The Three Styles
Gary Rose, Ph.D.

Health education is a sophisticated form of interpersonal communication and when we are engaging in this endeavor, we usually adopt one of three communication styles: Instruct, Guide, or Listen.
The three styles are defined as follows:
1. Instruct: Give information or advice. Other activities associated with this style include directing, informing, leading, educating, telling and using one’s expertise. These are used when there is specific information that one wants to provide, hopefully which the person wants to receive.
2. Listen: Understand the person’s experience. Other activities used include gathering information, following, eliciting, attending and empathizing. These are used when one wishes to understand how the person feels or what has happened to them.
3. Guide: Encourage person to set his/her own goals and find ways of achieving them. Other activities associated with this style include coaching, negotiating, mobilizing and motivating. These are used when the person is facing change, having to make decisions and to act upon them.
The guiding style is best understood as a style of communication that integrates elements of both instruction and listening, but differs fundamentally from these other two styles. Critical to effective guiding are activities such as collaboration, empowerment, affirmation and the entertaining of alternatives.
The following observations are worthy of note:

1. No one style is better or more patient-centered than another. Which one to use depends on the circumstances.
2. Each style can be used with more or less skill. For example, a few, carefully chosen, well-matched words of instruction can sometimes make all the difference, while its opposite is not difficult to imagine. So it is with both listening and guiding.
3. A mismatch between the style and problem at hand is conceivable, for example, if we were to instruct a child that has burst into tears.
4. Over-reliance on one style might prove unfruitful. For example, it might be of value to listen to a child who refuses to get out of the bath, but perhaps not for hours while the child and the water get cold!
5. Flexible shifting between styles is probably the norm in most helpful consultations.

Motivational interviewing is best understood as a refined, evidence-based example of the guiding style, which makes use of both listening and instruction, in the service of supporting the individual’s resolution of the dilemmas of why and how shall I change.