Motivational Interviewing with Patients
One of the biggest challenges that pharmacy professionals face is helping people change longstanding behaviours that pose significant health risks. When patients receive compelling advice to adopt a healthier lifestyle by cutting back or stopping harmful behaviours (eg. smoking, overeating, heavy drinking) or adopting healthy or safe behaviours (eg. taking medication as prescribed, eating more fruit and vegetables), it can be frustrating and bewildering when this advice is ignored or contested.
A natural response for a practitioner who encounters such opposition (termed ‘resistance’ in the psychological literature) is to reiterate health advice with greater authority or to adopt a more coercive style in order to educate the patient about the imminent health risks if they don’t change. When these strategies don’t succeed, the practitioner may characterise the patient as ‘unmotivated’ or ‘lacking insight’. However, research around behaviour change shows that motivation is a dynamic state that can be influenced, and that it fluctuates in response to a practitioner’s style. Importantly, an authoritative or paternalistic therapeutic style may in fact deter change by increasing resistance.
Motivational interviewing is a counselling technique that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy; and Empower the patient.
Data from meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in other areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management.
There are barriers to implementing MI in general practice; these include time pressures, the professional development required in order to master MI, difficulty in adopting the spirit of MI when practitioners embody an expert role, patients’ overwhelming desire for ‘quick fix’ options to health issues and the brevity of consultation times. These barriers to implementing MI in primary care represent significant cons on a decisional balance. On the other hand, the pros for adopting an MI approach with patients who are resistant to change are compelling. While I am not advocating MI for all patient interactions in general practice, I invite you to explore your own ambivalence toward adopting MI within your practice, and consider whether you are ‘willing, ready and able’. Practitioners who undertake MI training will have an additional therapeutic tool to draw upon when encountering patient resistance to change and a proven method for dealing with a number of common presentations within general practice.
You can learn more about how to do motivational interviewing by watching the video Introduction to Motivational Interviewing by the psychologist Bill Matulich. The video is available on the MORPh educational platform under Chronic Pain.
Remember:
“Think about how difficult it is to change yourself, and you will realize how insignificant are your chances to change others” Voltaire
Blog created by: Sally F Lau FFRPS, FHEA, MPhil, MRPharmS
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