Motivational interviewing is a patient-centered counseling technique that incorporates listening, interpersonal skills, and support to bring a patient from ambivalence to behavioral change. The patient is in control of the process and is allowed to explore their true intentions along with inner conflicts involved in achieving the desired outcome. It is imperative for the medical provider to be able to identify the stages of change and utilize motivational interviewing to restore patient power.
Change is hard. Anyone on a quest to make better lifestyle choices can attest to this. It is much easier to go with the flow than to withstand resistance. For example, at a dinner meeting, most attendees will succumb to the added calories from the bread basket to the sugary desserts, because it is easier to indulge than to resist. For this reason, the question of how to incite internal motivation in order to reach a goal has been applied in the weight loss industry for years. Many weight loss programs have found that incentives help to influence inner motivation. Corporate wellness programs use incentives ranging from prizes to cash deposits in health spending accounts to motivate employees to obtain a healthy weight, and multiple weight loss programs use gifts such as keychains, praise, and stickers once a weight milestone is achieved. The problem with incentives is that although they may work for some, they do not work for all. In addition, awards lose appeal over time. Many have found that the instant gratification of indulgence outweighs the patience and planning required to earn the incentive, negating the entire purpose of the incentive program or plan.
So, what really motivates people to change? Is it the external nudges from the healthcare provider reminding the patient that they have excess weight to lose or a supportive community providing encouragement and accountability? Motivational interviewing teaches that although external influences incite inspiration, only the patient’s intrinsic strength creates sustainable motivation. In motivational interviewing, the five components include: precontemplation, contemplation, preparation, action, and maintenance. The role of the provider is to understand each stage and provide patience, compassion, and guidance along the journey. It is important to gauge the patient’s level of commitment and aid in acknowledging responsibilities, readiness, and the steps taken to execute each goal. Calling out inconsistencies between the patient’s words, choices, and actions will only serve to enhance this process. In weight management, patients often feel that they have lost control, especially when their attempts are unsuccessful. Providers can restore this loss of control and empower patients by echoing their internal conversations and analyzing deep-rooted ambitions.
The provider that is best able to leverage the patient’s strengths through promoting introspective autonomy will be most successful in cultivating the patient’s self-actualization and goal achievement.
This post was written by Melody Covington, MD. Dr. Covington is the CEO of Abundant Health & Vitality Associates in Charlotte, N.C.