View from the Chairside: I use Motivational Interviewing, do you?
By Dr. Richard Anderson
Dr. Richard K. Anderson is a practicing general dentist in Ottawa, ON. He graduated from The Schulich School of Medicine and Dentistry at Western University in 2008. He is involved with the Ottawa Dental Society and volunteers with the Ottawa Mission Dental Clinic. He loves his family and his profession.
Motivational Interviewing and New Year’s Resolutions
Picture this: A patient walks into to your dental office, and before you even pick up the drill or carry out an injection, a conversation takes place that leads your patient to a lifetime of optimal oral health. What just happened? How could a simple conversation change your patient’s life so positively? I would like to introduce you to Motivational Interviewing (MI), its purpose, its techniques, and how you can elicit a positive behavioural change in your patients.
As a dentist, I want the best oral health for my patients. In other words, I want to prevent and eliminate oral disease. If I can encourage my patients to adopt positive behaviours, I can then consider myself successful in preventing and eliminating oral disease. As you are well aware, it is not that simple to motivate patients to change their habitual behaviours, even when they learn about the damage it causes to their health. Ambivalence to change is common. On the one hand, the patient knows that they need to change, but on the other hand, they are comfortable and set in their ways. Traditionally, this has led the counsellor or clinician to give direct advice as the authoritative expert in their field. And, most often, this type of advice lead to patient’s resistance and lack of change, because the patient would defend their ambivalence.
The stubbornness, evasiveness and/or anger that ensued was the opposite of the desired result. This has led clinicians into an area of research within psychology which has been shown to increase the likelihood of eliciting positive behavioural change. Motivational Interviewing addresses the common problem of ambivalence about behaviour change and honours people’s autonomy and self-determination to make their own choices. MI is a person-centered, goal-oriented, collaborative conversation intended to strengthen a person’s own motivation and commitment to change. This is the intent of MI: the clinician does not impose change, but supports change congruent with the patient’s own values and concerns.
The MI Approach
There is more to the practice of MI than simply understanding its intention. I personally like to use MI techniques in a particular way:
- I use non-judgmental, open-ended questions which allow for further conversation, rather than a brief ‘yes or no’ answer.
- I affirm the patient’s skills and strengths which builds rapport and helps the patient see themselves in a new and positive light.
- I listen carefully and give reflective responses which demonstrate empathy and guide the patient towards talk of change.
- I summarize the key points of the conversation which allow for structured, organized thinking, and summaries that promote some ideas and minimize other ideas.
The New Year’s Resolution Example
Edward is a 50-year-old male patient with a history of smoking a pack a day for the past 30 years. He does not have a family physician. The poor conditions of his gum and his teeth mean that Edward will be frequently returning for appointments. He presented for a new patient examination where the following conversation unfolded:
- Would you mind telling me about your tobacco use?
- People often smoke because there is a something that has benefited them in some way. How has smoking benefited you?
- What are some aspects of smoking you are not happy about?
- I’d like to let you know about some of the risks in smoking that you might not already be aware of, but I want to emphasize that it is your choice alone to decide to make a change.
- Could you rate, on a scale of 0-10, the importance of making this change relative to other priorities in your life?
- What would it take for you to go from a ‘5’ to a ‘7’?
- If things worked out in the best possible way for you, what would you be doing in a year from now?
- After this discussion, are you clearer about what you would like to do? What will be your next step?
- What else do you think you will need to support you in this plan for change?
Edward proceeded to set an intention to live a smoke-free life as his New Year’s Resolution. Supplemental information and helpful resources were supplied. Nicotine replacement therapy and smoking cessation medications were prescribed. I arranged for follow-up appointments (either in-person or in the form of a phone call) beginning with the first week after the quit/change date.
This initial conversation, grounded in MI techniques, may dramatically change Edward’s life and give him a lifetime of optimal oral health.
I hope that I have demonstrated howMI can be an effective approach to bring about positive lifestyle changes in patients. MI is a collaborative person-centered form of guidance, which elicits and strengthens one’s motivation to change.
Do you think that you could use the MI approach in your practice? Why or why not? Have you tried it before? I look forward to hearing about your experiences using the MI technique or any another successful approach you have been using.