The Motivation To Change
Dr Anna Baker, Health Psychologist and Cognitive Behavioral Therapist shares how Motivational Interviewing can be used to help elicit behavior change in patients.
Motivational Interviewing (MI) is based on the premise that the motivation to change should not be imposed from outside, but elicited from within the individual. Rather than a form of therapy, it is a series of principles, backed by techniques, which can be used by Healthcare Professionals (HCPs) to support patients to explore their unhelpful beliefs about medication and work towards better adherence.
A closer look at MI
Motivational interviewing requires that the HCP work with the principles of expressing empathy, supporting self-efficacy, rolling with resistance and developing discrepancy. These are about seeing the issues from the patient’s perspective and allowing them to identify the barriers and ways to overcome these to enable change. For example it allows the patient to highlight or identify ways of moving towards a goal, rather than the HCP trying to provide the immediate solution.
It also requires using patient-centered communication techniques such as asking open-ended questions; using affirmations to acknowledge use of positive change talk from the patient and to encourage the patient to engage in constructive dialogue and explore their own thinking. In addition, MI involves being able to listen in detail to what the patient is saying and to identify the key points. Finally, it uses reflective listening to offer back to the patient what they have said to the HCP. This shows that not only they are heard, but also that they are understood.
How would a typical MI session take place?
MI sessions can take any form – face-to-face, online or by phone, in small groups – as long as there is open communication whereby patients can break down their personal barriers to change by developing their own solutions. The focus here is in creating a stronger and more productive relationship between the HCP and patient. It is about enabling the patient to take responsibility for their own issues and to collaboratively work through solutions.
And why does it work?
MI allows the HCP to view the therapeutic relationship as more of a partnership, less structured hierarchy. This allows for a more equal balance within a patients' relationship with their HCP. These principals and techniques can be used to help patients to take ownership of their disease and make effective decisions to manage it.
When is MI the most effective?
MI is particularly useful for new patients or those changing medication, as it is effective when helping patients to identify the pros and cons of changing treatment compared to staying with usual care.
MI in practice
As an example, in patients living with Diabetes, MI could be used to help support their motivation to change to a different form of treatment. A patient who has previously managed their illness through oral medication and diet may have concerns about changing to injections even though they may know it is the right thing to do.
While acknowledging the benefits to their physical health, they may have relevant concerns about its impact on their day to day living and personal relationships. By using MI techniques a HCP could support them to make the decision to change their behavior as well as helping inform strategies to implement goals for change. The techniques could also be used to develop a personal self-management program that builds confidence and ultimately supports better adherence.
This is a valuable approach to enhancing the HCP/patient relationship as well as a patient’s motivation to change their behavior. It can be effectively used to support patient’s developing strategies for better adherence and self-management. However, appropriate training and follow-up of HCPs is needed to ensure proper implementation of the approach, in order to get the best outcomes for both parties.