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Key messages about motivational interviewing
Breakout session highlight, Antoni Gual
The first point we highlighted was that whenever we use language, whenever we speak, we aim at changing. All the speakers who preceded me tried to change your opinion, or tried to change your attitudes towards some of the aspects we are facing. That is also what happens when we are treating patients, when we are having conversations with them. Quite often, however, we are not aware that this is our aim.
It was also very clear that, when we aim to help patients to change their behaviour towards drinking, we need to face the fact that they are ambivalent because anyone who comes to a consultation has had great moments with alcohol, and very bad moments with alcohol – otherwise they wouldn’t be there. You need this combination.
We have also seen that the best way is not to blame the patient for his ambivalence but to try to help him to identify it and overcome it. This is a communication style which we call a ‘guiding style’: Instead of confronting the patient externally with his inconsistencies, it tries to help him to be in contact with his internal discrepancies. This means identifying that his behaviour is leading him far from what his goals in life are, and this is a powerful tool to promote change.
We also talked a little about how difficult it can be sometimes to identify change talk, and how important it is to identify it and to differentiate between the two types of change talk. We also saw that, when we are working with a patient, we need to go step by step and we need to start by engaging the patient in the process, and continue by focusing and identifying and reaching agreement with the patient as to what the problem is. Providing solutions is not something that comes just from us when we talk about evoking, but we mean that we also take into account everything that the patient can bring to the situation in order to plan jointly with the patient how things need to change, and how that will be done.
One thing that also appeared in this model, and this came from the audience and it is important to bring it here, is that once we try to be motivational, we cannot forget the family because the family is quite often not motivational with the patient. The motivational approach needs also to be taken into account with the family. While we were having lunch, someone else approached me and told me something which it is also good to bring here, which is that motivation is also something we need to work on with the team. It doesn’t help that much if you are trying to be very motivating with the patient while the rest of your team is confronting them. Therefore, motivating those who are not motivated is usually quite a big challenge.
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