: Sounds like the cough is really getting to you! I’ve got a couple of ideas about how you might go about quitting, and getting some support while you do it. Would you like to hear them? (Asking permission before giving advice)
I hope you can see the differences between the two conversations. In the first case, the clinician is in the “expert trap”, being very condescending. I the second, there’s more of a collaborative spirit. That’s what we are looking for in our conversations with clients, that collaborative spirit.
