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Direct, Follow, or Guide?

David Mee-Lee, M.D., is a leading expert in co-occurring substance use and mental disorders. His monthly “Tips and Topics,” is now in its tenth year of publication on his website,, exploring subjects and solutions drawn from over 30 years of experience in person-centered treatment and program development. This month's topic addressed a motivational interviewing skill called Guiding. He pointed out that in we often feel that we are faced with the dilemma of simply directing or following a client as they discuss their substance use. According to Dr. Mee-Lee,

"Directing” is easy to do, as it involves just telling people what to do to change regardless of whether they are ready to do that. You have taken little time to listen to what goals and methods are important to them.

“Following” is also easy to do, as it involves just reflecting back what you hear they are saying. This can be frustrating to the client if every interaction is a question and summarizing without moving forward to get some sense of direction of what to do next.

“Guiding” is the art of using both Directing and Following to ask enough questions to clarify what goals and methods are important to the client, but then building on that knowledge to collaborate and Guide the person in a facilitated self-change process." For example:

Clinician: So I understand you want help to stop drinking. (Following)

Client: Yes, I’ve been trying to do that on my own for six months and am not getting anywhere.

Clinician: What have you tried that hasn’t been working? (Following)

Client: Well I went to some of those AA meetings, but I’m not as bad as those people.

Clinician: How many meetings did you go to? (Following)

Client: Two or three, but I didn’t get anything out of it except for one person I spoke to who seemed to really understand me.

Clinician: Did you get that person’s name and number? (Following)

Client: Yes, but I haven’t had any more contact.

Clinician: Would it be OK with you if I gave a suggestion? (Seeking permission to be Directive)

Client: Sure, go ahead.

Clinician: How would you feel about calling that person and seeing if they would go to a different meeting, because sometimes certain meetings fit certain people better? (Directing)

Client: I guess I could do that.

Clinician: You sound a bit unsure if you want to do that (Following). Do you need to think about it a bit more; or would you like to give it a try, at least one or two times? (Guiding)

As you can see, this approach has the advantage of demonstrating that we are listening to the client and helping to find an answer by getting permission to gently direct towards a solution. This collaborative style not only empowers clients but also engages them to be active participants in their own treatment.

Taken from Dr.Mee-Lee’s Tips and Topics July 30, 2013

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