Using Motivational Interviewing to Promote Patient Behavior Change and Enhance Health by Belinda Borrelli, PhD, MA. Medscape. Release Date: July 28, 2006.
Motivational Interviewing is a technique specifically designed to work with a patient’s issues regarding behavior change. Essential components of Motivational Interviewing include
- A mutual understanding between patient and clinician that the focus is on understanding the patient’s concerns rather than coercing the patient to change
- Enabling the patient to make an informed decision about changing
- A nonjudgmental stance on the part of the clinician that emphasizes listening and questioning rather than instructing or problem-solving
- A focus on the patient that requires gathering information about the patient’s issues prior to an exposure to the clinician’s views
A primary benefit derived from the insistence on an interviewing model is that, by definition, it fits the patient’s current position vis-à-vis behavioral changes. The Transtheoretical School holds that patients may be anywhere on a spectrum from not considering changing to be ambivalent about the change to ready to change. (See Current Models Of Compliance) It seems intuitively apparent that varying ones approach to patients, based on their position on this spectrum, could be effective.
The bulk of this article covers specific tactics of Motivational Interviewing , including
- Using OARS (open-ended questions; affirmations; reflective listening; summaries)
- Managing patient resistance
- Enhancing motivation to change
References supporting the effectiveness of Motivational Interviewing are listed but not explicated.
A brief section acknowledges the inherent problems of instituting any new element into a primary care practice, especially one such as Motivational Interviewing that requires specific training.
Commentary
While I’m a proponent of Motivational Interviewing, I admit to experiencing a degree of cognitive dissonance when considering the claim that it espouses a nonjudgmental point of view. It seems to me that motivational is closer to persuasive than to nonjudgmental, and it seems apparent that the goal is to promote specific behavioral changes that the clinician has determined are appropriate. It seems, in short, a clinician using Motivational Interviewing is about as nonjudgmental about the outcome as a car salesman is unbiased about his customer buying a car – i.e., the salesman is unbiased about which Ford the customer buys as long as he buys a Ford from him. Medically, a genuinely nonjudgmental stance would require making it explicit to the patient that an available – and acceptable option – is for the patient to reject the recommended treatment plan.
Other than that incongruity, which is inherent to the philosophy of Motivational Interviewing, this is a well done, carefully written introduction to Motivational Interviewing, which may, ironically, mitigate its persuasiveness. My nonscientific take on the piece is that, were I a busy primary care physician without prior knowledge of Motivational Interviewing,
- I doubt that I would succumb to the temptation of reading an article entitled “Using Motivational Interviewing to Promote Patient Behavior Change and Enhance Health”
- If I were to read it, the apparent cost/benefit ratio of introducing Motivational Interviewing into a practice would discourage me from investing my own time to learn the techniques, let alone take on the Herculean task of convincing colleagues and staff to integrate them into the practice.
I’m not suggesting that the article should have been sensationalized. I do believe those promoting Motivational Interviewing, which does seem to hold significant potential in enhancing compliance, would do well to make use of some of its own tenets, specifically the idea of finding out how a particular clinician feels about making such a change before providing instructions. And, until the benefits of Motivational Interviewing are more widely known, information about tactics should be paired with more extensive evidence of its effectiveness.
The bottom line, however, is the point I find myself repeating in many such circumstances:
Even if a clinician were convinced that Motivational Interviewing was effective, he or she would have to sustain the cost, in time, money, and hassles) of introducing this technique to the practice with no other incentive than the sense that “it’s the right thing to do.”
Surely, we can do better than that.
CME Information:
Valid for credit through July 28, 2007.
Credits Available: Physicians – maximum of 1.0 AMA PRA Category 1 Credit
Credits Available: Nurses – 1.2 nursing contact hours (None in the area of pharmacology)