While Motivational Interviewing (MI) has a highly technical component, it is also described as a way of being with someone. This means you can begin using MI with patients very early in the learning process. Here are a few ways to get started. Subscribe, or return soon for more comprehensive training and check the blog for examples of MI in action.
1. Embody the Spirit of MI
Our MI technical skills take time to learn and practice. You can demonstrate the MI spirit immediately. Implementation of these values has been shown to improve the quality of patient-centered care, and is the generally first stage of learning MI. When healthcare providers demonstrate these values genuinely and consistently, patients respond very well.
Remember to PACE yourself:
P – Partnership
A – Acceptance
C – Compassion
E – Empowerment
Patient-centered care is a hot topic for good reason and PACE can help you implement this model. When we partner with patients, they are more likely to implement their plan of care. When patients feel accepted, and when we acknowledge patients have the autonomy to follow our recommendations or not, we work together more effectively. Compassionate care has been rated by patients and physicians as both highly important and sadly lacking. Now, more than ever, healthcare workers need ways to express compassion without contributing to burnout and compassion fatigue (MI provides these tools). Empowering patients calls on their existing strengths and removes the onus of persuasion from your plate.
2. Practice empathy
Motivational Interviewing without empathy is manipulation. We do ourselves and our patients a tremendous service by seeking to understand their perspectives. We must remember that a routine day for us may not be routine or comfortable for our patients.
The practice of healthcare can absorb all our attention if we allow it, relegating the patient experience to an afterthought. Instead, let us maintain our spirit of curiosity and good assumptions. When conflict or miscommunication arises, use this perspective to find a beneficent root cause. Ask yourself: Could that patient’s angry attitude be rooted in fear? Could this patient’s “non-compliance” be rooted in something other than laziness or lack of caring?
Take it a step further: try to understand how you could come to the same conclusions, beliefs, and attitudes.
What would it take for me to feel safe in a strange environment?
What past experiences could make me prone to fear or anger in this setting?
When do I tend to trust myself more than ‘experts’?
We do not need to diagnose our patients’ inner state, only be open to possibilities. Be curious, seek understanding, and respect differences of perspective. We don’t have to agree with our patient’s perspective to provide them excellent care.
3. Tune your ears to change talk*
Change talk is any patient speech in the direction change. To be classified as change talk, their words do not need sincere intent or movement. Consideration and exploration, even in the hypothetical tense, counts as change talk. We can only capitalize on this language if we recognize it.
Pay attention to people (in real life and in media) as they make decisions, whether trivial or serious. In situations where a preferable outcome is clear, what language is used to favor that direction?
What reasons do they express for pursuing the change? What needs will it fulfill? Do they verbalize ability to complete the tasks associated with this change? Have they tried to make the change before, or attempted a preparatory step? What words of intention or commitment to this change do they use? This is all change talk.
When patients express change talk, Motivational Interviewing gives us tools to nurture it. With practice, we can guide patients through talking themselves into a change they wanted to make, but needed support to complete.
Coming soon here, you can observe MI-consistent conversations. In Motivational Interviewing we use an acronym to capture common indicator words: DARN CATS. Listen to the client/patient for these characteristic phrases. In my upcoming trainings, I’ll go into depth on this topic and we’ll practice tuning our ears to change.
*Change talk is the term used in MI, but it doesn’t have to be verbal. The term “talk” here includes written words or sign language, any form of interpersonal communication exchange.
4. Listen. Sit on your hands if you must
You are a helper. There may be a dozen reasons you chose your profession, but somewhere under the long hours and years of schooling is a desire to help. You’re also an expert in your field. With all your experience, sometimes you may begin to feel clairvoyant. A patient arrives with a problem, you see exactly what went wrong and you foresee a happy healthy future if they’ll just do as you ask. Unfortunately, this doesn’t always happen. Have you ever noticed how your expert help sometimes isn’t received as you expect?
Why can’t people just do what I tell them to do!
People push back when they feel the heavy hand of persuasion. Imagine a problem you’re trying to solve, wherein you have a few ideas. Now imagine your nosiest neighbors and family members standing around you shouting suggestions. They didn’t bother to ask what ideas you have, or what you’ve already tried. They just tell you what to do, loudly and insistently.
That is what patients experience when we do not partner with them nor empower them to draw from their own knowledge and strengths.
I promise Motivational Interviewing includes advice giving and the sharing of your expertise. I promise you will have the chance to develop action plans.
First: metaphorically sit on your hands and listen. Listen for core themes including needs, strengths and values, and ideas with merit. Listen with an asset-mindset, to avoid being buried under barriers. Solid listening skills will allow you to rule out suggestions your patient has tried and failed, and to match your interventions to their priorities. When paired with Motivational Interviewing tools, you will build patient confidence and motivation by amplifying existing strengths and directing energy into action.
When you listen to your patients, they are far more likely to listen to you.
5. Try out a tool or two
You may have heard some Motivational Interviewing techniques described elsewhere as active listening. This is a place to start, although MI takes us places active listening has heard of, but never visited. Open Questions are a tool comfortable to most new learners of MI. Open Questions typically begin with, Who, What, Where, How and sometimes Why (this one requires nuance of tone and phrasing to avoid the taint of accusation). These questions yield far more comprehensive answers and may reduce misunderstandings between patients and practitioners.
When you subscribe, you’ll get a Quick Start Guide to Motivational Interviewing. It includes practice with Open Questions, and an explanation of the remaining OARS:
Open questions, Affirmations, Reflections, and Summaries
With OARS, you can gather information necessary to your healthcare objectives, and engage your patient in the processes of understanding and implementing their care.
When I train professionals in Motivational Interviewing, they learn how to wield OARS for different situations. We might use them to build rapport, or to generate motivation towards a shared goal, or to confirm intentions and develop plans. The more you practice these dialogue tools, the more effectively you can row with precision. With MI, we practice as we learn; no need to attain mastery level knowledge first.