Motivational Interviewing
the whole relationship. Secondly, it is a very strong
predictor of a negative outcome for the treatment.
How many times have you heard “they key to healing
is a positive mental attitude?” Much of that attitude
is the patient believing the treatment will work.
Conversely, if they don’t, it probably won’t work, or
won’t be perceived by the customer as having worked.
They will attribute the success to some other factor or
they will declare the treatment a failure. Any way you
look at it, the outcome for you was not positive. is there a time that they would appropriate for you to
wear in order to give your feet a break?” Hopefully,
this leads the customer to the realization that they
don’t have to wear something dressy all the time.
They can have more foot friendly shoes to wear when
it is appropriate and change to more fashionable ones
when the occasion calls for it. Again, it was their idea,
so they are far more likely to stick with the treatment,
which in this case is more sensible shoes for everyday
use.
There are many ways to adjust your tactics. Recognize
that the resistance may be the birth of a new goal
or the alteration of an existing one. This is exciting
as it means the process is working and the customer
is actively engaged in wanting to change. After all,
getting the client to realize that doing the same thing
over and over and expecting a different result was
not going to work was the object we started trying to
accomplish in the first place, was it not? Embrace
this! Reframing is a strategy to use when the patient denies
the problem or doesn’t acknowledge the seriousness.
Here is another potential conversation. The client
says “I don’t know why my doctor sent me here and
is prescribing shoes like this. My feet don’t even hurt.
If I really had a problem, they would be bothering
me!” Reframed back to them, your response may be
“Your doctor is concerned for you because of your
diabetes. It has caused you a lack of sensation in your
feet which is why they don’t hurt. Perhaps the doctor
really cares about your wellbeing and to tell you
that this is something that you should be concerned
about.” This may help the patient realize that their
perspective is really misplaced by them worrying
about the appearance of the shoe rather than
protecting themselves from damage to their feet.
Paraphrasing can be a powerful tool for adjusting to
resistance. Hearing their own words come back to
them often will cause a customer to have an epiphany
about their current perspective. You must be very
careful with all of these strategies not to come off as
sarcastic which would derail the whole operation as it
is just a subtler form of argument. Paraphrasing while
agreeing with the patient will help to affirm that you
value their opinion. Adding a slight alteration will
sometimes get the process moving again. Something
like the customer saying “I hate the way these look
and would never go out with my friends looking like
this” could be met with you saying “I hear you saying
that these are unattractive and agree that they are
certainly not party shoes, but if they are comfortable
56
Pedorthic Footcare Association | www.pedorthics.org
Remember that adjusting to resistance requires that
you acknowledge change and embrace compromise
where you can.
SUPPORT SELF-EFFICACY AND OPTIMISM
Once momentum is gained, keep it going. This
positive energy is what your customer needs to
fuel their desire to change. You must help them to
acknowledge the possibility of change and use that