What is Motivational Interviewing?
The purpose of motivational interviewing is to bring a patient from ambivalence to a desired behavioral change. It is a patient-centric form of counseling. The process is meant to empower patients to be in control of their own health outcomes. Such empowerment often leads patients to explore their own inner conflicts before fully committing to change. It is important medical providers take a step back and allow patients to explore.
Rather than telling the patient what to do, providers should focus more energy on listening. They should listen to understand what motivates the patient. Then the provider should use this information to empower the patient to set his or her own goals. The provider should work less as a Doctor, and more as a teammate. It’s always important to remind patients that you are on their team. However, it is also imperative to let patients take ownership over their own health goals. Meaning you should not be setting your patients goals for them. Rather you should help them set a SMART goal for themselves every week. This will keep them on track and accountable to their desired lifestyle changes. When patients are responsible for setting their own goals, they are more likely to stick to them. Motivational interviewing does a great job empowering patients to take control of their own lives. It cannot be done without patience, understanding, empathy, and influence. The most important motivational interviewing acronym is OARS.
O – Open Questions:
The purpose of these questions is to inspire the patient to share their story. Open ended questions usually lead to the patient speaking a lot. This is a great situation to be in, so practice your listening skills. Examples of open questions include:
How can I help you with ___?
Help me understand ___?
How would you like things to be different?
What are the good things about ___ and what are the less good things about it?
When would you be most likely to___?
What do you think you will lose if you give up ___?
What have you tried before to make a change?
What do you want to do next?
Open questions are the opposite of closed questions. Closed questions usually lead to one-word answers. On the other hand, open questions lead to more impactful sharing.
A – Affirmations:
It is important you reinforce healthy behavior and other positive patient statements and actions with affirmations. They are meant to help build confidence in the patient’s ability to change. Affirmations are only effective when they are genuine. Examples of affirmations include:
I appreciate that you are willing to meet with me today.
You are clearly a very resourceful person.
You handled yourself really well in that situation.
That’s a good suggestion.
If I were in your shoes, I don’t know if I could have managed nearly so well.
I’ve enjoyed talking with you today.
R – Reflective Listening:
The idea is to mirror patient communications back to them. It leads the patient to feel as if their voice matters. Reflective listening also gives the speaker a chance to validate that they were understood. Effective and impactful communication is not possible without reflective listening. Often people call reflective listening to be paraphrasing or rephasing. Whatever you want to call it, it’s super important! Examples of reflective listening include:
So you feel…
It sounds like you…
You’re wondering if…
S – Summaries:
These can be considered a special form of reflective listening. They start with acknowledging that a summery is going to be made. They can look like this:
Let me see if I understand so far…
Here is what I’ve heard. Tell me if I’ve missed anything.
So what you’re saying is…
Summaries are used best when describing change statements. These are patient statements which display a willingness to change. There are 4 common types of change statements:
Problem recognition: “My use has gotten a little out of hand at times.”
Concern: “If I don’t stop, something bad is going to happen.”
Intent to change: “I’m going to do something, I’m just not sure what it is yet.”
Optimism: “I know I can get a handle on this problem.”
However if the patient is expressing ambivalence, as opposed to change statements, its important to include both sides of a viewpoint into a summary. Not just the positive talk about change. This increases the credibility of the summary. Including viewpoints and information from third party sources related to the patient is also another great way to summarize. The key however is to listen, and then be concise and effective with a summary. Finally end your summary with an invitation such as:
Did I miss anything?
If that’s accurate, what other points are there to consider?
Anything you want to add or correct?
The response to these questions often leads to concrete plans resulting in lasting change. Motivational interviewing is a skill which demands tons of empathy. The empathy empowers patience to believe they have a healthcare team mate they can trust. Such said trust is the first step to effective patient interactions and change talk.