Reflections are probably the most fundamental skill to learn if you are using a client-centered counseling approach. However, there are many other MI skills that complement reflections and are used throughout the 4 processes of MI. And the one we are focusing on today is not only used throughout all 4 processes, but is particularly important in the engagement process with the client. The skill is asking open questions. These questions invite the client to think before responding and offers a great deal of flexibility in how to answer. In addition, an open question seeks information, invites the client鈥檚 perspective, encourages self-exploration, and allows for the 鈥渙ption of surprise鈥� for the clinician.
Miller and Rollnick talk about a rhythm that occurs when a clinician is asking open questions. They refer to it as a dance, in particular, a waltz, where open questions are generally followed by a couple of reflections. A few examples they share include:
What brings you here today?
How has this problem affected your day-to-day life?
How do you hope your life might be different 5 years from now?
Where do you think this path that you鈥檙e on is leading you?
What would you say are the five things that you most value in life?
How do you hope I might be able to help you?
Again, you can see the wide range of answers you could receive and where you may be able to probe deeper into an issue and gather more details about a person鈥檚 experiences, knowledge, beliefs, and feelings. Open questions are especially valuable when building rapport and in maintaining session flow. At the same time, there are times when closed ended questions are appropriate when you may want to assess behavior and establish facts. A few closed ended questions offered by Miller and Rollnick include:
How long have you been feeling this way?
Do you smoke?
Do you think you can do this?
Who lives with you?
When did you have your last drink?
Where did this happen?
Determining whether to ask an open question or a closed question varies on the situation, but in MI, you will be asking many more open questions. Again, open questions encourages conversation on a particular topic, and when you follow these questions with a reflection, you invite the client to explore the topic even further and with more depth. The key is to remember to try and offer a couple of reflections for each open question and how important it is to use open questions when initially engaging with a client. Next month, we will continue with another of the core communication skills: affirmations. I hope you all have a great month and have opportunities to use and practice Motivational Interviewing!
For more information about Motivational Interviewing or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.