ON Chiropractic
CORE CONCEPTS IN
MOTIVATIONAL INTERVIEWING
MI
is “a person-centered counselling method for
addressing the common problem of ambivalence
about behavior change.”3 While BAP is faster and
simpler than MI, it is based on the same spirit and guidelines.
The Spirit of MI includes:
∞∞ Compassion: Actively promoting the other’s welfare and
giving priority to the other’s needs.
∞∞ Acceptance:
∞∞ Accurate empathy: Truly trying to understand the
patient’s situation.
∞∞ Affirmation: Acknowledging the patient’s strengths and
priorities.
∞∞ Absolute worth: Recognizing the absolute worth of
every human being.
∞∞ Autonomy support: Respecting the patient’s right
to choose whether or not to make a change, and
supporting their right to make a different change than
what you would recommend.
∞∞ Partnership: Active collaboration between two experts —
the practitioner as the expert on diagnosis and care and the
patient as the expert on their history, their current situation
and their goals.
∞∞ Evocation: Drawing on the person’s strengths and
resources for change, including their past successes.
These values remind us “to respect and honour the patients
we’re working with, to protect them and make a safe space for
them to make change, and to help them draw forth their inner
strength and acknowledge their own power.”4
The guidelines for MI include2:
∞∞ Resisting the righting reflex: Helping patients to express
their internal motivations for change, rather than telling
them what to do in an authoritarian manner.
∞∞ Understanding the patient: Using open questions to explore
the patient’s thoughts about “what is good and what is not
so good” about specific behaviours (e.g. sitting all day).
∞∞ Listening to the patient: Using accurate empathy to build
trust and build an alliance for change.
∞∞ Building self-efficacy: Communicating support and
confidence in the patient’s inherent ability to change.
MI asserts that patients already know what is best for them
and that clinicians have a responsibility to work collaboratively
with their patients to help them succeed while acknowledging
their goals and their autonomy. This approach has been
shown to be particularly effective with patients who have
resisted change or who have a history of persistent unhealthy
behaviours. “Four meta-analyses record efficacy across wide
spectrums of behaviours, ranging from substance abuse to
mental illness, criminal behaviour, medication non-adherence,
smoking cessation, sedentary lifestyle and others.”5
When working with patients on behaviour change, it can be
helpful to think of the practitioner’s role as a guide rather than
an authority. Connie Davis, RN describes the difference in the
CCGI’s BAP webinar:
“
If you pay a guide to take you on
a trip, you trust that guide to find
out from you what you really want to
experience, to understand your goals
for your trip. You also trust that guide
to have your safety in mind so that
they're acting in your best interest. And
they will not tell you what to see or tell
you what to experience, but they will
guide you in places where you can have
4
a successful experience.
”
It can be more effective to guide patients through healthy
lifestyle changes than to instruct or direct them. Guiding
focuses on encouraging patients, motivating them and asking
what they would like to accomplish. In this role, practitioners
help patients to explore their options when considering new
changes.
USING BRIEF ACTION PLANNING
B
rief Action Planning is a clinic-friendly tool that helps
patients invent and embrace their own homework
assignments and complete them successfully. The main
goal is to help patients build self-efficacy, a characteristic that
Canadian psychologist Albert Bandura defined as “people’s
beliefs about their capabilities to perform specific behaviours
and their ability to exercise influence over events that affect
their lives.”6 Self-efficacy is a strong predictor of a patient’s
ability to adopt healthy behaviours. “BAP aims to build self-
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