One of the major factors behind a patient’s resistance to change is a lack of motivation, for one reason or another. So, what can we do to help patients get motivated to change? We can use Motivational Interviewing (MI) to help them discover their own motivation!
Ambivalence is natural, but it is difficult to overcome. However, it is not the same as defiance or resistance, so it has to be treated differently. The “but” in the middle of a statement is the tell-tale sign of ambivalence. For example, if a patient says “I’ve tried losing weight before, BUT I just can’t stay on my diet”, you have an ambivalent patient. This is where MI can help.
The four guiding principles of MI are:
(R) Resist the “Righting Reflex” – Don’t be a “fixer”, avoid the natural tendency to correct the patient’s behavior
(U) Understand and explore the client’s motivation – Discover the patient’s values, beliefs, and concerns
(L) Listen – Really listen. Do not listen to respond. Listen to really hear what is going on with the patient and listen for the unspoken information they are providing
(E) Empower the patient – Ask permission! Let them be in control! Remember, it is a 50/50 partnership
Next, use OARS to recognize and elicit “change talk” from your patient, the change agent.
“O” Open-Ended Responses – Make the patient think! No “yes” or “no” questions.
“A” Affirmation – Affirm the patient’s strengths and feelings. Validate them!
“R” Reflection – Use your active listening skills and rephrase what the patient tells you so that they are able to hear what they are saying and see a reflection of themselves.
“S” Summarizing – Summarize the conversation so that everyone is in agreement before the appointment ends.
This is the first step in understanding the patient’s motivators so that you can partner together to set goals!