When counseling a patient who has arthritis about health behavioral change, rheumatology health professionals should resist the urge to give advice. Instead, allow the patient to do most of the talking.
Susan J. Bartlett, PhD, a clinical psychologist at McGill University Health Centre in Montreal, Quebec, Canada, recommended motivational interviewing. Dr. Bartlett defined this counseling style as directive, client-centered, and seeking to guide an individual toward behavior change by trying to target the patient’s ambivalence to this change.
“At the heart and soul of motivational interviewing is trying to talk with patients differently,” Dr. Bartlett said. “We are trying to help individuals motivate themselves.”
Dr. Bartlett spoke about motivational interviewing at a session titled, “Behave Yourself! Practical Application of Cognitive Behavioral Theories to Motivate Change in Patients with Arthritis,” at the 2011 ACR/ARHP Annual Scientific Meeting here in November 2011. Joining her in the presentation was Sarah E. Hewlett, RN, PhD, professor of rheumatology nursing at the University of the West of England in Bristol, U.K., and a consultant nurse at University Hospitals, Bristol. [Editor’s note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
Motivational interviewing is based on 30 years of psychosocial research. A unique feature of the technique, according to Dr. Bartlett, is that it addresses patients who are not ready to change as well as those who are. Rather than giving advice or diagnosing the problem, the counselor (care provider) listens and guides patients to make their own solutions, she explained.
Motivational Interviewing Steps
Several of the steps to motivational interviewing that Dr. Bartlett outlined are as follows:
- Enhancing self-motivation. Show that you understand the patient’s perspective by expressing acceptance and affirmation. Reflect back what the patient is saying. Elicit change statements by asking open-ended questions, such as, “How important is it to you to become more physically active?”
- Resolving ambivalence. Ask why the patient wants to change a behavior and what is preventing that person from changing.
- Assessing readiness. Ask the patient, “When is the best time for you to attempt behavior change?” and, “How ready are you to make the change now?”
- Accepting resistance. If you encounter resistance to change, accept it. Summarize aloud the patient’s ambivalence. For instance: “It sounds like you want to quit smoking, but you enjoy cigarettes. It seems that you’re not ready to quit now.”
A major focus of this approach is actively eliciting “change talk” from patients. Change talk includes statements indicating that the patient recognizes that a behavior is a problem, expresses concern about his or her ability to change, or mentions reasons for changing.