Florida Medical Association

FMA Magazine - Q2 2013

Magazine of the Florida Medical Association

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Does 'Motivational Interviewing' Get Patients on the Right Track? By Karen Cyphers, Ph.D. No doubt physicians are aware that most people don't really like being told what to do, and they certainly don't enjoy being scolded when they don't. Yet, when it comes to guiding patients in chronic disease management or the kicking of bad habits, what is the alternative? To a growing number of physicians, the answer is "motivational interviewing." No, it is not something an especially peppy television reporter would do, but a technique used to engage patients in health and lifestyle management. In an April 30 report, Wall Street Journal writer Laura Landro described how health-care providers are "helping patients kick bad habits ... by turning the tables on the traditional doctor-patient relationship." Rather than instructing patients on what to do and telling them how to do it, this non-traditional strategy involves first asking the patient what changes he or she is willing to make and then swooping in with some encouragement, confidence building and follow-through. The technique originated in the 1980s from clinical psychologists and was used primarily in substance abuse and addiction counseling. According to a training website, the method is "semi-directive" and "client-centered," and is designed to elicit behavioral change by "helping clients explore and resolve ambivalence." Psychobabble or something more? Motivational interviewing (MI) is a rather structured method that is more focused and goal-directed than traditional counseling. It draws upon a field of study regarding intrinsic motivation that acknowledges the importance of goals being internally driven. In simple terms, the desire to change must come from within. "Rather than push a person beyond what they think they can do, the technique aims to get patients to set their own minimum goals," writes Landro, who interviewed Chet Fox, a professor of family medicine at the University at Buffalo in New York. Fox works with the American Academy of Family Physicians on MI courses, and he states that a major goal of the technique is to help patients identify their own barriers to, and levels of, commitment. MI is reliable and flexible, acknowledging that people can reach the same goals through different methods. In 2005, Weight Watchers began training its meeting leaders in the technique, and Aetna did the same with its telephone coaches in 2010. These groups and others have realized cost savings and improved outcomes through employing MI methods and coaches. In short, here are the four general principles behind motivational interviewing as explained by www.motivationalinterview.net.

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