Your patient says they're stopping the medication that's kept them stable. You remember your motivational interviewing training and decide to ask a question instead of giving another lecture:
"Don't you think staying on it would be better than risking another episode?"
Probably not your finest therapeutic moment.
It's shaped like a question, but the answer is built in. Any attorney in the room would already be on their feet.
A leading question tells the patient which answer we're hoping for. Instead of exploring their decision, the patient may find themselves defending it against yours.
That matters in MI for a specific reason: people tend to be moved by the reasons they hear themselves give. If the conversation becomes the patient explaining why they're right to stop, those are the reasons getting rehearsed.
It's also an easy habit to fall into, because it feels like MI. We asked instead of told. The format changed. The intent didn't.
Say so. MI doesn't ask us to pretend a real clinical risk isn't there.
Ask if you can share a concern, say it plainly, then ask what they make of it:
"Would it be okay if I told you what worries me about stopping?"
And after you've said it:
"What do you make of that?"
Naming the risk isn't the problem. Hiding it inside a question is.
"What's leading you toward stopping it?"
Then listen. Side effects, doubt that it ever helped, and fear of something else entirely are three different conversations, and what you say next should depend on which one you're in.
If it's weight gain, there may be options worth discussing together. If they're not convinced it ever helped, that's worth exploring before debating it. And if something else is driving the decision, you'd never have found it by asking whether they agree with you.
Knowing what a leading question is and catching yourself mid-sentence are two different skills.
Full members can practice this exact conversation in the Clinical Simulation Lab, linked from Psychotherapy Studio: a simulated patient, stable on aripiprazole after two hospitalizations, who has gained 28 pounds and already decided to stop. You read the chart, respond in your own words, and the patient responds to how you approached it. Afterward you get feedback on each turn, including where a question was really persuasion.
Practice motivational interviewing
What's your version of the leading question? The one you hear yourself say and immediately wish you'd phrased differently?