Motivational Interviewing (MI) – two styles of communication with a client struggling with alcohol use

Rick has been convicted of drink driving and has lost his licence for four months. Because Rick’s job involves driving to see clients his employer has stipulated he must seek counselling for his drinking behaviour. Rick arrives for his first session with his caseworker. The brief examples below show the traditional approach by a caseworker (CW) and a more Motivational Interviewing focused approach. Note some of the clear and the more subtle differences between the two approaches.

                      Traditional Communication            Motivational Interviewing Communication

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Miller and Rollnick (2013) explain that helping conversations with clients lie along a continuum. The style used by the helper can be understood as directive at one end of the continuum and following at the other end. In the middle of the continuum lies the style known as guiding.

A directive style provides the client with advice, information and instruction. It has a place, for example, in explaining a medication regime or post-operative care requirements.

A following style also has a place in the helping style continuum. Sometimes clients just need to be heard, or to ‘get things off their chest’, and they may sometimes be best helped by just listening as they find their own path.

A guiding style can be explained by drawing on the analogy of hiring a local guide when visiting a foreign country (Miller and Rollnick, 2013). The best guides don’t just tell you what to do or follow you as you wander about. Instead they listen carefully to what you want to do and see, and offer their expertise if and when it is asked for. Guiding includes some use of the directive and following styles but focuses on collaborating with the client in a way that strengthens their motivation to change.

Look back again now at the examples above of traditional and Motivational Interviewing communication. What style of communication is reflected in each interaction? What do you think would make each interaction more or less helpful to Rick as he grapples with his drinking and desire to keep his job?

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Miller, W. R. & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). New York: Guilford Press.