For Clinicians: Motivational Interviewing

Patient Outcomes and Treatment Adherence

Back in 2021, I facilitated virtual workshops for health professionals in the Calgary area to learn and connect with one another. The information in this post was presented by Erin Zelinski during one of these workshops.

Erin can be reached for appointments through her website – Waterstone Psychology.

We’ll have the greatest impact with our clients if we are aligned with them.

Fostering Behavior Change

As a physio, or health practitioner, we’re always focused on our patient’s outcomes. This makes sense because they are coming to see us to get better, in some realm. For physios, it’s usually to decrease pain and increase function. I often see physios and clients get stuck in the process due to poor communication and planning.

Before a client comes to see a physiotherapist, or any health professional, they may go through these initial stages of behavior change:

Pre-contemplation – they haven’t yet commited to the change
Contemplation – they are aware of the issue but have not commited to the change

How to help in these stages as the clinician:

Build trust and rapport with the client
Provide education and information on the subject at hand
Personalize the positive outcomes for this individual
Meet them where they are at and validate this for them
Help identify the reasons for facilitating change

The great thing is that most clients who have decided to come to physio have made the first step in deciding on behavior change.

Here is how you, as as clinician, can help in the next stages, once the client is ready to make the change:

Preparation stage

Set clear goals with the patient, identify potential obstacles and how to plan around those
Start with small milestones and goals and build upon that

Action and Maintenance

Cultivate their skills in maintaining their goal
Help them realize they can become the person and identify with the behavior they are attempting to emulate
This is where many practitioners struggle, we need to learn to empower the client, insead of creating dependence
Identify and address additional barriers so that the client can reach and maintain the long term benefits

Relapse and Management

You may not always reach the end goal you had hoped for initially
Take note of warning signs for that individual of when they may be slipping and strategies to target these moments
Develop a plan for when they may need to check in so that there is accountability and a place to talk about the behavior or any issues arising
Set a direct check in point – for example 3 months or 6 months

Developing the Soft Skills

Learn when to speak and when to listen

This is a trick tip, because the goal is to always listen. During our subjective interview, we can be direct with our questions and answers, but during the rest our of treatment sessions, clients are always giving us insight, we just need to be listening.

Motivational Interviewing

As a clinician, you can improve your patient outcomes by improving motivation. There are 2 phases to do this:

Build motivation
Strengthen commitment

Erin’s tip is using the acronym R U L E:

Resisting the righting reflex

If the person is not ready to commit to the change, then you persisting that they must will actually be counterproductive and overwhelming

Understand the patient’s motivation

This is where the listen part becomes extremely important
Ask why, then ask why again, then ask why one more time – this will help dive deeper into the underlying meaningful activity or goal that really will drive this patient foward intrinsicially
What are their goals from their perspective?

Listen with empathy

Key tip: listen more
This person has made the step to show up to you in your clinic and they will likely tell you exactly why it is important to them

Empower the patient

You are a collaborator in their treatment plan, not a dictator, make sure to include them in the plan
The patient themselves are not the outcome, reaching their meaningful goal or task is
Put them in the driver’s seat, they need some control over the action and participation in their treatment plan to make it lasting and impactful