Part One of this series explains why motivational interviewing can be a game-changing practice within independent pharmacies. How it is executed, though, truly makes a difference in patients’ responses to their pharmacists’ suggestions and insight.
What MI is… and isn’t
Per an article by the creators of motivational interviewing, this is not a technique. “The term ‘technique’ suggests a relatively simple operation, a particular procedure for which there are specific prescribed steps to follow,” says Rollnick. “It is better understood as a clinical or communication method, a complex skill that is learned with considerable practice over time” (Ten Things, 2009). Furthermore, MI may resemble what independent pharmacies practice every day – motivation, listening – but it requires much more than that.
In order to weave motivational interviewing into the conversation, pharmacies must keep in mind that it is a method of guiding patients toward their intrinsic motivators that lead to healthier behaviors, versus repeating facts and lecturing. A key factor in the success of motivational interviewing is autonomy. Autonomy is a condition all people yearn for in their lives, especially in their health management; no one enjoys being told that they are incapable of caring for themselves, or are making detrimental decisions about their health. Often, well-meaning providers create resistance when they try to inform their patients about making changes to their lifestyle. Motivational Interviewing in Health Care advises the opposite approach: “Ironically, it is acknowledging the other’s right and freedom not to change that sometimes makes change possible.” When practicing MI, pharmacists must be prepared to accept that, once they offer their insight and guidance, the patients are the ones who control the outcomes.
When looking into motivational interviewing, it may seem overwhelming with the acronyms, do’s, and don’ts. However, successful MI is executed with 3 main skills: asking, listening, and informing.
It’s tempting to fall into the question-answer trap during the initial attempts at motivational interviewing. Patients may already feel defensive and providers may resort to the routine of asking questions and providing information. Offering expertise is acceptable, but when trying to promote behavior change, endless questions may leave the patient feeling frustrated and interrogated.
While closed questions are great for gathering brief, specific responses (name, phone number, etc.), open questions are an ideal starting point for those who are attempting MI for the first time. Open questions create opportunities for patients to go into more detail with their answers. Responders feel free to expand on their replies when asked open questions. For example, “How are you doing with your medicines?” encourages more feedback than “Have you been taking your medications?” When the patient knows their observations and opinions are valuable to providers, they feel more open to receiving guidance and taking charge of reshaping their behaviors.
As the patient opens up about their health-related issues, it is vital for the pharmacy staff members to do more than hear what they’re saying. Rather, active listening is a skill all providers should master. Fundamental Skills defines it as “a dynamic process that includes both hearing what is being said as well as processing and interpreting the words that are spoken (and/or unspoken) to understand the complete message that is being delivered” (3). The act of listening tends to be passive, but active listening requires complete, undistracted focus on the patient’s words and cues, both verbal and nonverbal.
Active listening relies on empathy to be effective, since placing oneself in the patient’s situation motivates the pharmacist to be more understanding and conscious of their responses. However, empathy and sympathy should not be confused with one another, cautions the authors of Making the Patient Your Partner:
Although empathy is momentarily experiencing another person’s way of seeing the world, the listener of course does not lose his or her identity. Also, empathy is feeling with another, not at all like sympathy, which is feeling for another. Empathizing with one another can be facilitated by asking oneself, “If I were having the same experience as [the patient], what would be my feelings, thoughts, or reactions?” (46-47)
While practicing active listening, pharmacy staff members should note any change talk from their patients. Change talk can either be preparatory or mobilizing. Preparatory change talk mentions a desire to shift current behaviors, and mobilizing change talk details specific actions that are geared towards change. Keep the Transtheoretical Model of Change in mind when listening to patients who are using change talk in conversations. (See Part One for more on this model.) Preparatory talk indicates the patient may be in the Precontemplation stage, and mobilizing talk means the patient is most likely in the Contemplation stage; both stages are ideal for introducing healthy behavior changes through Informing.
Stay tuned next week for an in-depth look at Informing, the third required skill for successful motivational interviewing, and practical uses of your pharmacy’s management system.
Gordon, T., & Edwards, W. S. (1997). Making the patient your partner: Communication skills for doctors and other caregivers. Westport: Auburn House.
Miller, W. R., & Rollnick, S. (2009). Ten Things that Motivational Interviewing Is Not. Behavioural and Cognitive Psychotherapy,37(2), 129-140. doi:10.1017/s1352465809005128
Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press.