December 18, 2018
By Colleen M. Farrell
Most patients already know what their health care providers want them to do. Eat better. Exercise more. Quit smoking. Take medication.
But trying to get patients to kick the habit - any bad habit - or adopt a new one can be a challenge.
Yet there’s a patient-centered approach called motivational interviewing that can help patients make changes that last. Rather than telling patients what they should do, providers explore with patients what is important to them and together they use those priorities to develop a treatment plan that is personally meaningful.
“Patients are more likely to change their behaviors when it’s for reasons that are important to them, not to the doctor,” said Karen Gsellmeier, quality improvement advisor at Common Ground Health who coaches clinicians on using motivational interviewing as part of a broader effort to improve health care delivery called Practice Transformation.
For example, smokers don't need to be told that their habit is bad for their health. Instead, providers can explore what would motivate a patient to quit. Do they want to set an example for their kids or to be there for grandchildren? Will quitting help their relationships with loved ones? Are they actually ready to stop?
Empathy is also required on the part of the provider, because “change is incredibly difficult,” Gsellmeier said.
In addition to smoking cessation, Carol Thompson, a registered nurse and care manager at Tri-County Family Medicine's Geneseo and Nunda offices, has found motivational interviewing to be a great way to help patients better manage their diabetes and adhere to diets. The guided exploration helps patients “identify and work through their ambivalence” and helps practitioners better understand barriers that could be preventing a patient from improving their health, she said. “Also, it reinforces patients’ autonomy instead of dictating to them what they ‘must do’.”
For Licensed Clinical Social Worker Maria Panitsidis, a senior counselor and supervisor at Huther Doyle, an addiction treatment center, motivational interviewing lets her act as the client’s co-pilot. When she asks open-ended questions about the client’s current lifestyle, situation and goals, she helps the client home in on what he or she wants to accomplish. It can also help clients understand that they are accountable for their actions.
Using this approach is “letting them know through your words and empathy and body language that, ‘You know what's best for you. Now you have to help me understand how I can help you,’” Panitsidis said.
That empowering approach can lead to profound change as it did with Selena Ingram. Already on probation for petit larceny, Ingram sought inpatient rehabilitation from Huther Doyle in September 2017 to avoid going back to jail after testing positive for drugs.
“I was tired of using,” Ingram said. “It was starting to get out of control.”
Ingram’s nearly 30-year crack cocaine habit and depression had worsened after she lost her mother, sister, brother, and uncle in a short spate of time.
“All those deaths that I really hadn't gotten over, didn't talk through, I kept on getting sicker and sicker, and I wanted to hide and I didn't want to feel,” she said.
A lot of Ingram’s recovery work involved asking her why she sought treatment. Her probation terms mandated she be there, although she resisted treatment at first. But over time, and after losing her apartment, Ingram’s opposition began to weaken. After a relapse, Panitsidis arranged for Ingram to stay at the House of Mercy, a homeless shelter and advocacy center in Rochester. Ingram said she immediately felt welcomed there and finally became a full participant in her own recovery. She spoke during group therapy. She became more open during counseling sessions. She made healthier choices.
She started to heal.
“Here I am today,” Ingram said proudly.
Ingram has graduated from the second phase of treatment. She volunteers at the House of Mercy and has plans to move to an apartment and enjoy life with her fiancée.
“Everything is starting to go good,” she said.