An Inspiring Dialogue on Motivational Interviewing
In a recent discussion, Dr. Steven Pearce, Dr. Bruce Berger, and I explored the transformative power of motivational interviewing (MI) in patient care. Dr. Bruce Berger, a pioneer in introducing MI to healthcare, shared practical strategies clinicians can use to understand their patients’ motivations for treatment adherence. Dr. Steven Pearce, a gastroenterologist and creator of the film Love Evolved, responded with excitement: “I’m thrilled. I can’t wait for him to give me more examples because I’m going to use them in about an hour!”
Understanding Motivational Interviewing
Dr. Berger explained that MI is a patient-centered, evidence-based approach designed to help patients overcome ambivalence or resistance to health behavior changes. Contrary to its name, MI does not involve motivating the patient directly. Instead, it focuses on exploring and understanding the patient’s own motivations to address their illness.
Key Principles of Motivational Interviewing
Dr. Berger outlined the following principles that make MI effective:
- Valuing Patients as Experts: Patients are experts on how they perceive their illnesses and treatments. MI treats their perspective as equally important.
- Exploring Patients’ Perspectives: MI encourages healthcare professionals (HCPs) to delve into how patients understand their illness and treatment, their emotions, and what matters most to them.
- Acknowledging Progress: Instead of scolding patients for partial adherence, MI celebrates progress. For example, an HCP might say, “I see you’re taking your blood pressure medication four days a week. That’s a great start toward managing your health.” This acknowledgment is followed by questions like, “What motivates you to take the medicine on those days?” and “What would help you take it every day?”
- Building Positive Relationships: MI fosters trust by avoiding scolding, fixing, or correcting patients, which can lead to defensiveness or disengagement.
- Evidence-Based Impact: Studies show that MI significantly improves adherence to health behaviors and overall health outcomes.
- Fostering Connection: Above all, MI emphasizes connection. By exploring ambivalence in a respectful manner, HCPs demonstrate that the patient’s perspective is valuable and their decisions are honored.
The Spirit of Behavioral Coaching
The essence of MI lies in the understanding that healthcare professionals owe everything to their patients. Patients owe nothing in return. They hold the ultimate decision-making power regarding their health, and MI enables HCPs to influence these decisions with empathy and respect.
Dr. Berger emphasized that persuasion and paternalism are counterproductive, especially when patients are ambivalent. Instead, MI encourages exploration. For example, rather than persuading a patient to quit smoking, an HCP might ask about their desire to quit and their past attempts. This approach avoids defensiveness and builds trust, encouraging the patient to engage in open dialogue.
Seeing the “Loving Essence” in Patient Care
Dr. Pearce shared how his experience in a spiritual psychology course transformed his approach to patient care. In the course, participants practiced “seeing the loving essence” of others by holding hands and maintaining eye contact for a minute. Dr. Pearce incorporated this practice into his medical interactions, focusing on the unique journeys of his patients. He noted, “It revolutionized how people responded to me; they stopped leaving my practice and actually liked me!”
He added, “We get so caught up in checking every box that we forget there’s a soul going through something. Motivational interviewing fascinates me because small nuances can make a big difference, and I’m eager to learn more.”
Transforming Patient Care Through Motivational Interviewing
Motivational interviewing transforms patient care by fostering meaningful connections and empowering patients to take charge of their health. By celebrating small wins, exploring patients’ motivations, and avoiding a paternalistic approach, MI builds trust and enhances treatment outcomes. As Dr. Pearce and Dr. Berger demonstrate, integrating MI into clinical practice can revolutionize both the patient experience and the clinician’s ability to make a lasting impact.
To learn more about motivational interviewing, visit Stanford Physician Advocate.
For additional insights from Dr. Bruce Berger, explore his work on Behavioral Health Care. You can also watch Dr. Steven Pearce’s film Love Evolved to delve deeper into his transformative journey.