When we provide advice to our clients, we make sure it is based on solid scientific evidence. What about how we deliver the advice? Is there evidence that can direct us here? Indeed, careful Motivational Interviewing research on specific wording does tell us what works and what doesn’t. In other Tips, I have outlined ways to format our advice (#59). Briefly, this means first eliciting what the client already knows about the topic and what is needed right now, then providing the information in a neutral manner and asking for a response. Here we look in more detail at the language we use when actually providing the advice, the “provide” portion of Elicit/Provide/Elicit.
A mind is like a parachute…
it only works when it is open.
Frank Zappa
People don’t Resist.
They Exist in the only way they know how.
Paul Dell
In MI research, sessions are coded to show the moments when clients react to the counselor with arguments and statements of not being willing to change as compared with the moments when clients voice change talk (Tip #69). Here is what has emerged from the research:
Small pieces of information are taken in better than large parcels. A useful metaphor here is an eye dropper rather than a shovel. When we provide just a bit and then ask for a response, the client is able to “digest” the information and to ask for clarification if needed. This also allows us to pause and check in to see whether the client has had enough or wants more.
Information that is provided when the client is not ready will rarely be remembered. More important, this will likely bring up an argument from the client. Any momentum toward change will be lost. So asking permission first works wonders. This could be: “I have some information about that. Might I share it now?” In some situations we feel we have been granted permission because the client asks a question. It is still useful to ask what the client knows already and to use your eye dropper.
Information given in a neutral manner without persuasion is least likely to evoke resistance in the client. Persuasion feels like a debate, making points or even shaming. Our arguments may begin with “But you know…” or “But the research shows…” or “You really should…” We can often sense the argument building. Continuing to add information or make points will just elicit more arguments for not changing from the client.
How to tweak wording from persuasion to neutral? Here are examples:
| Persuasion that will bring up arguments to not change | Neutral information that will evoke thought |
| “Breast-feeding is the best way to feed your baby.” “It’s really not that hard to do. I know you can do it.” |
“Breast milk contains exactly what babies need.” “Most moms find breast-feeding convenient.” “Moms who stay in touch with our breast-feeding counselors get comfortable with it pretty fast.” |
| “That’s too much carbohydrate for one meal.” “You have to limit your carbs to 3 or fewer at each meal.” | “This (food model or chart) is the amount of carbohydrate that your body can handle easily at one time.” “When more than this amount of starch is eaten at a meal, blood sugar goes above normal for several hours.” |
| “Why don’t you add a small snack in the afternoon so you aren’t starving when you get home?” | “A bit of food that contains some protein a couple of hours before leaving work allows a normal appetite at dinnertime.” |
Each of these examples of neutral language can be followed with an eliciting question such as, “How does that sound?” or “What are your thoughts?” Research shows that this manner of providing advice is least apt to evoke a negative reaction and most apt to encourage some movement toward change.
The key elements in all effective advice-giving are collaboration and autonomy. When the advice is given in a collaborative relationship with an acceptance of the autonomy of the client, the counselor has done what she can to encourage valuable use of the advice. There are more examples of wording that supports autonomy in Tip #131.